Objective: Lower back pain has a lifetime prevalence of 80%. Epidemiological studies on back pain indicate that risk increases with age and that diet-related disease, along with back pain, is increasing in epidemic proportions. While aging adults have the highest diet quality when compared to other age groups, older adults still fail to adhere to the recommended daily caloric. The purpose of this study was to explore the relationship between nutritional risk and general musculoskeletal pain and specifically LBP.
Methods: 1000 people aged 65 or older were queried on health services utilization and pain and nutritional risk factors were analyzed. Patients were asked about the presence of back pain as well as completing the DETERMINE checklist which assesses nutritional risk factors and the Geriatric Depression Scale short form. Univariate and bivariate analysis were completed. We also completed ordinary least squares regression, treating nutritional risk as a continuous outcome and a second model using multivariate logistic regression in a model in which we treated nutritional risk categorically, according to the ranges prescribed in the instrument.
Results: An overall nutritional risk score for those with LBP was 4.3 compared to 2.9 among those without LBP. Those with LBP were also more likely to score higher on the Geriatric Depression Scale as well as to have cardiovascular disease. Patients with low back pain were statistically more likely to report having a poor appetite due to illness or condition, oral health problems making it difficult to eat (p<0.001), financial difficulty buying food, polypharmacy, and not always being physically able to shop, cook, or feed themselves. One-point increases in nutritional risk were associated with a 15% increase in the likelihood of LBP; in categorical analyses, moderate nutritional risk and high nutritional risk were associated with an increase in likelihood of LBP.
Conclusion: Poor nutrition risk scores were associated with an increase in prevalence of LBP. Those with back pain were more likely to report poor appetite, oral problems, polypharmacy, and issues with ability to purchase healthy food options. Practitioners should pay special attention to the dietary history and nutritional assessments of those with LBP in this age range, as well as socio-economic issues that could have effects on the ability to make healthy choices.
Author keywords: Nutrition; Back Pain; Geriatrics
Author affiliations: JAK: Medical College of Wisconsin Department of Neurosurgery, Milwaukee, Wisconsin, United States; MWE: University of Southern Mississippi College of Nursing and Health Professions, Hattiesburg, Mississippi, United Sates; B-KB: University of Southern Mississippi School of Health Professions Dr. Lynn Cook Hartwig Public Health Program, Hattiesburg, Mississippi, United States; RAL: Private Practice Chiropractor, Starkville, Mississippi, United States; REK: Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Alabama, United States; CJB: Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States; DB: Mississippi State University Department of Food Science, Nutrition, and Health Promotion, Starkville, Mississippi, United States
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