الفهرس 
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Abstract
Rheumatoid arthritis (RA) is a systemic autoimmune inflammatory disease-causing synovitis in multiple joints especially hands and legs, pain, joint destruction and disability gradually. Rheumatoid arthritis is the most common type of inflammatory arthritis in the older populations, its incidence increases with aging until about the eighth decade of life. Around 1% of the world population affected by rheumatoid arthritis. If not treated aggressively it can be a major cause of disability, decreased quality of life, need for joint replacement surgery. Rheumatoid arthritis has adverse effects on health- related QoL including physical, social, psychological, familial, occupational and sexual aspects. Rheumatoid arthritis elderly reports feeling of embarrassment, social isolation and restriction lifestyles which results in moving older peoples from family home to nursing home and interference with daily activities and had psychological distress. Rheumatoid arthritis is a common problem for elderly people, their family, friends and the health professionals who care for them. Community health nurse (CHN) is responsible for providing care in every level of prevention and CHN should be able to assess pattern, risk factors and effect on the RA on quality of life in order to develop a sensitive intervention care. Aim of the study: The aim of this study was to assess the relation between functional status and quality of life of the elderly with rheumatoid arthritis. Subjects and Method: • Study design: A descriptive cross- sectional study design was used in this study. • Setting and sample: This study was conducted at rheumatoid clinic in Ali Ibn Aby Taleeb Health Insurance Hospital and Rehabilitative clinic in Tanta University hospital. The sample size was 120 elderly patients with rheumatoid arthritis who were attended the previous settings through a period of six months. Tools of the study: Four tools were used by the researcher in order to obtain the necessary data. Tool 1: A structured interview schedule: It consisted of the following parts: Part (1): Bio socio-demographic characteristics of the elderly with rheumatoid arthritis: It included data about age, sex, and marital status, level of education, previous occupation, residence area, family income and person who live with the elderly. Part (2): Past and present health history of studied elderly with rheumatoid arthritis: It included data about health history of the elderly as: number and causes of previous hospital admission, chronic diseases, family history with rheumatoid arthritis, onset of RA, duration of RA, previous and present manifestation of disease, extra-articular manifestations as: (subcutaneous nodules, Sjogren syndrome, pulmonary involvement and vacuities) which elderly was suffering from it and type of treatment and medications received. Tool II: Katz Activities of Daily Living (Katz ADL): It was a standardized questionnaire developed by Katz et al., (1970) and it was adopted by the researcher to assessment of functional ability of the elderly with rheumatoid arthritis by measuring the basic activities of daily living. Katz ADL index measured ability to conduct self-care. It consisted of six-item instrument, which assessed the independence or dependence in the activities of bathing, dressing, toileting, transferring, continence and feeding. Elderly patients were scored yes/no for independence in each of the six functions. Scores ranged from 0-6, a score of 6 indicated full function, 4 indicated moderate impairment and 2 or less indicated severe functional impairment. Tool III: Instrumental Activities of Daily Living (Lawton’s IADL): It was a standardized questionnaire developed by Lawton’s and Brody, (1969) and it was adopted by the researcher for assessment of functional ability of the elderly with rheumatoid arthritis by measuring instrumental activities of daily living. It was used to assess independent living skills of an individual and measures functional ability as well as declines and improvements over time. It assessed 8 domains of function like telephoning, shopping, food preparation, housekeeping, laundering, use of transportation, use of medicine and financial behavior. Women were scored on all 8 areas of function but, for men the areas of food preparation, housekeeping and laundering were excluded. Elderly patients were scored according to their highest level of functioning in that category. A total score ranged from zero (low function, dependent) to eight (high function, independent) for women, and 0 through 5 for men. Tool IV: World Health Organization Quality of life-BREF (WHOQOL-BREF). WHOQOL-BREF was an abbreviated generic quality of life scale developed by World Health Organization in the year 1997.The WHOQOL-BREF instrument comprised twenty-six items. The twenty-six standard items contained two generic items (over all QOL and general health) and remaining twenty-four items could be further classified into four domains: Physical health included seven items (items 3, 4, 10, 15, 16, 17 and 18), where Physiological items included six items (5, 6, 7, 11, 19 and 26), Social relationships included three items (20, 21 and 22). Finally, environmental included eight items (8, 9, 12, 13, 14, 23, 24 and 25). The score ranged from 26-130. The