Back Pain in the Elderly The authors identify causes of back pain in the elderly population and offer assessment guidelines and various management techniques. By

PAULA R.

M O B I L V / K E E L A A.

Hr~R

ack pain is often a problem for the elderly because the strength of the spinal column and its supporting structures decreases with age. Estimates of the prevalence of complaints of back pain in this population range from 20% to 38%. !' 2 National survey data of visits to physicians by patients 75 years of age and older reveal that back pain is the third most frequently mentioned complaint and the most commonly mentioned musculoskeletal symptom. 3 In a recent study of pain among nursing home residents, low back pain was the most frequently mentioned source of pain and was reported by 40% of the residents reporting pain. 4 Not only must the elderly with back pain deal with the pain itself, which often becomes chronic in nature, but also their functional ability and quality of life can be severely limited. Because of the opportunity for regular and increased interaction with this population, whether in hospitals, long-term care facilities, residential communities, senior centers, or other community service agencies, knowledgeable nurses can be instrumental in the assessment of back pain in the elderly and in implementing successful interventions to decrease discomfort, increase functional ability, and improve quality of life.

B

Case Studies The following case studies illustrate two very common situations encountered by nurses working with geriatric patients with back pain. Case Study No. 1. One day, 68-year-old Edna Jackson and her husband were attending a garage sale when she stepped in a "bad place" on the sidewalk and fell, fracturing two lumbar vertebrae. She experienced severe pain over the fractured vertebrae and surrounding area, but had no radiation of the pain to her lower extremities. An orthopedist diagnosed osteoporosis as the major cause of the vertebral fractures. After an initial period of bedrest, she was fitted with a spinal corset. Mrs. Jackson contin-

PAULA R. MOBILY, PhD, RN, and KEELA A. HERR, PhD, RN, CS, are assistant professors at University of Iowa, College of Nursing, Iowa City, Iowa. 34/1/35395

It0 Geriatric Nursing March/April 1992

ued to have pain. It was aggravated by activity but was never completely relieved even with rest. Ibuprofen was prescribed and "helped a little bit." Her low back pain became a major problem for her, greatly interfering with her sleep and daily activities. Case Study No. 2. Elmer Graves is a 79-year-old retired farmer with osteoarthritic back pain. He has had his back pain for many years, but it has continued to worsen. The pain is in his lower lumbar area. He describes the pain as "deep, gnawing, and aching" and states that the pain is always worse when it rains or when it is cold outside. There is some local tenderness over the area of pain with spasm of the surrounding muscles. The pain radiates into his right buttocks and calf and into the side of his foot. He reports that he is "awful stiff" when he gets up in the morning, but he gradually improves as the day progresses. He notes that the pain gets worse with activity and is relieved by rest. He takes indomethacin daily and occasionally takes Equagesic (meprobamate with aspirin) for muscle spasms. He, too, reports that the osteoarthritis in his back has a severe impact on his daily activities. "I sure don't call these my 'Golden Years'." Etiology o f Back Pain in t h e Elderly Back pain in the elderly may have many different causes. It most commonly results from degenerative changes in the spine and associated structures; metabolic problems, such as osteoporosis, resulting in fractured vertebrae; rheumatic or inflammatory disease; and trauma to the spine, surrounding tissues, and associated nerves. In addition, back pain can result from metastatic disease or problems originating in the abdomen such as gastrointestinal and genitourinary problems, abdominal

