Back Pain In Seniors
As a person ages, they are more likely to experience back pain. In fact, it is estimated that up to 70% of seniors experience back pain. The high prevalence of back pain among seniors is primarily due to the degeneration of the spinal joints over time. This degeneration of spinal joints is a normal part of the aging process and does not always cause pain. However, as the cushioning discs between spinal vertebrae lose water and flatten out, the bones may begin to rub against each other and nerves may be compressed resulting in pain.
Give that back pain is a common outcome of aging, millions of seniors across America struggle with various levels of back pain. Let’s take a look at back pain and care options that may apply to you or your loved one.
The degeneration of spinal joint cushioning is called osteoarthritis of the spine and because it is degenerative, it will often worsen with time. An individual may start out with back pain that is infrequent or mild but progress to pain that is constant and significantly more severe. Other common degenerative conditions that may result in back pain for seniors include degenerative spondylolisthesis which occurs when one vertebrae slides forward over the vertebrae below it due to weakening of the bones and joints of the spine and spinal stenosis which occurs when the lower spine is narrowed as a result of weakened joints, bones, and ligaments.
Another common cause of back pain among seniors is a compression fracture. Many common types of fractures are not degenerative and are a result of acute trauma. However, compression fractures are caused by osteoporosis, an age-related condition in which the bones lose their mass, and not trauma. This loss of bone mass leaves the bones weakened and vulnerable to fracturing from even slight impact.
When To See A Doctor About Back Pain
Some types of back pain are temporary and will fade on their own in a week or two with home treatments such as over-the-counter medication, heat, and/or cold treatment. This type of back pain is often caused by an injury or illness. For longer-lasting degenerative back pain such as spinal stenosis, a herniated disc, spinal cord discomfort, or acute back pain, a doctor’s help may be needed. Signs it may be time to see a doctor about back pain include pain:
- Pain that has not improved after a week of treatment at home
- Pain that keeps an individual awake at night
- Pain that gets more intense or more consistent with time
- Pain or numbness that spreads down the legs
- Pain that causes tingling, weakness, or numbness
- Pain that is accompanied by swelling or redness in the back
- Experiencing lumbar discomfort, spinal cord irritation, symptoms of a herniated disc, symptoms of nerve damage, lower-back pain, acute back pain, amongst others.
A doctor may take x-rays to find the source of back pain. If the pain is found to have a degenerative cause, a course of treatment will be started.
Back Pain Treatment
Treatment for back pain may vary depending on the type of back pain - low-back pain or upper - and the overall health of the individual. Treatments can range from mild interventions to surgical procedures. Some common strategies for back pain relief include:
- Increased exercise and strength training programs - These activities are usually done under the guidance of a physical therapist and may help combat the age-related degeneration of the spine.
- Massage and heat therapies - These activities provide pain relief and should also be overseen by a healthcare professional such as a physical therapist.
- Braces - Wrapping braces around the back and stomach may promote stability and decrease pain.
- Restriction of some activities - Restriction of activities that cause the most pain can help to reduce pain overall. For example, a doctor may recommend that a patient experiencing low-back pain limit the amount of lifting they do during the day.
- Medications - Depending on the individual and the severity of their pain, medications such as anti-inflammatory drugs, relaxants for muscles, and narcotics may be prescribed.
- Steroid injections - Steroid injections into the affected area can provide relief in some cases.
- Surgery - Disc replacement surgery or spinal fusion surgery may be performed if a patient is not experiencing improvement from other treatments.
- Other - Some common forms of treatment may include spinal manipulation, mindfulness-based stress reduction, a systematic review of back pain, a microendoscopic discectomy, transforaminal lumbar interbody fusion, introduction of an interspinous process device, use of a minimally invasive pedicle screw, prescribing anti-inflammatory agents or nonsteroidal anti-inflammatory agents,
Some patients are also able to reduce their back pain with alternative treatments such as chiropractic adjustments or acupuncture (a form of traditional Chinese healthcare in which needles are inserted into the body in specific spots to derive health benefits). Recent published statements from the Food and Drug Administration (FDA) advise that physicians recommend chiropractic treatments and acupuncture as part of a pain management plan.
