A community survey of identifiable symptomatic shoulder disorders in a sample of 644 elderly people over age 70 (318 male and 326 female) revealed a prevalence of 21%. Shoulder disorders were more common in women (25%, versus 17% in men). Approximately 70% of the cases of shoulder pain involved the rotator cuff. Fewer than 40% of the subjects sought medical attention for these symptoms. Increased medical awareness is needed, since the elderly often do not volunteer information about such symptoms.Hospital-based studies have suggested that nontraumatic symptomatic shoulder disorders, although common in middle-aged adults, are relatively rare in the elderly (1-3). One community survey found a less marked difference in prevalence, but the maximum age of the study subjects was only 74 years (4). These findings contrast with those of pathologic studies, which have suggested that there is progressive degeneration of the rotator cuff with age (5-7), with tendon rupture being found in 20% or more of shoulders from patients of all ages, examined postmortem (8-10). One study suggested that there was no true relationship between clinical symptoms and pathologic changes (1 I).It was considered that physically fit middleaged people were more likely than the elderly to stress their tendons and, hence, produce symptoms. However, a recent hospital study of elderly patients (over age 70) who were admitted to an acute-care geriatric unit found that 21 of the 100 surveyed had a symptomatic shoulder disorder, mostly related to the rotator cuff (12). Not only was the frequency greater than might have been expected, but only 3 of these subjects had sought medical treatment for those symptoms. It could be argued that although these patients had been admitted for acute conditions, the patients might, as a group, be physically more infirm than elderly persons living in the community. Therefore, they might have been more predisposed to the development of shoulder disease. To try to discover the true prevalence of symptomatic shoulder disorders in the elderly population, a community-based prevalence study was undertaken.Patients and methods. It was decided to assess a similar number of males and females in order to be able to compare the findings with those in other populations of different sex ratios. In our hospital study, 26% of females and 16% of males were affected (12). Based on an expectation of some reduction in frequency among people in the community, it was estimated that at least 600 persons (300 males and 300 females) would need to be surveyed to produce statistically meaningful epidemiologic prevalence data.A random sample of male and female patients aged 70 years and over was derived from age and sex registry lists from 2 general medicine group practices. The patients were predominantly Caucasian, from

As there is relatively little information about the effectiveness of occupational therapy (OT) in RA a questionnaire was devised to assess whether patient knowledge and performance of joint protection manoeuvres improved following OT intervention and, if improved, whether this was sustained over 6 months. A photographic multiple choice questionnaire was devised covering major categories of activities of daily living. The study population consisted of 55 patients with RA attending a rheumatology clinic who had not previously had OT treatment. Patients had a single instruction/treatment session with an occupational therapist of 1-h duration. Prior to treatment the questionnaire was administered by an independent assessor who re-administered the questionnaire 1 month and 6 months after the OT session. Following treatment there was a significant increase in scores at 1 month compared with pre-treatment (P < 0.001). There was no significant change in score at 6 months compared with 1 month. Qualitative analysis of age and sex showed no significant effects. OT leads to sustained improvement in patient knowledge and probably performance of joint protection manoeuvres in RA.