Pain, Functional Limitations, and Aging

Department of Medicine, University of California at San Francisco, 4150 Clement, San Francisco, CA 94121, USA.
Journal of the American Geriatrics Society (Impact Factor: 4.57). 09/2009; 57(9):1556-61. DOI: 10.1111/j.1532-5415.2009.02388.x
Source: PubMed


To examine the relationship between functional limitations and pain across a spectrum of age, ranging from mid life to advanced old age.
Cross-sectional study.
The 2004 Health and Retirement Study (HRS), a nationally representative study of community-living persons aged 50 and older.
Eighteen thousand five hundred thirty-one participants in the 2004 HRS.
Participants who reported that they were often troubled by pain that was moderate or severe most of the time were defined as having significant pain. For each of four functional domains, subjects were classified according to their degree of functional limitation: mobility (able to jog 1 mile, able to walk several blocks, able to walk one block, unable to walk one block), stair climbing (able to climb several flights, able to climb one flight, not able to climb a flight), upper extremity tasks (able to do 3, 2, 1, or 0), and activity of daily living (ADL) function (able to do without difficulty, had difficulty but able to do without help, need help).
Twenty-four percent of participants had significant pain. Across all four domains, participants with pain had much higher rates of functional limitations than subjects without pain. Participants with pain were similar in terms of their degree of functional limitation to participants 2 to 3 decades older. For example, for mobility, of subjects aged 50 to 59 without pain, 37% were able to jog 1 mile, 91% were able to walk several blocks, and 96% were able to walk one block without difficulty. In contrast, of subjects aged 50 to 59 with pain, 9% were able to jog 1 mile, 50% were able to walk several blocks, and 69% were able to walk one block without difficulty. Subjects aged 50 to 59 with pain were similar in terms of mobility limitations to subjects aged 80 to 89 without pain, of whom 4% were able to jog 1 mile, 55% were able to walk several blocks, and 72% were able to walk one block without difficulty. After adjustment for demographic characteristics, socioeconomic status, comorbid conditions, depression, obesity, and health habits, across all four measures, participants with significant pain were at much higher risk for having functional limitations (adjusted odds ratio (AOR)=2.85, 95% confidence interval (CI)=2.20-3.69, for mobility; AOR=2.84, 95% CI=2.48-3.26, for stair climbing; AOR=3.96, 95% CI=3.43-4.58, for upper extremity tasks; and AOR=4.33; 95% CI=3.71-5.06, for ADL function).
Subjects with pain develop the functional limitations classically associated with aging at much earlier ages.