Care Needs For Back Pain
Back pain may make everyday tasks more difficult. A person with back pain may find movement too painful or they may have a limited range of motion (ROM) as a result of their back pain. Treatments (including pain-relieving medication) may help an individual function better to complete daily tasks. However, because back pain in seniors is often degenerative, it may become harder to do these tasks over time. As pain increases or spreads to other areas of the back or body, an individual’s ability to walk and stand may decrease.
Activities Of Daily Living
An individual experiencing back pain may need assistance performing their activities of daily living (ADLs). ADLs are the tasks a person needs to do every day to take care of themselves including:
- Bathing or showering
- Personal grooming
- Personal hygiene
- Getting in and out of bed
- Walking around
- Sitting and standing
An individual experiencing back pain may find these activities more challenging when experiencing back pain. They may no longer be able to pull a shirt over their head, reach certain buttons, or stand long enough to pull on pants. They may be unable to maintain their balance in the shower or reach all the parts of their body that need to be cleaned. They may have difficulty getting up from a sitting position making it difficult to use a toilet.
Various types of assistance are available for these tasks. While some people may need a caregiver to complete some of these tasks for them, others are able to manage some tasks with assistance. Assistive technology is often used to help people maintain some independence while safely performing ADLs. Some examples of assistive technology include:
- Shower hand rails - Having a railing in the shower to hold onto can provide people with the balance they need.
- Shower chair or benches - These enable a person to sit while showering and can help prevent falls.
- Front-buttoning or velcro tops and bottoms - Many companies manufacture clothes that are easier for seniors experiencing chronic pain to manage.
- Raised chair cushions - The impact of sitting and standing can be minimized by by raising the height of the chair
- Raised toilet seats - May help minimize the strain of standing and sitting.
The equipment an individual needs will be determined by their pain and ability level. Physical and occupational therapists may be able to provide additional guidance on the equipment that would be most beneficial. In many cases, these assistive devices can help people care for themselves for much longer than they would be able to otherwise. Even when an individual is no longer able to perform ADLs independently, assistive devices may also be used to help caregivers who are helping an individual with ADLs.
Other Daily Tasks
In addition to ADLs, there are many other tasks a person needs to complete in their everyday life. These activities are sometimes referred as instrumental activities of daily living (IADLs). IADLs include tasks such as:
- Household chores
- Medication management
- Bill payment
- Appointment keeping
For many people with back pain, household chores present the greatest challenge. They may be unable to use a vacuum, lift heavy objects, or dust high shelves. They may have trouble maintaining their home to a safe and clean standard. Cooking may also present difficulties due to the need to stand for extending periods of time and reach ingredients and cookware.
While many people with back pain are able to manage their finances, appointments, transportation, and medications the same way they did prior to the onset of back pain, some people become overwhelmed and are no longer able to handle these tasks. Additionally, back pain can cause depression in seniors with chronic back pain. Depression can cause difficulties with memory and concentration making management of IADLS very challenging.
For an individual experiencing back pain, pain medication may enable one to continue daily activities and participate in needed physical therapy treatments. The exact medications prescribed can vary depending on a patient’s overall health and medical history but often include:
- Non-steroidal anti-inflammatory drugs (NSAIDS) - Non-steroidal anti-inflammatory drugs are medications used to control pain and inflammation. Over the counter NSAIDS are the most common type of pain reliever and include ibuprofen and naproxen. Stronger NSAIDs are available by prescription and include celecoxib and diclofenac.
- Topical treatments - Creams and patches used to control pain are topical treatments. These treatments have ingredients such as menthol or capsaicin.
- Muscle relaxants - Muscle relaxants are prescription only medications used to relieve and control painful spasms in muscles. They include medications such as baclofen and carisoprodol and look to ease the pain in muscles.
- Opioids or narcotic medications - Opioids or narcotic medications may be prescribed for people with chronic pain that has not responded to milder medications. These medications have more side effects than other pain medications and may be addictive. They include milder medications such tramadol or tylenol with codeine as well as strong narcotics such as morphine or vicodin.