masses, or aortic aneurysms.5 Regardless of the cause, the pain is important in planning and evaluating optimal however, back pain in the elderly results from one or care. Data obtained can be used to determine the nature more of the following physiologic alterations: (1) muscle and extent of the problem and as a basis for selecting and strain, (2) muscle spasm, (3) inflammation, and (4) irri- evaluating the outcome of interventions prescribed or setation or compression of nerves. Because osteoporosis re- lected to deal with the pain after medical evaluation. sulting in vertebral fractures and osteoarthritis of the A careful and focused history is important when aslumbar spine are common causes of back pain in the el- sessing back pain in the elderly. General assessment paderly, a brief review of the major pathophysiologic mech- rameters include onset of the pain and any associated anisms and resulting symptoms is presented. trauma; location, quality, intensity, and duration of the Osteoporosis. Osteoporosis is a metabolic disease of the pain; and any factors the patient has found that intensify bone causing progressive loss of bone mass. It most com- or relieve it. In addition, it is important to assess specifmonly occurs in women afically any pattern of radiation to other body areas ter age 40, although both sexes are affected. It has such as the buttocks, leg, Regardless of the cause, however, or foot; relationship of the been associated with small pain to movement or posistature, low body weight, back pain in the elderly results poor calcium intake, high tion; and any related motor or sensory complaints. Bealcohol intake, sedentary life-style or immobilizafrom one or more of the following cause it is often difficult for t i o n , and e a r l y menoindividuals to specifically pause. 6 Most patients are aphysiologic alterations: (1) muscle describe the nature of their symptomatic until fracback pain, a body drawing tures occur. Compression is useful. Using this, the strain, (2) muscle spasm, (3) fractures of the thoracic or patient can identify the lolumbar vertebrae are most cation(s) of pain and select inflammation, and (4)irritation or symbols common and may occur to identify the with minimal trauma. Evquality or character of the compression of nerves. eryday activities such as pain experienced. Informatying shoelaces, turning tion concerning previous over in bed, and even problems with back pain sneezing or stretching have been known to cause frac- should also be assessed, including age of onset, frequency tures of demineralized vertebrae. Typically, sudden onset and duration of symptoms, health professionals conof moderate to severe pain over the involved vertebra(e) sulted, and previous medical treatment and its effectiveaccompanies the fracture, with localized tenderness on ness. Because the onset of back pain is often insidious palpation and paravertebral muscle spasm frequently ev- with the elderly and may be chronic in nature, the patient ident. Lateral radiation of pain occurs if emerging nerve may have tried a number of home remedies or strategies roots are entrapped. The pain is usually aggravated by to treat the pain. It is important to assess these strategies activity but may not be entirely relieved with rest. 6 Pain and determine their effectiveness. A number of important observations should be made. is most pronounced at the time of fracture and in most cases subsides gradually in 1 to 3 months.5 These include the patient's gait; postural alterations; difOsteoarthritis. Back pain caused by osteoarthritis re- ficulty moving, sitting, or bending; guarding or restrictive suits when loss of cartilage, often associated with the motions; and facial expressions or vocalizations indicative "wear and tear" of aging, stimulates growth of osteo- of pain. Palpation of the spine and paravertebral muscles phytic spurs in the lumbar segments of the spine. 6 These can be used to assess localized or generalized tenderness spurs impinge on nerve roots, most commonly L4, L5, and the presence or absence of associated muscle spasm. and SI, resulting in pain; Depending on the segment of Because back pain can severely affect the individual's the spine involved, the pain may radiate to the anterior daily life, the impact of the pain with regard to the elder's and medial thigh; the great toe and dorsum of the foot; or functional ability and quality of life should be considered. the buttocks, posterior calf, and lateral foot. 6 Patients Interference with activities of daily living should be astypically describe the pain as a dull ache often accompa- sessed, including self-care activities, sleep patterns, famnied by muscle spasms. Localized stiffness on arising, ily and household responsibilities, recreational and social which gradually subsides with activity, is common. activities, and the impact of back pain on relationships Weather changes often exacerbate the pain. 7 with others. Because chronic back pain can severely limit activity, fears and threats related to personal autonomy Assessment and independence may be of great concern to the elderly For many back problems affecting the elderly, few spe- and should be considered and explored. cific diagnostic physical findings or laboratory studies are Management available,5, 8 and the actual diagnosis of the origin of the pain will require assessment by a knowledgeable profesAs noted previously, back pain in the elderly results sional. Nursing assessment of the nature and impact of from muscle strain, muscle spasm, inflammation, and Jr-

