Date Published: April 15, 2019
Publisher: Public Library of Science
Author(s): Keitaro Makino, Sangyoon Lee, Seongryu Bae, Songee Jung, Yohei Shinkai, Ippei Chiba, Hiroyuki Shimada, Erin Bouldin.
This study examined the association between pain characteristics and the incidence of functional disability among community-dwelling older adults. This prospective cohort study included 4,365 older adults (mean age 74.7 years, 53.5% female) living in community settings. Pain characteristics, including severity and duration of pain, were assessed in participants who also underwent monthly follow-up assessment of functional disability for 24 months based on the national long-term care insurance system. Among the 4,365 participants, 2,149 (48.7%) reported pain, regardless of severity and duration. Of the 2,149 participants with pain, 950 (44.2%) reported moderate to severe pain and 1,680 (78.2%) reported chronic pain. Based on the univariate analyses, participants with moderate (hazard ratio [95% confidence interval]: 1.48 [1.05–2.09]) or severe (2.84 [1.89–4.27]) pain and chronic pain (1.50 [1.15–1.95]) showed significantly higher risk of disability incidence than did those without pain. After adjusting for covariates, severe pain remained a significant predictor (hazard ratio [95% confidence interval]: 1.66 [1.05–2.62]), but moderate (1.00 [0.69–1.47]) and chronic pain (1.04 [0.77–1.40]) did not. Our results established that moderate to severe pain or chronic pain affects functional disability; in particular, severe pain was independently associated with the incidence of disability. Subjective complaints of pain do not always correspond to physical causes; however, simplified questions regarding pain characteristics could be useful predictors of functional disability in community-dwelling older people.
As society is aging, increasing international attention is being paid to disability-free life expectancy in addition to longevity. A systematic analysis of the Global Burden of Disease Study 2015 reported that among 310 diseases and injuries worldwide, lower back and neck pains have the highest number of years lived with disability, calculated by multiplying the prevalence of a disorder by the short- or long-term loss of health associated with that disorder . Among community-dwelling older adults, the reported prevalence of any pain was over 50% [2,3,4,5]. It is known that older adults with daily pain are at higher risk of experiencing pain-related interference compared to younger adults . Pain in older adults is related to adverse health outcomes such as physical and psychological deficits [7,8], physical inactivity , falls , depression , and dementia . Therefore, pain may shorten the disability-free life expectancy of older people.
In this study, older adults with moderate to severe pain or chronic pain showed a significantly higher risk of functional disability. After adjusting for covariates, functional disability was associated only with severe pain but not with chronic pain.
Our findings indicate that moderate to severe pain or chronic pain affects functional disability; in particular, severe pain was independently associated with higher incidence of disability among community-dwelling older adults. Hence, pain management is important in the maintenance of independent living for community-dwelling older adults. Additionally, although subjective complaints of pain do not always correspond to physical causes, simplified questions on pain characteristics may be useful predictors of functional disability in community-dwelling older people.