P69. Older people living with degenerative spine disease and undergoing spine surgery: just trying to get back to a normal life

Abstract

<h3>BACKGROUND CONTEXT</h3> Lumbar degenerative spine disease is a consequence of aging. Globally, 266 million people are diagnosed with this debilitating condition annually. As the population ages, the number of spinal surgeries to address the symptoms of this condition will increase. However little information is available about the experiences of older people living with degenerative spine disease and who undergo spine surgery. <h3>PURPOSE</h3> The purpose of this study was to investigate older peoples' understandings of living with and having surgery for degenerative spine disease and the process they engage in to try to get back to their normal life. <h3>STUDY DESIGN/SETTING</h3> A qualitative approach, grounded theory (GT), in a Midwestern quaternary care hospital. <h3>PATIENT SAMPLE</h3> Participants were = 65yrs of age, hospitalized following spine surgery for degenerative spine disease. <h3>OUTCOME MEASURES</h3> Interviews lasted from 30-60 minutes. Early interviews were open and non-directional, to obtain the meanings that participants assigned to having spine surgery for degenerative spine conditions. As analysis progressed, interviews became more focused to add category depth. <h3>METHODS</h3> A total of 28 interviews with 14 individuals who were recruited for 2 in-depth interviews at 2-time points: T1 during hospitalization and T2, 1-3 months post discharge. All 14 participants were interviewed at T1; 10 at T2-one month; 2 at T2- two months and 2 at T2-3 months postdischarge (N=28 interviews). Interviews lasted 30-60 minutes. All interviews were audio recorded and transcribed verbatim. Consistent with GT, purposive and theoretical sampling was used. Data analysis included open, axial, and selective coding and was conducted by an interdisciplinary team. <h3>RESULTS</h3> Based on analysis of the data, a conceptual model was developed which illustrates the phases older persons with degenerative spine disease go through in their trajectory of trying to get back to their normal life. Three key categories identified were (1) losing me (2) fixing me and (3) recovering me. Multiple dimensions within each category were identified. All participants described a prolonged process of losing who they were in terms of functional independence and being able to socialize. Fixing me consisted of having to prove the need for surgery and preparing for surgery. Recovering me involved constant monitoring for success and progress with rehabilitation. For most, recovering me was ongoing- none identified they had returned to their normal. Several conditions, including setbacks and delays, slowed participants recovery trajectory. Throughout this process, participants had to continually adjust their expectations of what was returning to normal. Additionally, participants described complications as ongoing symptoms of their degenerative spine disease after surgery, and a long, protracted course in trying to get back to normal life. <h3>CONCLUSIONS</h3> The conceptual model, based on real-world patient experiences, details how older people engage in living with and undergoing surgery for degenerative spine disease. Our model can serve as the foundation for developing interventions to guide patient education programs for preparing for surgery, improve transitions of care and develop patient-centered approaches for treating and managing older people with degenerative spine disease and spine surgery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.