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Cai Y, Liu F, Wanigatunga AA, Urbanek JK, Simonsick EM, Ferrucci L, Schrack JA. Musculoskeletal Pain Characteristics and Objectively Measured Physical Activity in Older Adults. J Gerontol A Biol Sci Med Sci 2024; 79:glae039. [PMID: 38310640 PMCID: PMC10960625 DOI: 10.1093/gerona/glae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Pain is associated with reports of restricted physical activity (PA), yet the association between musculoskeletal pain characteristics and objectively measured PA quantities and patterns in late life is not well understood. METHODS A total of 553 adults (mean age 75.8 ± 8.4 years, 54.4% women) in the Baltimore Longitudinal Study of Aging (BLSA) completed a health interview and subsequent 7-day wrist-worn ActiGraph assessment in the free-living environment between 2015 and 2020. Pain characteristics, including pain presence in 6x sites (ie, shoulders, hands/wrists, low back, hip, knees, and feet), pain laterality in each site, and pain distribution were assessed. PA metrics were summarized into total daily activity counts (TAC), activity fragmentation, active minutes/day, and diurnal patterns of activity. Linear regression models and mixed-effects models examined the association between pain characteristics and PA outcomes, adjusted for demographics and comorbidities. RESULTS Unilateral knee pain was associated with 184 070 fewer TAC (p = .039) and 36.2 fewer active minutes/day (p = .032) compared to those without knee pain. Older adults with shoulder pain or hand/wrist pain had more active minutes compared to those without pain (p < .05 for all). For diurnal patterns of activity, participants with knee pain had fewer activity counts during the afternoon (12:00 pm to 5:59 pm). Analyses stratified by sex showed that these associations were only significant among women. CONCLUSIONS Our study highlights the importance of assessing pain laterality in addition to pain presence and suggests that pain interferes with multiple aspects of daily activity. Longitudinal studies are needed to assess the temporality of these findings.
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Affiliation(s)
- Yurun Cai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Fangyu Liu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Amal A Wanigatunga
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center on Aging and Health, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jacek K Urbanek
- Center on Aging and Health, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Eleanor M Simonsick
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
| | - Luigi Ferrucci
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
| | - Jennifer A Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center on Aging and Health, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Maihöfner C, de Haas A, Sethi V, Shanga G, Wilcox TK, Csoke E, Fabrikant K. Patients' experience and utilization patterns of diclofenac gel in Germany: a real-world study with a prospective longitudinal survey and a retrospective analysis of pharmacy data. Curr Med Res Opin 2023; 39:1649-1661. [PMID: 37545357 DOI: 10.1080/03007995.2023.2243804] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/25/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Describe and characterize treatment patterns, satisfaction, improvement in pain and functional impairment (health-related quality of life [HRQoL]) in users of over the counter (OTC) Voltaren gel diclofenac (VGD) 2.32% and 1.16% in a real-world setting. METHODS This observational real-world German study had prospective and retrospective components. The prospective data were collected from electronic surveys completed by adults who purchased VGD to treat their musculoskeletal pain at baseline and 4 and 12 weeks after baseline. Retrospective data were from a 12-month (March 2019 to February 2020) abstraction from dispensing software platforms used in select German pharmacies. RESULTS Surveys from 467 participants (mean age 60.8 years) were analyzed. Average pain severity at baseline was 6.0 on an 11-point Numeric Rating Scale (0 = no pain, 10 = worst possible pain), improving by 0.8 and 1.2 points at Weeks 4 and 12, respectively. Performance of functional activities (daily/physical/social activities and errands/chores) improved and the proportion of participants with at least moderate interference decreased at both follow-up timepoints. Retrospective analyses indicated that majority of patients receiving VGD (n = 95,085) were ≥65 years old (67.9%), had one dispensed tube (70.8%) and did not switch to another topical treatment (including other NSAIDs) (77.3%), and were co-prescribed at least one cardiovascular medication (74.3%). CONCLUSIONS This study provides the first real-world insights into OTC VGD use in Germany. The participants using VGD reported a decrease in pain severity and an improvement of HRQoL while under treatment, as well as resulting satisfaction with treatment. Patients infrequently switched to alternate topical therapies/NSAIDs.
