Pain Characteristics Associated with the Onset of Disability in Older Adults: The Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly Boston Study
Version of Record online: 13 MAY 2014
© 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society
Journal of the American Geriatrics Society
Volume 62, Issue 6, pages 1007–1016, June 2014
How to Cite
J Am Geriatr Soc 62:1007–1016, 2014.
- Issue online: 12 JUN 2014
- Version of Record online: 13 MAY 2014
- National Institute on Aging. Grant Numbers: P01AG004390, R01AG041525–01
- Pfizer Inc.
- Eunice Kennedy Shriver National Institute of Child Health and Human Development. Grant Number: 1K24HD070966–01
- widespread chronic pain;
- older adults;
- mobility limitation;
- activities of daily living
To determine the effects of chronic pain on the development of disability and decline in physical performance over time in older adults.
Longitudinal cohort study with 18 months of follow-up.
Urban and suburban communities.
Community-dwelling older adults aged 65 and older (N = 634).
Chronic pain assessment consisted of musculoskeletal pain locations and pain severity and pain interference according to the subscales of the Brief Pain Inventory. Disability was self-reported as any difficulty in mobility and basic and instrumental activities of daily living (ADLs, IADLs). Mobility performance was measured using the Short Physical Performance Battery (SPPB). Relationships between baseline pain and incident disability in 18 months were determined using risk ratios (RRs) from multivariable Poisson regression models.
Almost 65% of participants reported chronic musculoskeletal pain at baseline. New onset of mobility difficulty at 18 months was strongly associated with baseline pain distribution: 7% (no sites), 18% (1 site), 24% (multisite), and 39% (widespread pain, P-value for trend < .001). Similar graded effects were found for other disability measures. Elderly adults with multisite or widespread pain had at a risk of onset of mobility difficulty at least three times as great as that of their peers without pain after adjusting for disability risk factors (multisite pain: risk ratio (RR) = 2.95, 95% confidence interval (CI) 1.58–5.50; widespread pain: RR = 3.57, 95% CI = 1.71–7.48). Widespread pain contributed to decline in mobility performance (1-point decline in SPPB, RR = 1.47, 95% CI = 1.08–2.01). Similar associations were found for baseline pain interference predicting subsequent mobility decline and ADL and IADL disability. Weaker and less-consistent associations were observed with pain severity.
Older community-dwelling adults living with chronic pain in multiple musculoskeletal locations have a substantially greater risk for developing disability over time and for clinically meaningful decline in mobility performance than those without pain.