- Antidepressants - Antidepressant medications may prescribed for the management of chronic pain and have shown results even in patients who do not have depression. These medications may provide pain relief if taken regularly.
During the course of treatment for back pain, an individual’s medications may change several times. A doctor may have a patient keep a pain journal to record their daily pain levels. This tool may help a doctor assess what triggers the most pain, which treatments are working, and what may need to be changed.
Care Provider Options For Back Pain
If an individual with back pain is having difficulty completing ADLs and IADLS, they may need additional assistance. While many people are able to stay in their own home, there are some important considerations to keep in mind. An individual’s home will need to be a safe environment in order for them to care for themselves or receive care in it.
According to the National Council on Aging (NCOA), it is important to check the following in order to help prevent falls at home include:
- Floors - Rugs, loose cords, and clutter can all make walking across the floor hazardous.
- Staircases - Stairs that are cluttered, have broken steps, or are dimly lit can increase the risk of falling. Additionally, frequent stair climbing can aggravate chronic pain. For example, if an individual needs to climb the stairs every time they need to use the bathroom or get water, their home may not be a safe layout.
- Kitchens - In kitchens with high shelves, an individual may have trouble reaching the items they need to prepare meals for themselves.
- Bathrooms - Showers and tub floors can be slippery and a person experiencing back pain may be unable to support themselves. Toilet seats can also be too low to the ground for an individual to sit on and stand up from. Many bathrooms can be modified with assistive devices but this is not always possible.
In addition to home safety, an individual and their family should consider if they will be able to care for themselves at home independently. The ability to perform ADLS and IADLS including transportation needs, money management, and meal preparation will need to be considered.
If an individual is able to remain in their own home but needs additional assistance due to back pain, home care may be able to provide the care needed. When using a home care agency, a team of healthcare professionals will visit the individual at home. A nurse will assist with medication and pain management and will manage any other ongoing health conditions the person may have. A home health aide will assist with ADLs. Physical and occupational therapists will lead the individual in exercises and may be able to teach them how to better care for themselves.
Some home care agencies are also able to provide services to assist an individual with their IADLS. They may offer housekeeping services, meal preparations, and transportation management, however, not all agencies offer these services. It is important to note as well that these services are not covered by Medicare or other major insurance plans.
Medicare may cover the home health care of an individual who does not need any additional services. A doctor will need to certify that the person has a skilled need and that they are homebound. Medicare will cover home care on a part-time and temporary basis and the need for home care will have to be re-evaluated every 21 days.
If an individual requires long-term home care, additional services, or home care staff to visit their homes more often than Medicare covers, other payments will need to be considered. Medicaid, private pay, and long-term care insurance are all options that may pay for home care services. Different home care agencies accept different forms of payment so it is important that an individual and their family know what forms of payment the agency they choose will accept. The agency may have a social worker, Medicaid manager, or financial planner on staff who can help families navigate payment options.
It is important to select a home care provider who can best meet the needs of an individual experiencing chronic back pain. Meeting with several agencies can help make this decision one that the person and their families are comfortable with.
If an individual needs help to care for themselves frequently throughout the day as a result of chronic back pain, home care may no longer be an option. In these cases, an individual and their family may need to consider inpatient facilities.
Inpatient facilities include skilled nursing facilities (SNFs) and assisted living facilities (ALFs). SNFs are primarily for individuals with an acute, short-term need. In the case of back pain, a person who needs intensive physical therapy before it is safe for them to return home may enter an SNF to receive this treatment. Generally, a stay in an SNF occurs after a hospitalization. If an individual has had a fall or surgery as a result of back pain, the hospital team may recommend a SNF stay after discharge from the hospital.
Medicare will cover 100% of a person’s stay in a SNF for 20 days if there is a skilled need and there has been a qualifying hospital stay. On days 21 through 100, Medicare will pay a portion of the costs and the individual will be billed for the rest. After 100 days, Medicare will no longer pay for care in a SNF and the individual will need to look into other payment options. Medicaid, long-term care insurance, and private pay can all be used as forms of payment at most SNFs.