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Affiliation(s)
- Christian Maihöfner
- Department of Neurology, General Fürth Hospital, University of Erlangen, Germany
| | - Anke de Haas
- Medical Affairs, Haleon (Formerly GSK Consumer Healthcare), Munich, Germany
| | - Vidhu Sethi
- Medical Affairs, Haleon, Singapore, Singapore
| | | | - Teresa K Wilcox
- Epidemiology and Scientific Affairs, Formerly of PPD, Part of Thermo Fisher Scientific, Bethesda, Maryland, USA
| | - Emese Csoke
- Medical Affairs, Formerly of GSK Consumer Healthcare, Basel, Switzerland
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Muhammad T, Rashid M, Zanwar PP. Examining the Association of Pain and Pain Frequency With Self-Reported Difficulty in Activities of Daily Living and Instrumental Activities of Daily Living Among Community-Dwelling Older Adults: Findings From the Longitudinal Aging Study in India. J Gerontol B Psychol Sci Soc Sci 2023; 78:1545-1554. [PMID: 37279596 PMCID: PMC10461529 DOI: 10.1093/geronb/gbad085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVES We examined the prevalence and associations of self-reported difficulty in activities of daily living (ADL) and instrumental activities of daily living (IADL) with pain among community-dwelling older adults in India. We also explored the interaction effects of age and sex in these associations. METHODS We used the Longitudinal Ageing Study in India (LASI) Wave 1 data (2017-2018). Our unweighted sample included 31,464 older adults aged 60 years and above. Outcome measures were having difficulty in at least 1 ADL/IADL. We conducted multivariable logistic regression analyses to examine the association of pain with functional difficulties controlling for selected variables. RESULTS A total of 23.8% of older adults reported ADL and 48.4% reported IADL difficulty. Among older adults who reported pain, 33.1% reported difficulty in ADL and 57.1% reported difficulty in IADL. The adjusted odds ratio (aOR) for ADL was 1.83 (confidence interval [CI]: 1.70-1.96) and for IADL was 1.43 (CI: 1.35-1.51) when respondents reported pain compared with those without pain. Older adults who reported frequent pain had 2.28 and 1.67 times higher odds of ADL (aOR: 2.28; CI: 2.07-2.50) and IADL difficulty (aOR: 1.67; CI: 1.53-1.82) compared with those with no pain. Additionally, age and sex of the respondents significantly moderated the associations of pain and difficulty in ADL and IADL. DISCUSSION Given the higher prevalence and likelihood of functional difficulties among older Indian adults who experienced frequent pain, interventions to mitigate pain in this vulnerable population are needed to ensure active and healthy aging.
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Affiliation(s)
- Thalil Muhammad
- Department of Family & Generations, International Institute of Population Sciences, Mumbai, Maharashtra, India
| | - Muhammed Rashid
- Department of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia
- Department of Physiotherapy, JSS College of Physiotherapy, Mysuru, Karnataka, India
| | - Preeti Pushpalata Zanwar
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Hopkins Economics of Alzheimer's Disease & Services Center, John Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Cosarderelioglu C, Nidadavolu LS, George CJ, Marx-Rattner R, Powell L, Xue QL, Tian J, Oh ES, Ferrucci L, Dincer P, Bennett DA, Walston JD, Abadir PM. Angiotensin receptor blocker use is associated with upregulation of the memory-protective angiotensin type 4 receptor (AT 4R) in the postmortem brains of individuals without cognitive impairment. GeroScience 2023; 45:371-384. [PMID: 35969296 PMCID: PMC9886717 DOI: 10.1007/s11357-022-00639-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 08/04/2022] [Indexed: 02/03/2023] Open
Abstract
The reported primary dementia-protective benefits of angiotensin II type 1 receptor (AT1R) blockers (ARB) are believed, at least in part, to arise from systemic effects on blood pressure. However, there is a specific and independently regulated brain renin-angiotensin system (RAS). Brain RAS acts mainly through three receptor subtypes; AT1R, AT2R, and AT4R. The AT1R promotes inflammation and mitochondrial reactive oxygen species generation. AT2R increases nitric oxide. AT4R is essential for dopamine and acetylcholine release. It is unknown whether ARB use is associated with changes in the brain RAS. Here, we compared the impact of treatment with ARB on not cognitively impaired individuals and individuals with Alzheimer's dementia using postmortem frontal-cortex samples of age- and sex-matched participants (70-90 years old, n = 30 in each group). We show that ARB use is associated with higher brain AT4R, lower oxidative stress, and amyloid-β burden in NCI participants. In AD, ARB use was associated with lower brain AT1R but had no impact on inflammation, oxidative stress, or amyloid-β burden. Our results may suggest a potential role for AT4R in the salutary effects for ARB on the brains of not cognitively impaired older adults.
