Background/Purpose: The majority of research in low back pain has focused on the middle-aged segment of the population. As such, there is a gap in knowledge about low back pain among older adults (>=65 years). The purpose of these analyses is to describe differences in clinical characteristics between older adults with and without low back symptoms. 

Methods: The sample for these analyses consists of 1,010 participants >=65 years of age who participated in the Johnston County Osteoarthritis Project from 2008-11. Participants had a mean age of 74.1 (SD 6.5), 69% were female, 29% were African American, and had mean body mass index (BMI) of 30.4 (SD 6.4). Low back symptoms were defined at clinical interview by “On most days do you have the symptoms of pain, aching or stiffness in your lower back?” General function was measured with the Health Assessment Questionnaire (HAQ) and, among those with reported low back symptoms, disease specific function with the Roland-Morris Low Back Pain Disability Questionnaire (RMDQ). The Centers for Epidemiological Questionnaire Scale (CES-D) was categorized at <16 or >=16 to represent mild depressive symptoms. Self-reported physical activity was measured as moderate (i.e., at least 10 minutes at a time, such as brisk walking, bicycling, vacuuming, gardening or anything else that causes small increases in breathing or heart rate) or vigorous (i.e., at least 10 minutes at a time, such as running, aerobics, heavy yard work, or anything else that causes large increases in breathing or heart rate). Lateral lumbar spine films were graded at each lumbar level in a semi-quantitative fashion (0-3) for disc space narrowing (DSN) and osteophytes (OST) according to the Burnett Atlas. Differences were determined by Chi-square tests. 

Results: Fifty-nine percent (n=599) of older adults reported the presence of low back symptoms. The Table provides sample sizes, proportions and p-values for each clinical characteristic by low back symptom status. Among those with low back symptoms, self-reported general function (i.e., HAQ) was significantly (p<0.001) lower, depressive symptoms were significantly (p<0.001) greater and the reported mean RMDQ score was 7.6 (SD 6.9), indicating a perceived 31.7% disability. Those with low back symptoms were less likely (p=0.03) to report participation in weekly moderate physical activity. A similar finding was present with vigorous activity but not statistically significant. Particpants with low back symptoms had more severe DSN (p=0.04), whereas OST severity was similar between the groups.

Conclusion: These findings highlight the impact low back symptoms have across multiple health domains in older adults. Interventions to increase physical activity have been shown to improve multiple outcomes among middle-aged adults, but the effectiveness is unknown in older adults. Clinical trials of physical activity are needed in this subgroup, which is particularly susceptible to declining general function.

Characteristic	No Low Back Symptoms	Low back symptoms	p-value
HAQ, n (%)			<0.001
0	114 (27.0%)	60 (16.2%)
1	194 (45.9%)	118 (31.9%)
2	115 (27.2%)	192 (51.9%)
CES-D, n (%)			<0.001
<16	544 (93.8%)	334 (86.3%)
>=16	36 (6.2%)	53 (13.7%)
Moderate Physical Activity	423 (70.6%)	251 (64.0%)	0.03
Vigorous Physical Activity	72 (14.1%)	35 (10.6)	0.08
DSN, n (%)			0.04
0	117 (20.3%)	55 (14.4%)
1	183 (31.7%)	115 (30.2%)
2	150 (26.0%)	104 (27.3%)
3	127 (22.0%)	107 (28.1%)
OST, n (%)			0.10
0	45 (9.1%)	18  (5.3%)
1	242 (49.0%)	160 (47.5%)
2	142 (28.7%)	117 (34.7%)
3	65 (13.2%)	42 (12.5%)

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/characterization-of-low-back-symptoms-in-a-community-based-sample-of-older-adults-the-johnston-county-osteoarthritis-project/