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Available from: Edward H Yelin, Aug 10, 2015
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    • "More than 50% of older adults suffer from persistent (musculoskeletal) pain that is often disabling (Thomas et al., 2004; Pickering, 2005; Covinsky et al., 2009). Despite the urgency to better account for and manage older people's pain experiences, research on its psychosocial determinants is still on its infancy (Gibson and Weiner, 2005). "
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    ABSTRACT: Background: This study aimed to investigate the interplay between enduring and situational aging stereotype (AS) effects in older adults’ self-reports of clinical and experimentally-induced pain. We expected that, as compared to the situational activation of positive AS or a neutral condition, the activation of negative AS would lead to more severe self-reports of clinical pain (H1), higher CPT pain threshold (H2) and lower CPT pain tolerance (H3), especially among older adults who more strongly endorsed AS. Methods: This is a prospective study across two moments in time. In Time 1, 52 older adults (Mage=74.7; 51.9% women) filled out measures of cultural AS endorsement, clinical pain severity and interference. Three months afterwards (Time 2), some of these participants collaborated in an experimental study on the effects of AS activation on reported clinical pain (n=40) and experimentally-induced (by a Cold Pressor Task) pain threshold and tolerance (n=35). Results: Our results supported H2, i.e., as compared to the activation of positive AS or a neutral condition, when negative AS were activated older adults showed higher CPT pain thresholds, but this effect was more salient among those who more strongly endorsed AS at T1. Conclusions: This study stresses the influence of cultural AS in older adults’ pain experiences showing that the situational activation of negative aging stereotypes greatly increases experimentally-induced pain thresholds of elder’s who more strongly endorse those stereotypes. It also highlights the relevance of interventions at the level of the physical and/or social environments surrounding elders in pain.
    European journal of pain (London, England) 12/2014; in press(7). DOI:10.1002/ejp.626 · 2.93 Impact Factor
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    • "Weaver et al. (2009) already found a positive association between frailty and pain. Due to close associations between pain and physical components of functional limitation (Covinsky et al., 2009), and between this functional limitation and frailty, further research is needed to determine whether the pain–frailty relationship is mediated by physical function. The fact that frail individuals reported good health less frequently has already been shown by others (Fried et al., 2001; Kiely et al., 2009). "
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    ABSTRACT: The purpose of this study was to design and validate a self-reported assessment tool for the identification of frailty. A thousand community-dwelling older adults (≥60 years), users of the medical insurance of the French national education system, received (Year 1) a postal questionnaire requesting information about health and socio-demographic characteristics. Among those who responded to the questionnaire (n=535), 398 individuals were classified as frail, pre-frail, or robust. One year later (Year 2), the same questionnaire was sent to this group and n=309 were returned. Frailty was operationalized using four criteria: low body mass index (BMI), low level of physical activity, and dissatisfaction with both muscle strength and endurance. Frailty constituted a single entity, different from physical limitation and co-morbidity. Compared with robust individuals, frail persons were older, had more chronic diseases, higher levels of disability and physical function decline. Pre-frail individuals had an intermediate distribution. Those people classified as either frail or pre-frail had higher frequency of hospitalization, and a higher probability of co-morbidity than robust. Frailty was also associated with higher mortality. Our screening tool for frailty was able to evidence important characteristics of this syndrome, i.e., it is a single entity with grades of severity which are associated with health problems. Detecting and categorizing frailty may lead to early therapeutic interventions to combat this condition.
    Archives of gerontology and geriatrics 09/2011; 54(3):e249-54. DOI:10.1016/j.archger.2011.08.003 · 1.85 Impact Factor
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    • "Functional decline usually occurs due to chronic diseases and is deeply connected with old age as a part of the aging phenotype (Covinsky et al., 2009). Although the prevalence of limited functional significantly increases with age (Nunez et al., 2006) should be considered in addition to the extent of the impact of demographic, health, behavioral and economic aspects on the development of impairments (Hardy and Gill, 2004; Covinsky et al., 2009). This research also identified an association between physical aspects with age and joint symptoms. "
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    ABSTRACT: Musculoskeletal disorders are the major causes of the pain in the elderly population. Rheumatic conditions restrict participation in activities and mobility, as well as cause difficulties in the execution of self-care tasks. The assessment of health related quality of life (HRQOL) is an important indicator of the impact of rheumatic diseases on the physical, mental and social aspects. This study aims to analyze the influence of rheumatic diseases and chronic joint symptoms on the quality of life of the elderly (n=2209) aged 60 years or over. The effects of rheumatism and joint symptoms on quality of life were investigated by the Outcome Study Short-Form Health Survey (SF-36), and this analysis was adjusted for age and sex. The univariate analysis of variance and analysis of covariance (ANOVA and ANCOVAS) were used for statistical procedures, p≤0.05. Rheumatic diseases affected: functional capacity (F(1, 2012))=10.9 and pain (F(1, 2012))=34.77. Joint symptoms affected all components of the SF-36: physical functioning (F(1, 2012))=10.9; physical problems (F(1, 2012))=72.61; pain (F(1, 2012))=164.29; general health (F(1, 2012))=71.95; vitality (F(1, 2012))=55.78; social aspect (F(1, 2012))=73.14; emotional aspect (F(1, 2012))=49.09 and mental health (F(1, 2012))=44.72. There was a significant impact of rheumatic diseases on physical health, and that joint symptoms affected self-evaluations of physical and mental health. These results will contribute to a better understanding of this systemic disease and will be used for planning effective interventions.
    Archives of gerontology and geriatrics 08/2011; 54(2):e77-82. DOI:10.1016/j.archger.2011.06.038 · 1.85 Impact Factor
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