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Affiliation(s)
- Caglar Cosarderelioglu
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA
- Department of Internal Medicine, Division of Geriatrics, Ankara University School of Medicine, Ankara, Turkey
- Department of Medical Biology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Lolita S Nidadavolu
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA
| | - Claudene J George
- Department of Medicine, Division of Geriatrics, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Ruth Marx-Rattner
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA
| | - Laura Powell
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA
| | - Qian-Li Xue
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA
- Johns Hopkins University Center On Aging and Health, Baltimore, MD, USA
| | - Jing Tian
- Department of Biostatistics, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Esther S Oh
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA
| | - Luigi Ferrucci
- National Institute On Aging, National Institutes of Health, Baltimore, MD, USA
| | - Pervin Dincer
- Department of Medical Biology, Hacettepe University School of Medicine, Ankara, Turkey
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Jeremy D Walston
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA
| | - Peter M Abadir
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA.
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Yuan H, Ahmed WL, Liu M, Tu S, Zhou F, Wang S. Contribution of pain to subsequent cognitive decline or dementia: A systematic review and meta-analysis of cohort studies. Int J Nurs Stud 2023; 138:104409. [PMID: 36527860 DOI: 10.1016/j.ijnurstu.2022.104409] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/21/2022] [Accepted: 11/21/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dementia is an urgent public health problem worldwide, and the determination of the contribution of pain to cognitive decline or dementia is significant for the prevention of dementia. OBJECTIVE To comprehensively explore the contribution of pain to subsequent cognitive decline or dementia and analyze possible influencing factors. DESIGN Systematic review and meta-analysis of cohort studies. METHODS We systematically searched MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Library, China National Knowledge Internet, WANFANG DATA and VIP for cohort studies from database inception to January 21, 2022. Random-effects meta-analysis was used to pool odds ratios (ORs) and 95% confidence intervals (CIs) of incident cognitive decline or dementia among patients with pain. Subgroup analyses and meta-regression were used to explore the sources of heterogeneity. RESULTS A total of 35 cohort studies containing 1,122,503 participants were included. As a whole, pain (OR = 1.24; 95% CI = 1.17-1.31) was a risk factor for subsequent cognitive decline or dementia; headache, migraine, tension-type headache, widespread pain, and irritable bowel syndrome, but not burning mouth syndrome, were also risk factors. Pain increased the risk of all-cause dementia (OR = 1.26; 95% CI = 1.18-1.35), Alzheimer's disease (OR = 1.28; 95% CI = 1.12-1.47), and vascular dementia (OR = 1.31; 95% CI = 1.06-1.62). Pain interference (OR = 1.42; 95% CI = 1.16-1.74) was associated with an increased risk of cognitive decline or dementia, while pain intensity was not. Pooled results from studies with sample sizes less than 2000 or with relatively low quality showed that pain did not increase the risk of cognitive decline or dementia. There was no statistically significant increase in the risk of cognitive decline or dementia in people with pain aged ≥75 years. CONCLUSIONS Our results demonstrated that pain increased the risk of subsequent cognitive decline or dementia. Sample size, study methodological quality, types of pain, pain severity (pain interference), and age composition of the study population may affect the relationship between pain and cognitive decline or dementia. REGISTRATION PROSPERO (CRD42022316406).
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Affiliation(s)
- Hui Yuan
- School of Nursing, Xuzhou Medical University, Jiangsu, China.
| | | | - Mengdie Liu
- School of Nursing, Xuzhou Medical University, Jiangsu, China.
| | - Shumin Tu
- Anesthesia Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
| | - Fang Zhou
- School of Nursing, Xuzhou Medical University, Jiangsu, China.
| | - Shuo Wang
- School of Nursing, Xuzhou Medical University, Jiangsu, China.