Unlike SNFs, ALFs are meant to be long-term solutions for individuals. These facilities do not offer skilled services and are not paid for by Medicare. In an ALF, a person will receive assistance with ADLS and IADLS. Different ALFs provide different levels of service, however, most facilities are able to assist with medication management and personal care. Housekeeping, meals, transportation services, and activities are also usually provided.
Some communities are known as continuing care retirement communities (CCRCs) offer multiple levels of care all in one building or on one campus. An individual may be able to start out in an ALF level of care and move back and forth between SNF care as needed. These communities can help ensure residents feel at home no matter what care needs they encounter as they age.
Selecting A Care Provider
When selecting a care provider, either in home or in a facility, individuals and their families should takes steps to ensure the provider they select meets their needs. They should meet with home care agencies or take tours of inpatient facilities. Caregivers assisting an individual with this selection should make sure to research and meet with multiple agencies or facilities. Some important considerations to keep in mind include:
- Are staff friendly and welcoming? If visiting a residential facility, watch how the staff interacts with the residents. Make sure staff are speaking to the residents in a kind and caring manner.
- Has the agency or facility treated patients with pain management needs before? It is important to make sure staff are trained to recognize signs of pain and provide relief, particularly in seniors with dementia who may be unable to express their pain level verbally.
- Is the facility clean? If the individual will be moving to a facility, make sure the facility is clean, smells good, and is laid out in a way that is friendly, homelike, and bright.
- Can the agency or facility meet the individual’s social needs? Home care staff should be able to check in and talk with the individual at least a few times a week. At a facility, daily activities should be held based on resident preferences, ability level, and requests.
- Can the agency or facility meet the resident’s spiritual needs? With home care, meeting an individual’s spiritual needs may include respecting religious traditions, arranging transportation to church services, or assisting to arrange for home visits from faith leaders. In a facility, church services may be offered on-site and weekly shuttles may take residents to services at nearby places of worship.
- Will the costs change if the individual’s level of care changes? Home care agencies as well as ALFs and CCRCs may be able to provide additional services as a person’s needs change. However, these additional services may incur additional costs.
- What training does the staff have? All staff members of both agencies and facilities who have direct contact with patients should be CPR-certified. They should also receive regular training on how to best meet the needs of the individuals they serve.
Effects On Caregivers
When an individual with back pain is no longer able to care for themselves the way they used to, caregivers may feel overwhelmed and helpless. Seeing someone in pain is often a difficult experience and it may be difficult to know the best way to help. A few ways caregivers may help an individual with back pain include:
- Learn about the condition - Learn as much as possible about back pain and the type of back pain the individual has can help a caregiver. Knowing the details of the specific condition causing the pain and the prognosis can assist in planning.
- Assist in keeping a pain log or journal - An individual may not be able to keep their own pain journal or may not report their own pain accurately. Studies have shown that seniors are likely to feel that their pain is “just part of getting old” and not report it accurately. Helping an individual keep a detailed and accurate pain journal can help ensure they are receiving the correct medications and other treatments.
- Assist with home modifications - If an individual will be staying in their own home, ensuring the home is a safe environment is an important step caregivers can take. A home health agency may be able to help with this planning.
- Make sure to listen - An individual experiencing back pain may express a range of emotions including depression, anxiety, and anger. Helping the individual discuss these feelings may make the condition seem more manageable.
- Consider arranging household chores around their pain level - A live-in caregiver may want to find tasks the individual with back pain can do that do not aggravate the pain. Talking to their doctor or physical therapist can be a good way to figure out what is appropriate. Having daily tasks assigned to them can help people with back pain feel more in control and help them stay independent longer.
- Encourage the individual to stay physically active - While a person with back pain may not be able to move as much as they once did, remaining physically active is important and can help slow the degeneration of the spine. Physical therapists may be able to show caregivers the best activities for individuals with back pain to do. If possible, doing the activities with them can be a very helpful show of support.
