Presented by: Dr Anthony French — Geriatrician Event: Challenges in the Ageing Spine - 2014

1. 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

2. 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

3. 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

4. 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

5. ATTITUDES AND
PERCEPTIONS IN OLDER
PATIENTS WITH BACK PAIN
" Myths
" Legends
" Opioid use and dependence
" Stoicism
" Surgical outcomes
" Normalising
" Therapies and therapists

6. 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

7. 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

9. 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.

11. 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