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Jia Z, Gao Y, Zhao L, Han S. Effects of pain and depression on the relationship between household solid fuel use and disability among middle-aged and older adults. Sci Rep 2022; 12:21270. [PMID: 36481918 PMCID: PMC9732289 DOI: 10.1038/s41598-022-25825-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
Household air pollution (HAP) is suggested to increases people's risk of disability, but mediating mechanisms between HAP and disability remains under-investigated. The aim of this study was to investigate the underlying mechanisms between household air pollution and disability in middle-aged and older adults (i.e., older than 45 years) using a nationally representative prospective cohort. In total, 3754 middle-aged and older adults were selected from the China Health and Retirement Longitudinal Study. Correlation analysis and logistic regression analysis were employed to estimate the association between HAP, pain, depression and disability. Finally, three significant mediation pathways through which HAP directly impacts disability were found: (1) pain (B = 0.09, 95% CI 0.01, 0.02), accounting for 15.25% of the total effect; (2) depression (B = 0.07, 95% CI 0.004, 0.02), accounting for 11.86% of the total effect; (3) pain and depression (B = 0.04, 95% CI 0.003, 0.01), accounting for 6.78% of the total effect. The total mediating effect was 33.89%. This study clarified that HAP can indirectly affect disability through the respective and serial mediating roles of pain and depression. These findings potentially have important implications for national strategies concerning the widespread use of clean fuels by citizens.
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Affiliation(s)
- Zhihao Jia
- grid.27255.370000 0004 1761 1174School of Physical Education, Shandong University, Jinan, 250061 China
| | - Yan Gao
- grid.27255.370000 0004 1761 1174School of Physical Education, Shandong University, Jinan, 250061 China
| | - Liangyu Zhao
- grid.27255.370000 0004 1761 1174School of Physical Education, Shandong University, Jinan, 250061 China
| | - Suyue Han
- grid.27255.370000 0004 1761 1174School of Physical Education, Shandong University, Jinan, 250061 China
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Kato T, Nishimura A, Ohtsuki M, Wakasugi Y, Nagao-Nishiwaki R, Fukuda A, Kato K, Sudo A. Is musculoskeletal pain related to locomotive syndrome even in young and middle-aged adults? Mod Rheumatol 2022; 32:213-220. [PMID: 33769924 DOI: 10.1080/14397595.2021.1906512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Locomotive syndrome (LS) is the leading cause of persons needing long-term care in old age and is characterized by locomotive organ impairment including musculoskeletal pain. The aim was to examine the association between musculoskeletal pain and LS in young and middle-aged persons. METHODS A total of 836 participants (male 667, female 169; mean age 44.4 years) were examined in this cross-sectional study. The LS was evaluated by three screening tools: the two-step test, the stand-up test, and the 25-question Geriatric Locomotive Function Scale. Musculoskeletal pain, exercise habits, physical function (walkability and muscle strength), and physical activity were also assessed. RESULTS The LS was found in 22.8% of participants. The number with musculoskeletal pain was significantly higher in those with the LS. A significant correlation was found between the degree of musculoskeletal pain and exercise habits. Less regular exercise was significantly associated with higher LS prevalence. Physical activity and function were greater in participants with more regular exercise. CONCLUSION Musculoskeletal pain was significantly related to LS even in young and middle-aged persons. The present results suggest that control of musculoskeletal pain and improvement of exercise habits in young and middle-aged persons might help prevent the LS.
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Affiliation(s)
- Toshihiro Kato
- Department of Rehabilitation, Suzuka Kaisei Hospital, Suzuka, Japan
- Department of Orthopaedic and Sports Medicine, Mie University Graduate School of Medicine, Tsu City, Japan
| | - Akinobu Nishimura
- Department of Orthopaedic and Sports Medicine, Mie University Graduate School of Medicine, Tsu City, Japan
| | - Makoto Ohtsuki
- Faculty of Health Science, Department of Clinical Nutrition, Suzuka University of Medical Science, Suzuka, Japan
| | - Yusuke Wakasugi
- Faculty of Health Science, Department of Clinical Nutrition, Suzuka University of Medical Science, Suzuka, Japan
| | - Rie Nagao-Nishiwaki
- Faculty of Health Science, Department of Nursing, Suzuka University of Medical Science, Suzuka, Japan
| | - Aki Fukuda
- Department of Orthopaedic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan
| | - Ko Kato
- Department of Orthopaedic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu City, Japan
