Pain is a significant contributor to disability among older adults and has a number of negative psychological outcomes including depression and anxiety. Pain is also a leading factor for opioid usage that has largely been understudied among older adults. Physiological changes for older adults can make pain management more challenging and the consequences of polypharmacy more concerning. Within UnitedHealth Group, the Research for Aging Population Team (RAP), in collaboration with the Healthcare Transformation Team (HCT), integrates research and interventions to provide services to insureds covered under AARP^® Medicare Supplement plans, insured by United Healthcare Insurance Company (for New York residents, UnitedHealthcare of New York). Building upon our current research agenda emphasizing the improvement of health and well-being for plan holders, the current symposium proposes to discuss areas of research and interventions that address chronic pain. First, a qualitative study uses content analysis to explore older adults’ experiences managing chronic pain. Second, a large survey study investigates the relationship between pain, social isolation, and quality of life. The third study examines high dosage opioid use and transition to care; and the final study included discusses interventions administered through a care coordination program with community health workers. Results of these studies indicate that chronic pain and its resulting health and economic implications will persist and likely grow as our population continues to age. Thus, a need exists for targeted interventions to reduce negative outcomes and to promote a holistic perspective of health.

Background: Chronic pain compromises quality of life for older adults and is associated with decreased social activity, impaired mobility, and depression. However, many older adults struggle to effectively manage pain and report their pain management regimens are only moderately effective.

Objective: The primary purpose of this study was to explore AARP Medicare Supplement insureds’ experiences with managing chronic pain.

Methods: Individuals with a diagnosis of chronic pain (n=19) participated in either focus groups or individual interviews. Participants described their experiences managing chronic pain, including its impact on daily life, attempted therapies, and sources for pain management advice. Interviews and focus groups were audio-recorded and transcribed. Data were imported into Nvivo, a qualitative data analysis program and analyzed using qualitative content analysis..

Results: Participants reported that chronic pain disrupted their routines. Barriers to effective pain management included financial constraints, limited insurance, and side effects of multiple medications. Participants who chose surgery reported cessation of pain; others relied on a combination of hot and/or cold compresses, avoidance of activity, over-the-counter (OTC) and/or prescription medications. However, pain persisted for many using these alternatives. Most participants had not used complementary or alternative therapies (CAM) but expressed interest if recommended. Participants received advice from the internet, family members, and clinicians and stressed the importance of screening sources for credibility.

Conclusions: Pain management for older adults should ideally consist of both pharmacologic and non-pharmacologic therapies. Clinicians should consider regimens that sufficiently address pain and facilitate ongoing physical activity and independence.

Background: Pain has a number of negative physical and psychological health outcomes for older adults and can adversely impact social relationships. However, little is understood about the prevalence and impact of self-reported pain among older adults with chronic pain and how social isolation might play a role.

Objectives: 1) investigate the prevalence of pain and psychosocial well-being among older adults with chronic pain, and 2) explore the relationship between well-being, social isolation, and pain levels.

Methods: Surveys were randomly mailed to 15,000 insureds covered under AARP^® Medicare Supplement plans with diagnosis codes of chronic pain and 4,423 individuals (30%) returned surveys.

Results: The majority of respondents were female (67%), higher income (51%), and >75 years old (53%). Pain was prevalent within this population with 32% reporting high levels and 51% reporting moderate levels of pain. Loneliness and social isolation was a serious concern for many: 24% reported high loneliness, 25% moderate loneliness, and 56% low social networks. Overall, as numbers of conditions and pain level increased, loneliness increased and social networks decreased. Regression analysis indicated that pain, loneliness, and social networks were associated with lower quality of life (p<.05).

Conclusions: Survey results demonstrated that many older adults with a pain diagnosis have high levels of pain and people with higher levels of pain tend to be lonelier and have smaller social networks. Consequently, social isolation may be a serious concern for those with pain. Further research will need to explore the impact of pain and social isolation and its outcomes.

Background: Older adults who initiate opioid use and transition to chronic use, including those taking high doses, are at increased risk for adverse events.

Objectives: Our objective was to determine the prevalence and characteristics of older adults who initiated opioids and transitioned to chronic use >90 days and/or who were high dose users.

Methods: Study populations were identified from insureds covered under AARP^® Medicare Supplement plans with at least one year of continuous medical and AARP^® MedicareRx Drug Part D plan enrollment. Opioid-naïve adults had a minimum of one opioid-free year prior to initiation and one year of follow-up. High dose opioid users must have filled at least 2 prescriptions for ≥15 days with dosages >120 milligram morphine equivalents (MMEs) per day.

Results: Among eligible older adults, 6% of those who initiated opioids transitioned to chronic use and about 3% were identified as high dose users. Those who transitioned to chronic use were older women, in poorer physical and mental health with back pain, and taking other pain-related and sleep medications. Chronic use was associated with back pain but not trauma or knee replacement surgeries. High dose users were younger males, in poorer physical and mental health with back pain and sleep problems, and using 4 or more pharmacies.

Conclusions: Chronic users and high dose users were characterized as complex patients, with poorer physical and mental health and sleep issues. Thus, multifactorial interventions to promote more effective pain management may need to include aspects of mental health and sleep management.

Background: Incorporating community health workers (CHW) as part of healthcare delivery is associated with positive patient outcomes including improvements in chronic diseases, quality of care and lower healthcare costs. However, limited research has examined the role of a CHW on helping older adults manage their chronic pain.

Objective: The purpose of this study was to evaluate the role that pain interventions administered by a CHW (as part of a care coordination program) had on the ability of older adults to manage their pain.

Methods: Data were collected from April 2016-December 2018. Participants were 196 individuals identified with significant issues with chronic pain and enrolled in a care coordination program offered by AARP^® Medicare Supplement plans insured by United Healthcare.

Results: Among this group, CHWs delivered 306 pain interventions and 428 referrals. Concerns related to pain included pain symptoms (72%), medical/dental care (16%) and medication side effects 4%). Interventions included continued ongoing surveillance (77%) and education (21%). Participants reported high levels of satisfaction with the CHW intervention on surveys post intervention. Participants endorsed that the program met their needs, helped them deal effectively with their pain, and they would use this program again.

Conclusion: CHWs can be effective in assisting older adults’ manage their chronic pain. Future research should evaluate the potential role of CHWs on additional health outcomes including cost and healthcare utilization.