As part of national Spinal Health Week (20 - 26 May 2024), the Australian Chiropractors Association (ACA) has released new research out of CQUniversity on the detrimental impact low back pain (a musculoskeletal disorder) is having on the overall health and wellbeing of older Australians.
Funded by the ACA, the 12-month longitudinal study, 'Back Complaints in the Elderly: Chiropractic – Australia' (BACE:C-A) investigated the clinical course and predictors of disability in older adults with low back pain (LBP) and identified strategies to limit the negative impact it has on older people.
Conducted by Lead Investigator, Associate Professor Katie de Luca, the study found that quality of life, comorbid chronic health conditions and lower leg limb pain all have detrimental effects on the overall health and wellbeing of older adults.
Concurrent musculoskeletal pain, loss of mobility, frailty, falls, urinary incontinence, poor sleep, and moderate to severe disability are all adverse health outcomes associated with chronic primary low back pain (CPLBP) in older people.
"Older Australians, particularly those over 65 years, are at high-risk of developing a musculoskeletal disorder including CPLBP which, if left untreated can have devastating consequences such as reduced physical capabilities, the loss of independence, social isolation, restricted mobility that could lead to disability, and progressive decline in mental capacity," said A/Prof de Luca.
A recent systematic review, co-authored by A/Prof de Luca, found that older people with CPLBP had significantly greater declines in multiple cognitive areas such as long-term memory, selective attention, processing speed, and executive function than older adults who do not have CPLBP.
"With the high prevalence of CPLBP in Australia's ever-growing aging population, the evidence that cognitive functioning declines in older Australians with LBP is concerning," said A/Prof de Luca.
"There is also strong evidence that depressive symptoms show a risk of future reporting of back pain onset that raises serious concerns about its impact on the mental health of our older people who suffer LBP."
A/Prof de Luca's research reports that community-dwelling older women with spinal pain have significantly poorer health status, lower physical and mental quality of life scores, and decreased functional ability than women without spinal pain.
The study showed that women with spinal pain also had an increased risk of multiple comorbidities (the number of chronic diseases and conditions experienced at the same time) and a significant incremental increase in the risk of spinal pain associated with an increased comorbidity count.
Diabetes, cardiac disease, pulmonary disease, mental health disorders and obesity were all found to be more common among women with spinal pain than in women without spinal pain demonstrating that comorbid chronic diseases may contribute to allostatic load (the wear and tear on the body) which accumulates with a person's exposure to chronic physiological, biological and/or psychological stress.
In older women, over 50% of those with spinal pain reported 2+ comorbidities. 56% of those with arthritis had experienced spinal pain in the previous month; 33% who experienced spinal pain had cardiovascular disease; 20% had some form of mental health disorder, and over 70% of women with spinal pain were classified as overweight or obese.
Addressing CPLBP among older populations can facilitate healthy ageing to ensure older people have the functional ability to maintain their own health and wellbeing to improve their overall quality of life.
With LBP the leading cause of disability world-wide and common in older Australians this can lead to the loss of physical and mental capacities, restricted mobility and the ability to participate in society, and the associated risks of significant comorbidities, higher mortality and a decrease in health-related quality of life; older Australians require healthcare that is tailored specific to the needs of the individual suffering LBP.
In response to a lack of research on healthcare options for older adults with back pain, A/Prof de Luca recently launched the COMEBACK study at CQUniversity to assess the feasibility of adapted exercises for older people with back pain and comorbid conditions.
The findings were significant in revealing that participants in the exercise program showed an overall increase in functional capacity and aerobic stamina, a decrease in depression and anxiety, and importantly, decreased frailty - all leading to an increase in reported quality of life.
However, according to A/Prof de Luca, evidence suggests the common treatment for LBP in the majority of older patients in Australia conflicts with her findings and the conservative care recommendations including those in the WHO guideline - for non-surgical management of chronic primary low back pain in adults in primary and community care settings.
"As a result, older people are significantly burdened by spinal conditions and a range of additional negative implications associated with back pain that could be effectively treated," said A/Prof de Luca.
"Currently, 50% of older LBP patients are less likely to receive a recommendation for exercise for their spinal pain than younger patients, and medications are being recommended for spinal pain in 849 of every 1000 problems in over 55-year-olds. That's 85% of patients who could access improved spinal healthcare if the recommended treatments were followed by prescribing physicians," she said.
Faced with a wide range of potential serious implications to the long-term health of older Australians including loss of cognitive impairment and physical disability, the findings of the ACA funded BACE:C-A study, together with recommendations from the WHO present a strong argument for improved assessment of older patients with LBP and treatment options including chiropractic healthcare.
ACA President, Dr David Cahill said, "In line with the University of Sydney's study (Lancet medical journal, 23 June 2023), the WHO recommends against the commonly prescribed use of opioids and paracetamol to treat low back pain as these medications have proven largely ineffective and come with a range of significant associated risks and side effects.
"A/Prof de Luca's research findings are consistent with interventions endorsed in the WHO guideline, which importantly include spinal manipulation and warn against bed rest," said Dr Cahill.
"Having invested over $2.2 million into neuromusculoskeletal research overall, the research conducted by A/Prof de Luca has added value to the field of chiropractic by presenting vital insights into improving the spinal health and overall health and wellbeing of older Australians who suffer spine-related pain," he said.
With prevention the best protection from back pain, people can
