The Relationship of Pain and Cognitive Impairment with Social Vulnerability—An Analysis of the Canadian Study of Health and Aging


  • Disclosures: All the data reported here were gathered using public funding from the National Health Research Development Program, which administrated a grant from the Seniors' Independence Research program (6606-3954-MC[S]). Funding for these analyses came from a career development award from the National Institute on Aging K23AG029815 and from the Canadian Institutes of Health Research through an operating grant (MOP-62823). Additional support came from the Dalhousie Medical Research Foundation (career support to KR as Kathryn Allen Weldon Professor of Alzheimer Research) and the Fountain Innovation Fund of the QEII Research Foundation. Funding agencies had no role in the design and conduct of the study; data collection, management, analysis, and interpretation of the data; and preparation, review or approval of the manuscript.

Joseph W. Shega, MD, Section of Geriatrics and Palliative Medicine (MC 6098), 5841 S. Maryland Avenue, Chicago, IL 60637, USA. Tel: 773-834-7999; Fax: 773-702-3538; E-mail:


Objective.  The objective of this study was to delineate the relationship between noncancer pain and cognitive impairment with social vulnerability.

Design.  The study was designed as a cross-sectional analysis of the Canadian Study of Health and Aging, 1996 wave.

Setting.  Community-dwelling older adults in Canada.

Subjects.  3,776 study participants.

Outcome Measures.  Pain was categorized as no or very mild pain vs moderate or severe pain. Cognitive impairment was dichotomized from the Modified Mini-Mental State Examination (0–100) to no (>77) or impairment (77 or <). Social vulnerability (outcome) was operationalized as the accumulation of 39 possible self-report variables related to social circumstance, scores range from 0 to 1, where higher scores indicate greater vulnerability. Additional covariates included demographics, depressed mood, comorbidity, and functional impairment. Bivariate and multivariate relationships between pain and cognitive impairment with social vulnerability were assessed using t-tests and linear regression, respectively.

Results.  Of 5,703 respondents, 1,927 were missing a component of the social vulnerability index and of these nine were missing a pain response, leaving 3,767 (66.1%) of the original sample. A total of 2,435 (64.6%) reported no/mild pain and 3,435 (91.2%) were cognitively intact. The mean (standard deviation) social vulnerability index was 9.97 (3.62) with scores ranging from 1.12 to 26.85. Moderate or severe pain 0.44 (95% confidence interval [CI] 0.21, 0.66, P < 0.01) and cognitive impairment 0.49 (95% CI 0.13, 0.86, P < 0.01) were independently associated with social vulnerability, but the interaction term was not statistically significant, 0.40 (95% CI −0.32,1.14, P = 0.27).

Conclusion.  Pain and cognitive impairment are independently associated with social vulnerability. Improvements in pain management might mitigate social vulnerability in a growing number of older adults with either or both conditions.