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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

Authors

  • Laura H. P. Eggermont PhD,

    Corresponding author
    1. Department of Clinical Neuropsychology, VU University, Amsterdam, the Netherlands
    • Address correspondence to Laura H. P. Eggermont, Department of Clinical Neuropsychology, VU University, Van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands. E-mail: lhp.eggermont@vu.nl

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  • Suzanne G. Leveille PhD, RN,

    1. College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
    2. Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
    3. Department of Medicine, Harvard Medical School, Boston, Massachusetts
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  • Ling Shi PhD,

    1. College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
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  • Dan K. Kiely MPH, MA,

    1. Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
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  • Robert H. Shmerling MD,

    1. Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
    2. Department of Medicine, Harvard Medical School, Boston, Massachusetts
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  • Rich N. Jones ScD,

    1. Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
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  • Jack M. Guralnik MD, PhD,

    1. Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
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  • Jonathan F. Bean MD, MS, MPH

    1. Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
    2. Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts
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Abstract

Objectives

To determine the effects of chronic pain on the development of disability and decline in physical performance over time in older adults.

Design

Longitudinal cohort study with 18 months of follow-up.

Setting

Urban and suburban communities.

Participants

Community-dwelling older adults aged 65 and older (N = 634).

Measurements

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.

Results

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.

Conclusion

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.

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