Age as a factor in admission to chronic pain rehabilitation

Objective: To examine access to multidisciplinary pain rehabilitation programs for older patients. Design: Telephone and written surveys of pain programs accredited by Commission on Accreditation of Rehabilitation Facilities. Visual Analog Scale (VAS) ratings of patient vignettes in which older patients were alternatively assigned their true age or a younger age. Participants: Health care professionals at pain programs. Main Outcome Measures: Telephone survey of admission policies and treatment services. VAS ratings of patient vignettes. Results: No program excludes older pain patients by age. However, 28% of programs had admitted only the youngest old (< 70 years). Age-related criteria, such as presence of concurrent medical diagnoses that are more likely to exclude older patients, are common. In addition, VAS ratings of patient vignettes indicated an age bias: the same patients were rated as 14.8% less likely to be admitted (p < .001) and 12.5% less likely to succeed if admitted (p < .001) when their true, older age was given than when a false younger age was provided. Conclusion: Pain program admission policies do not exclude older patients by age but frequently include age-related criteria that disproportionately exclude the elderly. There is also evidence of an age bias in which age per se reduces perceived suitability for pain program admission.