score twenty-six which referred to the worst possible QOL and the score 130 referred to (the best possible QOL). Scoring system was modified by the researcher to be as follows: • Poor quality of life: ≤70% of the total score. • Fair quality of life: >70% of the total score. • Good quality of life: ≥50% of the total score. The results of the study can be summarized as follows: - • More than half (53.3%) of studied elderly with RA their ages ranged between 60≥ 70 years with a mean of 70.69 ± 6.60 years. • More than half 55% of them were female and the rest of them were male. • More than one-third (36.7 %) of studied elderly with RA were housewife while, slightly less than two-thirds (63.3%) of them were working . • Nearly three-quarters (72.5%) of studied elderly with RA mentioned that their income enough while, about one-fifth (19.2) reported that their income wasn’t enough and owed while only (8.3%) of them had enough money and save. • More than two-thirds (68.3%) of studied elderly with RA were living with their families and more than one- fifth (20.8 %) of them were living in the geriatric home. While, the rest of the studied elderly with RA (10.8%)were living alone • Less than half (40%) of studied elderly with RA were married, nearly half (49.2%) of them were widow and the rest (5.8% and 5%) were single and divorced respectively. • More than one-third (37.5%) of studied elderly with rheumatoid arthritis were illiterates, nearly one -quarter (24.2%) had secondary education. While, less than one-fifth (15.8%) of studied elderly with rheumatoid arthritis were university educated and above and the rest of them (13.3%,9.2%) were read and write and elementary respectively. • More than half (57.5%) of studied elderly with rheumatoid arthritis were from an urban area and the rest of them (42.5%) from rural areas. • The average number of hospitalizations ranged from 5-30 with a mean of 18.92 ± 5.98 and nearly one-third (30.8 %) of them were admission to hospital for15 ≥ 20 times while, less than one-fifth (14.2%) of them were admission to hospital for 5 ≥ 10 times. • Three-quarters (75.8%) of them had hypertension and the majority (83.3%) of them had hyperglycemia, while all of them had acute pain in shoulders, elbows and hips, acute pain in the jaw and neck, acute pain in the small joints (hands and feet) and stiffness in the small joints (hands and feet). • Three-quarters (75%) of them had hypertension and the majority (83.3) of them had diabetes mellitus while, less than one-third (31.7%) of them had heart disease while less than three-quarters (71.7%) of them had osteoporosis and less than two-thirds (60.8 %) of them had osteoarthritis while more than half (55.8%) of them had liver diseases. • About period of elderly having rheumatoid arthritis was ranged between 20-60years with a mean of 35.29 ± 9.47. Slightly less than two-fifth (39.2%) of them had RA since 20 ≥ 30 years, while less than one-fifth (6.7%) of them had RA for 50-60 years. • All of the studied elderly with RA had burning sensation, itching, dryness of the eye, swelling, stiffness and pain in the joints, rash or dry skin, fever, weight loss, stiff joints usually in the morning and after the period of activity, vascular problems such as heart problems while the majority (99.2%) of them had continuous dry cough and half (50%) of them had swelling of the salivary glands, difficulty breathing and fatigue. • The majority (97.5%, 99.2% respectively) of the studied elderly with RA had fever, weight loss, stiff joints usually in the morning and after the period of activity, vascular problems such as heart problems and more than one-fifth (13.3%, 11.7% respectively) of them had difficulty breathing and fatigue. • All of the studied elderly with RA had treatment with medications, physio- therapy and all of them followed the treatment with medications methotrexate, hydroquin , diacerein and folicap 0.5. • There was highly statistically significant relation between overall quality of life, general health QoL domains and QoL categories in overall quality of life and general health, physical domain, psychological domain, environment domain and QoL categories (p =0 .000). But there was insignificant association between social relationships domain and QoL categories, where (p=0 .83). • There was a significant relation between marital status, education level and occupation before the retirement with QoL (p <0 .01). Also, there was no statistically significant relation between level of QoL and place of residence (p >0 .05). • Highly statistically significant relation between the levels of activities of daily living of elderly and their socio- demographic characteristics as sex and the elderly income per month at (p=<0 .00). While, there was no statistically significant relation with their level of education, occupation before retirement, place of residence and with who the elderly living with at (p =>0 .05). • There was statistically significant relation with their age and their monthly income at (p <0 .01). While, no statistically significant relation with their occupation, place of residence and who living with the elderly (p = > 0 .05). • Significance positive correlation between overall quality of life and general health and all domains of QoL except social relationship domain and instruments activities of daily living with (p=<0.0).