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.
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    • "Although these findings have been observed in other community-based studies of older adults, the epidemiology of pain in older adults is not well established. For example, the overall prevalence of pain estimated in previous studies ranges considerably from 24% to 72% [2] [3] [5] [7] [13] [26] [27] [51] [63]. Further, the age pattern of pain is not well characterized, as some studies suggest an increased prevalence with advancing age while others report a flat or decreasing prevalence [28]. "
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    ABSTRACT: This study sought to determine the prevalence and impact of pain in a nationally representative sample of older adults in the United States. Data from the 2011 National Health and Aging Trends Study were analyzed. In-person interviews were conducted in 7601 adults ages ⩾65years. The response rate was 71.0% and all analyses were weighted to account for the sampling design. The overall prevalence of bothersome pain in the last month was 52.9%, afflicting 18.7 million older adults in the United States. Pain did not vary across age groups (P=0.21), and this pattern remained unchanged when accounting for cognitive performance, dementia, proxy responses, and residential care living status. Pain prevalence was higher in women and in older adults with obesity, musculoskeletal conditions, and depressive symptoms (P<0.001). The majority (74.9%) of older adults with pain endorsed multiple sites of pain. Several measures of physical capacity, including grip strength and lower-extremity physical performance, were associated with pain and multisite pain. For example, self-reported inability to walk 3 blocks was 72% higher in participants with than without pain (adjusted prevalence ratio 1.72 [95% confidence interval 1.56-1.90]). Participants with 1, 2, 3, and ⩾4 sites of pain had gait speeds that were 0.01, 0.03, 0.05, and 0.08 meters per second slower, respectively, than older adults without pain, adjusting for disease burden and other potential confounders (P<0.001). In summary, bothersome pain in the last month was reported by half of the older adult population of the United States in 2011 and was strongly associated with decreased physical function.
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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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