treating the elderly patient

CHALLENGES IN THE AGEING SPINE

Dr Anthony M French FRACP Consultant Physician and Geriatrician Rehabilitation and Orthogeriatrics Senior Lecturer, UQ School of Medicine

Queensland Geriatric Medicine Group www.qgmg.com.au

GERIATRIC MEDICINE PERSPECTIVE

The ageing spine in terms of:

1.  Medical factors that limit management options

2.  Challenges with attitudes and perceptions relating to back problems in the older person

3.  Lifestyle factors and their role in balancing priorities with back pain management

Falls risk

Delirium

Cognition

Weight loss

UTI ?

No OP Rx

Low vit D No Rx

Myopathy?

Low serum Na & K

Anaemia ?

CKD

Ca & CV risk

AF & stroke risk

Sedative load

Continence

ADLs

MEDICAL FACTORS THAT LIMIT MANAGEMENT OPTIONS IN BACK DYSFUNCTION

" Pharmacotherapy tolerance

" Anatomical – body habitus, limb dysfunction, endurance

" Cardiorespiratory

" Operative fitness

" Recoverability / physiological reserve

" Rehabilitation potential

" Psychosocial factors

" Cognition

ATTITUDES AND PERCEPTIONS IN OLDER PATIENTS WITH BACK PAIN

" Myths

" Legends

" Opioid use and dependence

" Stoicism

" Surgical outcomes

" Normalising

" Therapies and therapists

LIFESTYLE FACTORS AND PRIORITIES " Fear of loss of independence

" Concerns about adverse outcomes limiting future activity

" Concerns about lack of therapy limiting future activity

" Financial implications

" Insurance implications including travel insurance

" Environmental factors including residential and transport

" Self perceptions, roles, relationships

SUMMARY " Back pain prevalence is high in retirees

" Public knowledge and understanding of options very varied

" Evidence based education and information important

" Countering ‘over the back fence’ advice very difficult

" Coping with chronic pain affects all aspects of life

" Accessing and selecting appropriate management options is affected by many extrinsic and intrinsic factors

" The ageing spine is a broad spectrum of pathology

QUESTION 2 On considering referral for surgical management of acute on chronic radiculopathic back pain in an 85 year old widow who lives in a low care facility.

THANK YOU Dr Anthony M French FRACP Consultant Physician and Geriatrician Rehabilitation and Orthogeriatrics Senior Lecturer, UQ School of Medicine

Queensland Geriatric Medicine Group www.qgmg.com.au