Barriers to Care Among Elderly Patients Diagnosed With Degenerative Conditions of the Lumbar Spine

STUDY DESIGN: Cross-sectional survey. OBJECTIVES: This study aimed to assess how advanced age (≥65 y) influences perceived barriers to care and surgical utilization among adults with degenerative lumbar spinal conditions (DLSCs), along with any accompanying racial and ethnic disparities within the elderly populations. SUMMARY OF BACKGROUND DATA: While social determinants of health such as age have been previously identified as predictors of surgical utilization in patients with DLSCs, investigation of specific barriers to care among geriatric patients remains limited. METHODS: Using the All of Us Research Program database, we conducted a cross-sectional analysis of adults diagnosed with DLSC who completed the Health Care Access & Utilization survey. Barriers to care were analyzed using a demographic-adjusted binomial logistic regression model. Subgroup analyses evaluated racial disparities specifically among elderly patients, stratified by age: 18-64 (nonelderly), 65-72, 73-79, and 80+ years. RESULTS: Among 28,683 DLSC patients, 15,286 (53.3%) were elderly. Surgical utilization increased with age (3.8% in <65 vs. 6.5% in 80+, P<0.001). Older age was associated with a stepwise reduction in barriers, including provider background concerns (AORs: 0.43 in 65-72, 0.30 in 73-79, and 0.25 in 80+) and co-pay costs (AORs: 0.44, 0.18, and 0.11, all P<0.001). Among elderly patients, transportation delays (AOR 1.76 in 65-72, P=0.015) and challenges acquiring time off work (AOR 2.25 in 73-79, P=0.049) were associated with increased odds of surgery. CONCLUSIONS: Although elderly patients generally report fewer barriers to care and higher surgical utilization rates than younger patients, disparities persist within the elderly population. These findings suggest that age-specific interventions addressing barriers to care should consider the intersectionality of age and race/ethnicity to effectively improve access to care for elderly DLSC patients.