Geriatric Nursing March]April 1992 I i l

ritation or compression of nerves. ~--~ERE IS Y O U R B A C K P A I N ? These physiologic alterations can U s i n g t h e s y m b o l s l i s t e d helo~, h a r k o n the d r a w i n g s t h e a~ezs serve as the basis for developing w h e r e y o u feel y o u r b a c k ~ a i D or r e l a t e d p a i n . If y o u feel :::e treatment goals. The therapeutic t h a n o n e s e n s a t i o n i n t h e S a m e a r e a , t h e n m a r k over t h a t azez ~i~h additional symbols that apply. H a k e s u r e y o u show all affac~e~ goals for the treatment of back pain areas. in the elderly can be classified as folSYMBOLS : lows: (1) to promote rest for the af/// >>> o o o X X X fected structures; (2) to diminish stabbing z:'-I-.numbness pins/needles burning muscle spasm; (3) to diminish inBACK FRONT flammation; (4) to diminish pain; ~ACE D0;~ ~ A C E U-~ and (5) to maximize functional ability by increasing muscle strength, range of motion, and endurance. An overview of these goals and associated treatment interventions is provided. Because some overlap exists between the different interventions with respect to the therapeutic goals, the interventions will serve as the organizing framework for the remainder of the discussion. Some of the interventions discussed may necessitate \/ consultation with a physician or physical therapist or require a physician's order; however, many of the interventions discussed can be initiated by a nurse independently. It should be noted that effective management of back pain in the elderly typically requires the use of multiple interventions. Because the nurse often has the opportunity for regular and frequent interaction with a patient, she/he can be a key in helping the elder to find the most effective combination of interventions for pain management. Rest. A period of rest, either in bed or reclining chair, is often prescribed for anyone suffering from back pain and for the e l d e r l y in p a r t i c u lar.S, 6, 7, 9 Until recently, convenFor patients with osteoarthritic back pain, such as Mr. tional therapy for the treatment of back pain almost always included bedrest--often prolonged. Although the Graves, a balance of rest and activity, incorporating sevuse of rest as an effective and appropriate treatment mo- eral rest breaks during the day, is recommended. 7 An dality for back pain has been subject to some debate, re- hour of non-weightbearing rest in the afternoon often cently the relative consensus is that rest is indicated dur- permits increased activity without pain later in the day. ing episodes of back pain in general and specifically for For the elderly such as Mrs. Jackson who had back pain acute episodes of pain, as long as the risk of prolonged in- from fractured vertebrae, 5 to 7 days of bedrest is recactivity is considered. The rationale for a period of rest is ommended immediately after the fracture, with gradual that it will enhance the natural mechanisms of healing mobilization after the first week.6 During the period of and prevent the aggravation of further injury and prob- mobilization, the patient may begin sitting for a few minutes four times a day for 2 or 3 days progressing to eight lems. S The nature and duration of rest should be guided by times a day. As soon as sitting becomes comfortable, the nature and severity of the pathologic condition caus- walking should resume. 6 The goal is to restore normal ing the back pain, physicians' orders, and the patient's ambulation within 2 weeks. After the acute period, the symptoms. However, the duration of bedrest should be patient's symptoms should guide the amount and duralimited to a maximum of 2 weeks in most situations re- tion of rest to maintain optimal function and activity without excessive pain. gardless of the cause of the pain. s

A

Z

iJ uf< .

