title: Ageism, negative attitudes, and competing co-morbidities--why older adults may not seek care for restricting back pain: a qualitative study.
abstract: BACKGROUND
  Back pain, the most common type of pain reported by older adults, is often undertreated for reasons that are poorly understood, especially in minority populations. The objective of this study was to understand older adults' beliefs and perspectives regarding care-seeking for restricting back pain (back pain that restricts activity).
  
  
  METHODS
  We used data from a diverse sample of 93 older adults (median age 83) who reported restricting back pain during the past 3 months. A semi-structured discussion guide was used in 23 individual interviews and 16 focus groups to prompt participants to share experiences, beliefs, and attitudes about managing restricting back pain. Transcripts were analyzed in an iterative process to develop thematic categories.
  
  
  RESULTS
  Three themes for why older adults may not seek care for restricting back pain were identified: (1) beliefs about the age-related inevitability of restricting back pain, (2) negative attitudes toward medication and/or surgery, and (3) perceived importance of restricting back pain relative to other comorbidities. No new themes emerged in the more diverse focus groups.
  
  
  CONCLUSIONS
  Illness perceptions (including pain-related beliefs), and interactions with providers may influence older adults' willingness to seek care for restricting back pain. These results highlight opportunities to improve the care for older adults with restricting back pain.
authors.affiliation: Department of Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9169, USA. una.makris@utsouthwestern.edu.|Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA. una.makris@utsouthwestern.edu.|Department of Veterans Affairs, Dallas, TX, USA. una.makris@utsouthwestern.edu.
authors.forename: Una E
authors.initials: UE
authors.lastname: Makris
authors.affiliation: Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA. robin.higashi@utsouthwestern.edu.
authors.forename: Robin T
authors.initials: RT
authors.lastname: Higashi
authors.affiliation: Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA. emily.marks@utsouthwestern.edu.
authors.forename: Emily G
authors.initials: EG
authors.lastname: Marks
authors.affiliation: Department of Medicine, Yale School of Medicine, New Haven, CT, USA. liana.fraenkel@yale.edu.|Department of Veterans Affairs, West Haven, CT, USA. liana.fraenkel@yale.edu.
authors.forename: Liana
authors.initials: L
authors.lastname: Fraenkel
authors.affiliation: Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. SaleJ@smh.ca.|Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada. SaleJ@smh.ca.
authors.forename: Joanna E M
authors.initials: JE
authors.lastname: Sale
authors.affiliation: Department of Medicine, Yale School of Medicine, New Haven, CT, USA. thomas.gill@yale.edu.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Gill
authors.affiliation: Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, NY, USA. mcr2004@med.cornell.edu.
authors.forename: M Carrington
authors.initials: MC
authors.lastname: Reid
mesh_terms: D000369:Aged, 80 and over; D063506:Ageism / Q000706:statistics & numerical data*; D001290:Attitude; D001416:Back Pain / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D005260:Female; D017144:Focus Groups; D006801:Humans; D015994:Incidence; D008297:Male; D059408:Pain Management; D010349:Patient Compliance / Q000706:statistics & numerical data*; D036301:Qualitative Research; D012919:Social Behavior