Session Information
Session Type: Abstract Submissions (ARHP)
Background/Purpose: Back pain is highly prevalent among older adults and often undertreated. The reasons for this gap in care are poorly understood, especially in older adults from diverse racial and ethnic backgrounds. Our objective was to understand why older adults, in a racially diverse population, with restricting back pain (RBP– back pain severe enough to restrict activity), may not seek care.
Methods: We conducted one-on-one interviews and focus groups with older adults (ages ³65 years) who reported RBP within the past 3 months. We recruited participants from 3 different sources (interviews and focus groups in Connecticut and focus groups in New York) to ensure a racially diverse sample; recruitment efforts ended once saturation was achieved. A semi-structured discussion guide was used in both the interviews and focus groups to prompt participants to discuss their experiences with RBP, including beliefs and attitudes about management. Audio recordings were transcribed and subsequently analyzed (using NVivo) in an iterative process to develop thematic categories.
Results: We conducted 23 one-on-one interviews and 16 focus groups (n=70 participants), for a total of 93 participants. Participants were mostly female (68%), older (median age=83 years), over one-half lived alone, and 46% self-identified as belonging to a minority group. We identified 3 themes for why older adults may not seek care for RBP (Table 1): (1) participant and perceived provider beliefs about age-related inevitability of RBP, (2) participants’ fear of medication and/or surgery, and (3) older adults’ perceived relative importance of RBP versus other comorbidities. There did not appear to be any trends in our findings based on race/ethnicity.
Conclusion: Findings demonstrated that a range of illness perceptions influence older adults willingness to seek care for RBP. Many of the barriers discussed may be addressed by improved patient-physician communication. Understanding the older adult’s perspective regarding reasons they may not choose to seek care is an important step toward identifying opportunities to improve the quality of care for older adults with RBP. Providers, in turn, might benefit from clinical guidance regarding the treatment of low back pain specifically in older adults (e.g. poly-pharmacy, frailty, multiple co-morbidities), that recognizes the impact of ageist myths and assumptions, and providers’ focus on medical and surgical interventions.
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Theme |
Sample Quotes |
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1. Participant and provider beliefs about inevitability of back pain in older adults |
I honestly think that at this point, my body is broken, it’s worn out. I mean, [chuckle] that’s why I say, someone in their 70s you could help a lot more, but I honestly don’t know what could be done now outside of keeping comfortable. |
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I’ll tell you what the doctor thinks: “you’re 93 years old!” I see that all the time when I go to the office. Like everything is taken very lightly. |
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2. Participant fear of medication and/or surgery |
They [providers] always want to give me medicine. I don’t want medicine [emphasis original]! Because I don’t think it helps anyÉI don’t want another medication. |
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That’s the thing. They don’t tell you much. They’d rather give you medication.
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He told me [the surgery] was a success É he said “it worked out” from the X-ray, that it looks like it’s going to be successful, but the painÉthat’s what to me, what I would say is successful, if I didn’t have any more pain. It was not successful! |
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3. Relative importance of back pain compared to comorbidities |
I am having back pain right now for years. Not only for months, for years. My doctorÉ I have other problemsÉ So she even told me that they are only patching me up because I have other problems; prostate, liver, heart, and all different problems. That is what she told me about this pain.
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My concentration at this point is my diabetes. I’ve had that and I’ve had that for almost 30 years. And that has presented problems along the wayÉthey know more about that than what I’m going through with my back. |
Disclosure:
U. Makris,
None;
R. Higashi,
None;
E. Marks,
None;
L. Fraenkel,
None;
J. Sale,
None;
C. Reid,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/ageism-fear-and-competing-co-morbidities-why-older-patients-may-not-seek-care-for-restricting-back-pain-a-qualitative-study/