112

G e r i a t r i c N u r s i n g March/April 1992

Whenever periods of bedrest are ordered or indicated, pain applied 20 minutes per hour is often recommended, it is important that the hazards of inactivity, such as skin with the use of moist heat similarly applied for more breakdown, muscle weakness or atrophy, constipation, chronic back pain. 9 Both of these methods are thought to and venous thrombosis, all of which may be of particular work by reducing muscle spasm or by inhibiting the concern in the elderly, be considered and appropriate pre- transmission of pain messages to the brain. Cryotherapy (cold) is also thought to reduce inflammation.8 Ice masventive interventions instituted immediately. Spinal Support. Spinal support, most often provided by sage is a form of cryotherapy. Focal application of ice braces or corsets, is sometimes prescribed for the elderly massage for 2 minutes over any areas of hypersensitivity with back pain. I° Patients with spinal fractures from and tenderness may alleviate pain and muscle spasm by trauma, osteoporosis, or other pathologic conditions in- inactivating muscle trigger points. 9 Moist heat can be applied by hot moist compresses, hot volving the lumbar spine may be fitted with braces or cormoist towels or washcloths, sets during the acute phase or immersion in water. The to reduce spinal mobility should be 40 ° and to provide support to the T.RE~YM~.NYGO~I~ AND RI~LAI"E_D!HIERVEN,, temperature to 45 ° C or 104 ° to 113 ° spinal column and surroundTJ-O_NSIN ~ E Ii~AN~/~-ElilEbI?OF FJ 1 With the elderly, in paring structures while healing B~CK PAIN :lflslTfl_~I~LDE-RLY ticular, it is important that occurs.6, 9, I0 Patients are the skin be inspected regutypically instructed to wear larly to be sure that no tissue the brace or corset when sitdamage has occurred from ting, standing, or walking. the effects of the heat or These supports are of most & A:pi~Eec~iQn,©?~eat.o.ndo~ld, moisture. value during a transitory Cold can be applied in a phase of acute back probvariety of ways. Commerlems or until the spinal and cially available equipment, ~ h ~ a c~l~gl~~a-a-aag.eme~ abdominal muscles are sufwaterproof bags, frozen gel ficiently strengthened, packs, washcloths dipped in through a program of exerwater with ice shavings and cise, to provide needed supthen wrung out, or even a port to the spine. A period of package of frozen vegetables weaning, in which the pacan be used. Ideally, cold tient gradually reduces the packs should be sealed to wearing of the support in the prevent dripping and should morning hours, saving the be flexible to conform to support for later in the day body contours. It is imporwhen the patient may be tant to remember that all more fatigued, is often reccold packs used in this way ommended.9 should be wrapped with Despite their potential cloth to prevent tissue damtherapeutic benefit, braces age and provide a comfortand corsets may cause secondary problems for the patient. A poorly fitted support, able intensity of cold for the patient. For ice application or massage, ice cubes or small or one that is difficult to put on, may actually defeat the therapeutic intention. Spinal supports may severely limit blocks of ice can be used. Ice frozen in a polystyrene cup spinal motion and be uncomfortable, resulting in poor with portions of the polystyrene peeled away to expose compliance. It is important that the patient fully under- the ice or ice frozen in a cup with a wooden ice cream stand the purpose and importance of the support and, stick provides a convenient and simple method for ice apbased on the type of support prescribed, be taught the plication and massage, which avoids chilling the hands. most effective and efficient method of putting it on. Ice massage will cause erythema of the skin, resulting Whenever the support is removed, the skin should be ob- from the normal histamine reaction. This should not be mistaken for tissue damage. However, because ice masserved for areas of pressure or breakdown. Spinal supports also increase abdominal pressure with sage can cause tissue damage, it should be used no longer unfortunate sequelae. Mrs. Jackson was fitted with a cor- than 10 minutes or discontinued when numbness, alterset after her vertebral fracture. Although the corset did nating blanching and dilation of vessels, or shivering ocaid in pain relief, the increase in pressure to the abdomen curs.l 1 Although application of cold or ice massage may be exresulted in a prolapse of her bladder, initiating a spiral of untoward side effects and severely affecting her quality of tremely effective in reducing back pain, many elderly persons may be reluctant to try it because of the association life. Application of Heat and Cold. Application of both heat of cold weather or dampness and pain. It is important to and cold is used in the treatment of back pain. During give simple, easy to understand rationale for its effectiveacute episodes, the use of cold compresses over areas of ness in relieving pain and to stress that the cold or ice will

Geriatric Nursing March/April 1992 113

be applied to a small area of the back only. For an added sense of warmth and comfort, the simultaneous use of a heating pad or blanket on other parts of the body during the application of cold or ice to the back is suggested. Application of heat and cold are interventions that not only are effective in relief of back pain but also are easy to use, readily available, inexpensive, and low risk when used properly. In addition, these modalities can be easily taught to the patient or family member. This provides an intervention that can be used independently when pain occurs, providing a sense of control over the pain. Both Mrs. Jackson and Mr. Graves found heat to be effective in reducing pain and paraspinal muscle spasms. Relaxation Therapy. Relaxation therapy is often very effective in treating elders with low back pain. Although the exact mechanism by which relaxation therapy works is unclear, several hypotheses have been proposed. Muscles surrounding the area of injury or inflammation in the back may remain chronically tense in a protective posture. As these muscles are relaxed, pressure on the site of injury is reduced, concomitantly reducing the frequency of muscle spasms and thereby reducing pain. Also, pain may cause high levels of physical and emotional stress, resulting in increases in adrenocorticotropic hormone and norepinephrine levels, both analgesic antagonists, which