Regardless of the type of care required for back pain, there will be costs associated with receiving that care. Before choosing a home care provider, staying in an SNF, or moving into an ALF or CCRC, the costs will need to be considered. The cost of each option will vary depending on an individual’s care needs, however, the average costs for healthcare services according to the Department of Health and Human Services are as follows:
- Home health aide services - $20.50/hour. Home health aide services include assistance with ADLs.
- Homemaker services - $20.00/hour. Homemaker services include assistance with ADLs such as meal preparation and housekeeping. They do not generally include bathing or dressing services.
- ALF stays - $3,628/month. ALF costs will vary greatly depending on the level of care provided and if they are part of a CCRC or not.
- SNF stays - $7,698/month for a private room. SNF stays in a semi-private or shared room cost an average of $6,844/month.
An individual and their family will need to figure out what they can afford to pay and what assistance is available to them. More detailed information on the options for covering these costs is available here.
Planning for the care needs of an individual with back pain can be complicated and draining. An individual may want to consider setting up a power of attorney. A power of attorney can handle financial decisions for a person and help an individual choose the appropriate type of long-term care they require. It may also be helpful to set up a living will or advanced directive.
Many SNFs require a person to have a living will or advanced directive on file so staff know a resident’s wishes in the event of an emergency. For any individual with a chronic condition, a living will can help ensure their requests for medical treatment are met even in the event they are unable to verbally make the request themselves.
FAQs About Back Pain In Seniors
1. Will a person with back pain always need surgery?
No. While surgery can help people who have not been helped by other treatments such as medications, exercise, rest, or steroids, it is not always recommended. Some people find relief from other methods and surgery is not needed. For other patients, surgery may not be recommended due to a high risk of complications from factors such as dementia, advanced age, or other conditions. If a doctor thinks surgery may be an option, they will discuss this with the individual and their family.
2. Can back pain be prevented?
While degenerative back pain is often age-related, there are some preventive measures an individual may take to help reduce the risk of suffering from back pain. These measures are part of an overall healthy lifestyle and include:
- Quitting smoking - Toxins from cigarettes can impair the bones’ ability to absorb nutrients leading to degeneration of the spine.
- Exercise - Regular exercise such as walking or yoga may help keep the spine strong and flexible.
- Healthy eating - Food high in omega fatty acids and antioxidants such as fish, nuts, and vegetables may help maintain bone density and bone health.
- Maintaining a healthy weight - Having a lower body mass puts less pressure on the bones, disks, and joints of the spine resulting in less and/or slower degeneration.
- Avoiding alcohol - Alcohol may mask back pain and have negative effects on an individual’s mood.
Despite implementing these strategies, many individuals still experience a degree of spinal degeneration, however, it may not be nearly as severe or debilitating.
3. Are people with back pain more likely to fall?
Seniors are more likely to fall than people under 65 years of age. In an individual with back pain, this risk may be greater. The pain may make walking much harder and may cause fatigue which can lead to falls. A individual’s range of motion may be limited due to back pain which may cause them to fall. In addition, people who have chronic back pain are often on pain medications. These medications may cause dizziness and confusion which can increase the risk of falling.
4. Can back pain be cured?
Because back pain in seniors is normally degenerative, it cannot be cured. However, medication, exercise, and sometimes surgery may help an individual manage their pain and resume a normal life. A doctor and healthcare team will help determine the most appropriate course of treatment and re-evaluate the individual’s response and ongoing needs.
Proximity of care is very important when considering options
Research care options that are nearby when thinking about the next step for your loved ones.
Leona J. Werezak RN, BSN, MN is a registered nurse and adjunct nursing professor. She has 24 years experience working in a variety of healthcare settings including such remote locations as the Arctic Circle. Her research in early stage dementia was published in the Canadian Journal of Nursing Research and re-published in their 40th anniversary issue which showcased exceptional research published since the journal began. Her work in dementia care has also been published in the Journal of Gerontological Nursing. She currently teaches surgical nursing care on a thoracic/vascular unit to baccalaureate nursing students. Her clinical work with nursing students involves extensive work with older adults who have multiple chronic health conditions.