(B-155) Disparities in Nonpharmacologic Chronic Pain Treatments for Older Adults with Alzheimer’s disease and Related Dementias

Background: Chronic pain is a leading disability among older adults with Alzheimer’s disease and related dementias (ADRD). Pain management with common analgesics and opioids increase the risk of polypharmacy and falls. Nonpharmacologic treatments are therefore recommended as safer therapies for chronic pain; however, their utilization among older adults with ADRD is not known.

Objectives: To compare the one-year incidence of nonpharmacologic treatment by ADRD status after a new chronic pain diagnosis

Methods: We conducted a retrospective cohort study using Medicare fee-for-service claims from January 2017 through December 2021. Eligible participants were community-dwelling adults aged 66 years or older with newly diagnosed chronic non-cancer back pain. We defined new chronic back pain as two or more claims for radicular and nonradicular back pain, occurring 90 to 183 days apart, with no back pain claims six months prior. Individuals could have multiple new chronic pain diagnoses. We excluded those with nonpharmacologic treatment six months prior to the chronic pain diagnosis. Among 2,245,250 new chronic pain diagnoses, 333,125 were eligible for analysis. We used the one-year Bynum Standard algorithm to classify ADRD at the back pain diagnosis and used current procedural terminology codes to measure the following nonpharmacologic treatments: physical therapy (PT), chiropractic care, and acupuncture. Follow-up was one year or until nonpharmacologic treatment receipt, death, or disenrollment from Medicare. We used Kaplan-Meier curves, weighted by inverse probability of censoring weights for loss to follow-up (8%), to measure nonpharmacologic treatment incidence by ADRD status.

Results: There were 333,125 new chronic pain diagnoses among 299,399 unique beneficiaries. Of these diagnoses, 30,297 (9.1%) involved ADRD. Compared to those without ADRD, more individuals with ADRD were female (71.6% vs. 66.6%), Hispanic (8.5% vs. 5.8%), and dually eligible for Medicaid (41.6% vs. 19.5%). The one-year incidence of nonpharmacologic treatment was 13.7% and 25.3% for those with and without ADRD, respectively (p < 0.001). Median time to treatment was 76 days (IQR: 9, 195 days) for those with ADRD and 65 days (IQR: 7, 188 days) for those without ADRD (p= 0.079). PT was the most common nonpharmacologic treatment (ADRD: 62.7%, no ADRD: 61.0%). Chiropractic care was more common among those without ADRD (19.8% vs. 14.5%), while acupuncture was higher in those with ADRD (22.8% vs. 19.2%, p< 0.001).

Conclusions: Nonpharmacologic treatments were less common for older adults with ADRD after a chronic pain diagnosis. These results suggest a gap in the provision of guideline-recommended pain treatments for a population vulnerable to polypharmacy and adverse drug events.