Regardless of the specific type of relaxation therapy used, it is important that the patient understand that this is a skill requiring regular practice for maximal effectiveness. then cause increased pain. 12 If stress can be decreased by using relaxation therapy, pain may be decreased concomitantly. Although many types of relaxation therapy exist, progressive muscle relaxation, in which patients are taught to tense and then relax major muscle groups in the body, is used most often for the treatment of back pain. However, other relaxation techniques, such as diaphragmatic breathing and self-generated relaxation, can also be effective in the management of back pain. One of the major benefits of relaxation as a mode of treatment is that it is an active self-management strategy. Once the technique has been learned, it can be used throughout the day, at the patient's discretion, to manage pain. Regardless of the specific type of relaxation therapy used, it is important that the patient understand that this is a skill requiring regular practice for maximal effectiveness. Although the elderly may be skeptical and somewhat reluctant to try relaxation initially, many find it both helpful and enjoyable. Both Mrs. Jackson and Mr.

114 Geriatric Nursing March/April 1992

Graves found that relaxation was effective in controlling their pain. It is recommended that patients practice the relaxation induction on a daily basis, regardless of their level of pain. Indeed, for back pain, relaxation appears most effective when used regularly on a preventive basis. Pharmacologic Management. As with rest, no consensus exists on the specific pharmacologic management of the elderly patient with back pain. The nature and severity of the pathologic condition causing the back pain will determine the pharmacologic treatment of choice. Analgesics, antiinflammatory medications, muscle relaxants, and sedative hypnotics are most often prescribed for the treatment of back pain. Elders receiving salieylates or nonsteroidal antiinflammatory drugs must be monitored for symptoms of gastric irritation that can progress to life-threatening gastrointestinal bleeding. The potential sedative and other central nervous system effects of many narcotic analgesics, muscle relaxants, and sedative hypnotics, if prescribed, may pose particular hazards for the elderly. Although these may be effective as an adjuvant therapy for short-term management of back pain in the elderly, long-term use of any of these types of medications requires careful monitoring for potentially serious side effects. Because of the increased opportunity for observation and interaction with the patient, nurses play a pivotal role in monitoring these side effects and instructing the patient and significant others in what they should watch for and report. Although pharmacologic therapy may be beneficial, the potentially serious side effects, particularly in instances of chronic back pain, make the use of other modalities for pain relief especially important and appealing for the geriatric patient with back pain. Transcutaneous Electrical Nerve Stimulation. Transcutaneous electrical nerve stimulation (TENS) may be prescribed as an adjunct therapy for the management of back pain in elderly patients. 6, 9, IOTENS is the technique of applying controlled, low-voltage electric currents to the body through the skin to modify or block the perception of pain by the central nervous system. TENS is rarely used alone in the treatment of back pain but rather as a part of a larger management program using other modalities, particularly exercise. TENS must be prescribed by a physician, but the actual treatment can be administered by physical therapists or by nurses with special education or training in the use of this modality. The success of TENS depends on the skill of the person administering it. Specification of electrode placement and the intensity and duration of stimulation must be determined by a knowledgeable professional. For patients who will be using this modality independently, thorough patient and family teaching is essential for success. Written instructions and a resource person(s) to contact if problems arise are recommended. Mr. Graves was started on TENS therapy to help control the pain that radiated to his leg and foot. He and his wife received instruction on the use of the equipment and the placement of the electrodes, and they were able to manage the therapy independently. He reported that TENS was very helpful in controlling his pain.

