Arthritis at Home: A Complete Guide for Older Adults and Families

The main types in later life

Osteoarthritis (OA) is the commonest. The cartilage that cushions a joint thins and roughens, bone edges thicken and the tissues around the joint become irritated. It typically affects the knees, hips, spine, base of the thumb and finger joints. Pain worsens with use and eases with rest; stiffness after rest usually lasts under half an hour; creaking is common. See knee osteoarthritis at home.

Rheumatoid arthritis (RA) and other inflammatory arthritis are caused by the immune system attacking the joints. Typical features: swelling and warmth in several joints on both sides, morning stiffness lasting more than an hour, tiredness, sometimes fever or weight loss. It needs specialist treatment to prevent damage. See osteoarthritis or rheumatoid arthritis.

Gout causes sudden, intensely painful, hot, swollen joints, often the big toe; see gout in older adults.

Other forms include psoriatic arthritis, ankylosing spondylitis and arthritis from infection or injury. Neck and back arthritis may press on nerves; see lower back pain after 60 and cervical collars and neck pain.

A diagnosis matters because treatment differs. A doctor can examine the joints, order blood tests and X-rays where needed and name the type.

Symptoms and what they suggest

• Pain that worsens with activity and eases with rest: typical of osteoarthritis.
• Stiffness for more than an hour after waking, swollen warm joints, tiredness: suggests inflammatory arthritis and needs a doctor soon.
• A single hot, red, severely painful joint, especially with fever: can be infection or gout; see a doctor the same day.
• Locking or giving way of the knee: possible mechanical problem.
• Numbness or tingling in the hands or feet: may be nerve compression or another cause.
• Pain at night that wakes you, or pain at rest: needs review.
• Deformity or loss of movement: progressive disease.

Daily routine for painful joints

Pacing. Spread tasks through the day, alternate heavy and light, sit to prepare vegetables and iron, and rest before pain becomes severe. Overdoing it on good days and collapsing on bad days is the pattern to avoid.

Morning. Stiffness is often worst on waking. A warm shower, gentle movements in bed before standing (ankle pumps, knee bends, shoulder rolls) and a few minutes of stretching help; see stretching for stiff older bodies.

Through the day. Change position every half hour; do not sit in one posture for hours; see sitting for long hours.

Evening. Warm the joints, do gentle exercises and plan the next day.

Sleep. Pain disturbs sleep, and poor sleep worsens pain. Support joints with pillows, keep the room comfortable and keep a routine; see sleep problems in older adults.

Keep moving, safely

Exercise is a core treatment for most arthritis, once any flare has settled and a doctor agrees. Strong muscles share the load on painful joints. See exercise with arthritis, exercises for knee and hip pain and chair exercises for seniors. The principles: choose low-impact activity (walking on level ground, cycling on a stationary bike, water exercise, chair routines), build up slowly, accept mild discomfort that settles within an hour and stop for sharp pain or next-day swelling.

Protect joints in daily life

• Use bigger joints for heavy tasks: carry with forearms, push doors with the body.
• Use built-up or easy-grip handles, jar openers and lever taps; see arthritis daily living gadgets and jar opener and kitchen aids.
• Sit to dress, cook and bathe where possible; use a shower seat and grab bars; see bathroom safety checklist.
• Avoid deep squatting and long cross-legged floor sitting if they hurt; use a raised toilet seat and chairs; see raised toilet seat guide.
• Use a stick in the hand opposite a painful knee or hip; see how to choose a walking stick.
• Wear supportive shoes; see choosing shoes for older feet.
• Avoid prolonged gripping and keep wrists straight; consider supports during painful tasks; see wrist supports and knee support buying guide.

Heat, cold and other comfort measures

A warm bath, warm towel or hot pack (with a cloth barrier, for 10 to 15 minutes) eases stiffness; a cold pack wrapped in cloth eases a hot, sore joint. Take special care with numb skin and fragile skin; see heat or cold for joint pain and hot pack safety for older skin. TENS devices help some people; ask a doctor first, especially with a pacemaker; see TENS units for pain.

Medicines and remedies: safe habits

Do not start, stop or change any medicine without a doctor. Older adults face special risks from some common painkillers, including stomach, kidney, heart and blood pressure problems, so always ask a doctor or pharmacist before using tablets, gels, balms or herbal products; see painkillers and older adults and supplements and medicine interactions. Evidence for many joint supplements is mixed; see joint supplements evidence. Keep a list of everything taken and take it to appointments; see keeping a pain diary and talking to the doctor. Warm oil massage may soothe but should not be applied to broken or inflamed skin.

Weight and food

Every extra kilogram adds load to knees and hips, so a healthy weight reduces pain for many people. But frail or underweight older adults should not diet; muscle matters. Protein, a varied diet and enough vitamin D support muscle and bone; see how much protein do seniors need and calcium and vitamin D guide. No special diet removes arthritis; gout needs specific advice; see gout in older adults.

Mood, loneliness and independence

Persistent pain wears down mood and social life. People stop going to temples, weddings and markets because of the effort. Low mood in turn makes pain feel worse; see depression in older adults and chronic pain in older adults. Encourage hobbies that suit the joints, short outings with a seat available and company; see mobility aids for temples and weddings and how can hobbies help seniors with arthritis.

Home set-up

• Good lighting and clear floors to prevent falls; see falls risk assessment at home.
• A firm chair with arms at a height that makes standing easy; see choosing a chair for an older person.
• A bed at a good height; see bed height and getting out of bed.
• Kitchen items at waist height; see kitchen setup for seniors.
• Lever handles instead of knobs, and rails on steps; see handrails and stair lifts.

Flares

A flare is a period of worse pain and swelling. Rest the joint briefly but keep it gently moving, use cold or warmth as it feels best, reduce the load, keep up general activity with other joints, and call the doctor if swelling, heat and redness are marked, if a flare does not settle in a few days, or for the first flare of inflammatory disease. Restart activity at about two-thirds of your previous level.

Warning signs

Call 112 for chest pain, severe breathlessness, signs of stroke or collapse. See a doctor the same day for a single hot, red, swollen joint, especially with fever; sudden inability to bear weight; a swollen, painful calf; new numbness or weakness; or pain after a fall. See a doctor soon for morning stiffness over an hour, symmetrical swelling, unexplained weight loss, persistent fatigue, or pain that is worsening despite home care.

Family support

Ask rather than assume; offer help with tasks that cause most pain; accompany your parent to appointments; keep records; encourage movement; avoid nagging; see motivating a parent to exercise and preparing for a doctor's visit with a parent.

When to ask a professional

A doctor should diagnose the type of arthritis and review medicines; a rheumatologist treats inflammatory disease. A physiotherapist prescribes safe exercise and teaches pacing. An occupational therapist advises on joint protection and aids. A dietician can help with weight and nutrition. A podiatrist can help with feet. Joint replacement is considered when pain is severe and home care and medicines no longer help; see joint replacement prehabilitation.