Triggers and decision-making patterns for receiving total knee arthroplasty among older adults with knee osteoarthritis: A qualitative descriptive study.

Aims and objectives To explore triggers of and decision-making patterns for older adults with knee osteoarthritis to receive total knee arthroplasty. Background Older adults with knee osteoarthritis pain are often reluctant to undergo total knee arthroplasty until their physical health and psychological health have deteriorated. This delay may lead to poor long-term outcomes after the surgery. Thus, it is important to help these older adults decide to undergo total knee arthroplasty in an appropriate time frame. Design A qualitative descriptive study. Methods Older adult outpatients scheduled to receive total knee arthroplasty within 1 month (N = 79) were recruited by convenience from two medical centres and one regional hospital in northern Taiwan. Data were collected in individual interviews using a semistructured guide and analysed by thematic analysis. Results The main triggers for older adults to receive total knee arthroplasty were severe pain and inability to walk. We identified four decision-making patterns for undergoing total knee arthroplasty: tried everything to relieve pain and surgery was the last choice; previously received total knee arthroplasty; perceived oneself as still young and wanted to enjoy life; and adjusted work characteristics, but in vain. Conclusion Healthcare providers of older patients with knee osteoarthritis must carefully assess their characteristics, especially age, occupation and previous total knee arthroplasty, to guide them in deciding to undergo total knee arthroplasty. Clinicians also need to provide appropriate information about osteoarthritis care, pain medications, total knee arthroplasty, the relationship between knee osteoarthritis pain and quality of life, as well as the relationship between preoperative status and postoperative long-term outcomes for older adults to maintain their quality of life. Relevance to clinical practice Our findings provide evidence for healthcare providers to offer information and support to their older adult patients with knee-osteoarthritis pain who are deciding whether to undergo total knee arthroplasty.