Imagery. Imagery, or using one's imagination to develop sensory images that decrease the intensity of pain, can be used in the treatment of back pain, particularly chronic back pain. Numerous imagery techniques for pain relief are available. For example, the elder can be taught to transform pain into a fantasy object such as a bird and have it leave the body; to use visual imagery to put him/herself into a pleasant situation incompatible

As with relaxation therapy, the advantage of using imagery to help control back pain is that it can be used independently by the patient, is minimally time consuming and low risk, and may provide a sense of control over the pain. with pain, such as a walk in the woods or along a beach; or to imagine a ball of healing energy that is circulated in the area of the pain and takes away the hurt. When using imagery with elderly patients, recalling a past experience that they enjoyed is often a very effective technique. The elder can be encouraged to recall the specific sensory experiences associated with this experience. After a few sessions in which the nurse provides verbal stimulus to recall the specific aspects of this experience, many elderly can then recreate the experience independently. Elders may prefer to tape the nurses verbal stimuli or tape their own verbal re-creation of the experience. As with relaxation therapy, the advantage of using imagery to help control back pain is that it can be used independently by the patient, is minimally time consuming and low risk, and may provide a sense of control over the pain. Diversion. Diversion, or distraction, is another technique that may provide relief from back pain in the elderly. It may be defined as focusing attention on something other than pain sensation or as a kind of sensory shielding in which the patient shields him/herself from the sensation of pain by increasing other sensory input. II Commonly used diversional activities include listening to music, reading, watching TV, or otherwise engaging in enjoyable hobbies or activities. The use of reminiscence, caring for plants, and pet therapy are less commonly thought of as diversional activities but can be effective in managing back pain in the elderly. It is important that selection of any diversional activities be based on patient preferences. Both Mrs. Jackson and Mr. Graves effectively used diversion to manage their pain. Exercise. Exercise has become one of the most important therapies for the management of back pain. Regular

stretching, strengthening, endurance, stamina, and physical conditioning exercises are recommended in the treatment and management of back pain in the general population, 8 as well as the elderly with back pain. 9, IO, t3 Therapeutic exercise is typically active in nature and is designed to increase strength and mobility of the spine and its supporting structures, sitting and standing tolerance, and range of motion. Because of their advanced age and the number of potential pathologic mechanisms underlying back pain in this population, a program of graded exercise prescribed by a knowledgeable professional is essential. Individual exercise programs were developed for both Mrs. Jackson and Mr. Graves and were extremely helpful in maximizing functional ability. Once an exercise regimen is prescribed, the elderly patient will need careful instruction on the specific performance of each exercise. A handout to serve as a reference is recommended to ensure proper understanding and performance of the exercises. Periodic assessment of the elder's progress with respect to the achievement of specific exercise goals, compliance, and effectiveness of the exercise regimen is important. The nurse can be a key resource in maximizing the effectiveness of this intervention. Many elders are concerned about resuming normal recreational activities. In general, progressive walking, bicycling, and swimming are safe and are recommended forms of exercise for those with back pain. Therapeutic effects of these activities are increased muscle strength and endurance. Activities such as jogging, active contact sports, golf, vigorous tennis, snowmobiling, horseback riding, downhill skiing, and bowling are tisually discouraged.9, 12 Ergonomics. Ergonomics, the study of the "laws of work," can help the elderly patient with back pain learn the most efficient ways to use his body to avoid or minimize injury, strain, or pain and maximize functional ability. It can be a key in the successful management of back pain in the elderly. Ergonomic counseling involves patient education in body mechanics and its relationship to specific activities.

Elders with back pain should be taught proper ways to sit, stand, lift, carry, and perform other activities of daily living in ways that will reduce biomechanical stress on the spine and its supporting structures. Elders with back pain should be taught proper ways to sit, stand, lift, carry, and perform other activities of daily living in ways that will reduce biomechanical stress on the

Geriatric Nursing March/April 1992 115

spine and its supporting structures. Good posture with all activities is important. Patients should be taught to lift by bending at the knees, keeping the back straight. Positioning one foot ahead of the other and keeping arms close to the body will aid in maintaining balance while lifting. Although prolonged periods of standing should be avoided, resting one foot on a stool during these periods reduces the amount of strain on the back. Propping oneself up on pillows or slouching in a chair exerts more compressive force on the spine than lying supine, sitting erect, or standing and should be avoided. Elevation of the feet, with knees higher than hips, is recommended when sitting. Many elderly report that they are most comfortable in a recliner that simulates this position. When in bed, patients are generally most comfortable lying on their back or side with knees and hips flexed. A firm, supportive mattress is recommended. A bed board ('/2 to 3,4 inch thick) placed between the mattress and box springs can provide needed firmness and support. When getting out of bed, the patient should be taught to first turn onto the side and then use the upper extremities to push up into a sitting position. Finally, firm supportive chairs and car seats may prevent or reduce back pain.

