الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Chronic low back pain is a serious health problem affecting more than 50% of community-dwelling older adults worldwide and its prevalence increases with advanced age. It has a significant effect on all aspects of the life of older adults and their families as well as the community and healthcare systems. CLBP affects the physical status of older adults causing activity limitation, loss of independence, and increased risk for fall among older adults. Moreover, it impairs their psych-social wellbeing and may results in depression.
This study aimed to determine the relationship between chronic low back Pain and risk of fall and depression among community dwelling older adults.
Research tools and method:
Design: The study followed a descriptive correlational research design.
Setting: The study was conducted in the outpatient clinic which affiliated to the Physical Medicine, Rheumatology and Rehabilitation Department; at the Main University Hospital, Alexandria.
Subjects: The study subjects comprised a convenience sample of 120 older adults attending the previously mentioned setting. The inclusion criteria were: older people aged 60 years and more, have CLBP (persisting for longer than 3 months) (27), free from back surgery or traumatic injuries and neurological disorders; such as stroke and Parkinson disease, able to communicate effectively, and accepted to participate in the study.
Tools of the study:
In order to collect the necessary data for the study, four tools were used.
Tool (I): ’’Socio-demographic characteristics and Clinical Data of the Older Adults with CLBP Structured Interview Schedule’’
This tool was developed by the researcher and includes four parts:
- Elders’ socio-demographic data such as age, sex, marital status, level of education, occupation before retirement.
- Health profile of the elders as diagnosed spinal disorders, general health problems, medications consumed, and history of previous prescribed physiotherapy sessions.
- Predisposing factors of CLBP as weight, height, BMI, smoking, caffeine consumption, practicing regular exercise, and daily exposure to sun.
- Assessment of CLBP including onset, site, radiation, type of pain, duration.
Tool II: ’’Colored Analogue Pain Assessment Scale (CAS)’’
It was developed by McGrath et al. (1996) (178) based on the old version of Visual Analogue Pain Assessment Scale (VAS) (1923) (179). It was used in this study to assess older adults’ CLBP severity. The total score of the CAS is 10 and classified as follow; 0 no pain, 1-3 mild pain, 4-6 moderate pain, and 7-10 severe pain.
Tool III: ’’Fall Risk Assessment Scale for Older People’’
This tool was developed by Cannard (1989) (181). This scale was used in this study to assess the risk factors for falls among older adults with CLBP. The total score of the scale is 19; low risk for fall ranged from 3-8, moderate risk ranged from 9-12, and severe risk ≥13.
Tool IV: ’’Beck Depression Inventory (BDI)’’
It was developed by Beck (1996) (182). It is a twenty one-question multiple-choice self-reported inventory. It was used in this study to assess the severity of depressive symptoms in older adults with CLBP. The total score of the scale is 63 and classified as follow:0-10 no depression, 11-16 mild depression, 17-20 borderline clinical depression, 21-30 moderate depression, 31-40 severe depression, and >40 extreme depression.
Method:
- An official letter was issued from the Faculty of Nursing Alexandria University and forwarded to the director of the Main University Hospital and the head of the Physical Medicine, Rheumatology and Rehabilitation Department to obtain their approval to collect the data.
- Tool I (Socio-demographic characteristics and Clinical Data of the Older Adults with CLBP Structured Interview Schedule) was developed by the researcher. The Arabic versions of tool II and tool III were used in this study.
- Tool IV (Beck Depression Inventory) was translated into Arabic language by the researcher and reviewed for content validity and was tested for reliability by using Cronbach’s coefficient alpha, r=0.93.
- A pilot study was carried out on 11 older adults who fulfilled the inclusion criteria and selected from the previously mentioned setting. Those elders were excluded from the study sample.
- The data collection covered a period of 4 months started from the beginning of November 2017 till the end of February 2018.
The main results obtained were as follow:
- The age of the study subjects ranged from 60 to 86 years with a mean of 71.98 ±6.65. More than one half (55.0%) of them were females. 42.5% were married, and 35.8% were widow. Illiteracy was prevailing among 40.0% of the study subjects. More than one fifth (29.2%) of them were housewives followed by 25.8% were employees and the same percent (25.8%) were workers while 85.8% had no current work.
- More than three quarters (75.8%) of the study subjects had no social activities as visiting relatives or friends and 55.8% of them didn’t practice any recreational activities. CLBP was the first cause of their inability to participate in these activities.
- Nearly all of the study subjects (99.2%) suffered from various spinal disorders which were the main cause of their CLBP with spinal osteoporosis was the most common one (42.0%) followed by spinal stenosis (29.4%), spinal osteoarthritis (25.2%), and lumbar disc prolapse (23.5%).
- Musculoskeletal disorders such as rheumatoid arthritis and osteoarthritis were the most prevalent (76.5%) among the study subjects followed by cardiovascular diseases (66.4%), diabetes mellitus (44.5%), renal disorders (39.5%), and gastrointestinal disorders (33.6%).
- Analgesics and anti-inflammatory drugs were consumed by 74.2% followed by cardiovascular drugs (65.8%), hypoglycemic agents (44.2%). renal drugs (39.2%), and GIT drugs (30.8%).
- Regarding history of physiotherapy, 58.8% of those who received previous physiotherapy sessions were non-compliant with the previously prescribed sessions and the main cause of non-compliance was the high cost of these sessions (46.7%).
- Concerning predisposing factors of CLBP, 61.7% of the study subjects had positive family history of spinal disorders. 53.3% were smokers and the majority (91.7%) used to drink caffeinated beverages. Moreover, 60.0% of them had overweight and 17.5% were obese. 61.7% didn’t practice exercise regularly and 76.7% didn’t expose to sun daily.
- The severity of CLBP fluctuated between severe in 49.2% to moderate in 45.8% of the study subjects. This pain characterized by continuous pattern among 60.0% of them and duration of more than thirty minutes each pain episode in 51.7%. Improper body alignment was the most common (80.8%) aggravating factor of pain, and analgesics were the first alleviating factor (72.5%).
- A statistically significant relationship was found between the degree of fall risk and the severity of depression with severity and duration of CLBP among the study subjects.
Based on the findings of this study, it can be concluded that:
CLBP has significant relationship with physical and psychological status of older adults. Older adults who are suffering from CLBP are at risk for fall and depression and this risk is positively correlated with pain severity.
Based on the findings of the present study, the following recommendations are suggested:
1. Developing and conducting an educational program for older adults with CLBP and their families related to pain self-management strategies which include pain management techniques such as exercises, relaxation techniques, and good body mechanics This is through producing educational materials in the form of printed booklets or colored brochures in order to help them to follow the principles of managing their pain and facilitate coping and adjustment with CLBP.
2. Providing health teaching for older adults with CLBP and their caregivers related to home environment modification in order to apply measures to overcome hazards and decrease their risk for falls.
3. Screening of balance, motor function, and fall risk of older adults with CLBP should be an integral part of the gerontological nurses’ regular assessment and evaluation, and should be incorporated in to the routine care of those patients. This will help to identify functional problems and intervene as early as possible.
Recommendations for future researches:
1. More studies are needed to determine the effect of nursing strategies on improving physical and psychological function among older adults with CLBP.