PROFESSIONAL OPPORTUNITIES 1992 RATES Rates Per Issue:

1 Time

Same Ad 3 Times

30 words or less Each additional word

$96.00 2.40

$81.00 2.00

Count all words, including abbreviations. Initials and numbers count as one word. "Box 000" counts as 2 words. Box Service--S7.00 first insertion only. Payment nmst accompany insertion order. Set within a ruled border: $55.00 additional per issue. Forms close 27th of month previous to month of issue. Send your ad to: GERIATRIC NURSING Journal Advertising D~partment

Mosby-Year Book, Inc. 11830 Westline Industrial Dr. St. Louis, MO 63146-3318

Conclusion Chronic back pain is a common complaint in the elderly. As with Mrs. Jackson and Mr. Graves, back pain may become long term and require multiple modalities for effective management. Nurses who are knowledgeable about the causes, pathophysiology, and treatment interventions for back pain can be instrumental in the successful m a n a g e m e n t of this problem, resulting in increased comfort, functional ability, and overall quality of life for those elders.

Only professional advertisements for Opportunities Available or Fellowships ~ill be accepted.

REFERENCES 1. Lavsky-Shulan M, Wallace RB, Kohout FJ, Lemee JH, Morris MC. Prevalence and functional correlates of low back pain in the elderly: the Iowa 65+ rural health study. J Am Geriatr Soc 1985;33:23. 2. Bergstrom G, Bjelle A, Sundh V, Svanborg A. Joint disorders at ages 70, 75 and 79 years: a cross-sectional comparison. Br J Rheumatol 1986;25:333-41. 3. Koch H, Smith MC. Office-based ambulatory care for patients 75 years old and over: national ambulatory medical care survey, 1980 and 1981. Adv Data NCHS 1985;101:1-14. 4. Ferrell BA, Ferrell BR. Pain in the nursing home. J Am Geriatr Soc 1990;38:409-14. 5. Svara CJ, Hadler NM. Back pain. Clin Geriatr Med 1988;4:2:395-410. 6. Gandy S, Payne R. Back pain in the elderly: updated diagnosis and management. Geriatrics 1986;41:59-72. 7. Wigley F. Osteoarthritis: practical management in older patients. Geriatrics 1984;39:101-20. 8. Scientific approach to the assessment and management of activity-related spinal disorders: a monograph for clinicians. Spine 1987;12:7S. 9. Swezey RL. Low back pain in the elderly: practical management concerns. Geriatrics 1988;43:39-44. 10. Burton C, Nida G, Ray C, Heithoff K. Treating low back pain in the elderly. Geriatrics 1978;33:61-9. I 1. McCaffery M, Beebe A. Pain: clinical manual for nursing practice. St Louis: CV Mosby, 1989. 12. McCarthy RE. Coping with low back pain through behavioral change. Orthop Nurs 1984;3:30-5. --i3. Piscopo J. Prescriptive exercise for older adults. J Phys Edue Recreation Dance 1985;56:65-9.

116 Geriatric Nursing March/April 1992

OPPORTUNITY AVAH,ABLE New York--Nursing Faculty: 10-month tenure track. NLN Accredited RN to BSN program & new MS in Gerontological Nursing Program. Responsibilities include teaching, advisement, committee work, curriculum development & ongoing research. Graduate program implementation is pending award of grant funds. Earned doctorate & MSN req'd, with specialization in gerontology at either level & prior graduate level teaching experience with a record of scholarly accomplishments. Salary & rank dependent on qualifications & experience. Rvw. begins 4/21/92. Send ltr., vitae, list of 3 prof'i, refs. with tele. nos. to NSG Search, Box 10, The College at New Paltz, NY 12561. AA/EOE. Women & minorities are urged to apply.

Back pain in the elderly.

Back Pain in the Elderly The authors identify causes of back pain in the elderly population and offer assessment guidelines and various management tec...
1MB Sizes 0 Downloads 0 Views