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Valdes-Hernandez PA, Montesino-Goicolea S, Hoyos L, Porges EC, Huo Z, Ebner NC, Woods AJ, Cohen R, Riley JL, Fillingim RB, Cruz-Almeida Y. Resting-state functional connectivity patterns are associated with worst pain duration in community-dwelling older adults. Pain Rep 2021; 6:e978. [PMID: 34901680 PMCID: PMC8660002 DOI: 10.1097/pr9.0000000000000978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/25/2021] [Accepted: 10/19/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION An individual's chronic pain history is associated with brain morphometric alterations; but little is known about the association between pain history and brain function. OBJECTIVES This cross-sectional study aimed at determining how worst musculoskeletal pain intensity (WPINT) moderated the association between worst musculoskeletal pain duration (WPDUR) and brain resting-state magnetic resonance imaging functional connectivity (RSFC) in community-dwelling older adults (60-94 years, 75% females, 97% right-handed). METHODS Resting-state magnetic resonance imaging functional connectivity between region of interests was linearly regressed on WPDUR and WPINT. Predictions were compared with a control group's average RSFC (61-85 years, 47% females, 95% right-handed). RESULTS Three significant patterns emerged: (1) the positive association between WPDUR and RSFC between the medial prefrontal cortex, in the anterior salience network (SN), and bilateral lateral Brodmann area 6, in the visuospatial network (VSN), in participants with more severe chronic pain, resulting in abnormally lower RSFC for shorter WPDUR; (2) the negative association between WPDUR and RSFC between right VSN occipitotemporal cortex (lateral BA37 and visual V5) and bilateral VSN lateral Brodmann area 6, independently of WPINT, resulting in abnormally higher and lower RSFC for shorter and longer WPDUR, respectively; and (3) the positive association between WPDUR and the left hemisphere's salience network-default mode network connectivity (between the hippocampus and both dorsal insula and ventral or opercular BA44), independently of WPINT, resulting in abnormally higher RSFC for longer WPDUR. CONCLUSION Musculoskeletal effects on brain functional networks of general healthy individuals could accumulate until being observable at older ages. Results invite to examinations of these effects' impact on function and memory.
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Affiliation(s)
- Pedro A. Valdes-Hernandez
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Soamy Montesino-Goicolea
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Lorraine Hoyos
- University of Central Florida, Department of Clinical Sciences, Orlando, Florida, USA
| | - Eric C. Porges
- Center for Cognitive Aging and Memory, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Zhiguang Huo
- Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Natalie C. Ebner
- Center for Cognitive Aging and Memory, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Psychology, College of Liberal Arts and Sciences, University of Florida, Gainesville, Florida, USA
| | - Adam J. Woods
- Center for Cognitive Aging and Memory, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Ronald Cohen
- Center for Cognitive Aging and Memory, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Joseph L. Riley
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Roger B. Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Yenisel Cruz-Almeida
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, USA
- Center for Cognitive Aging and Memory, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, Florida, USA
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Li X, Zhu W, Li J, Huang C, Yang F. Prevalence and characteristics of chronic Pain in the Chinese community-dwelling elderly: a cross-sectional study. BMC Geriatr 2021; 21:534. [PMID: 34620105 PMCID: PMC8499479 DOI: 10.1186/s12877-021-02432-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 07/20/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Chronic pain adversely affects health and daily life in the elderly. Gaining insight into chronic pain that affects the community-dwelling elderly is crucial for pain management in China, which possesses the largest elderly population in the world. METHODS This is a cross-sectional design study that followed the STROBE Guideline. A randomized cluster sampling method was used to recruit participants in the Sichuan Province from Dec 2018 to May 2019. In addition, face-to-face interviews were conducted to collect socio-demographic data, characteristics and health-seeking behaviors of chronic pain through a self-designed questionnaire. RESULTS A total of 1381 older adults participated in this study. Among these participants, 791 (57.3%) had chronic pain. Here, prevalence and pain intensity were both found to increase from the 60-69 group to the 70-79 group, which then decreased in the ≥80 group with no significant differences in sex (p > 0.05). The most common pain locations were observed in the legs/feet (53.5%), head (23.6) and abdomen/pelvis (21.1%). Among the elderly suffering from chronic pain, 29.4% sought medical help, 59.2% received medication and 59.7% adopted non-drug therapy. CONCLUSION Chronic pain is a common health concern in the Chinese community-dwelling elderly, which possesses different characteristics than other countries' populations. Therefore, easier access to medication assistance and provision of scientific guidance for non-drug therapy may serve as satisfactory approaches in improving pain management.
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Affiliation(s)
- Xiahui Li
- West China School of Nursing, Sichuan University, Chengdu City, Sichuan Province, China.,West China Hospital, Sichuan University, Chengdu City, 610041, Sichuan Province, China.,School of Nursing, Chengdu University, Chengdu City, Sichuan Province, China
| | - Wei Zhu
- West China Hospital, Sichuan University, Chengdu City, 610041, Sichuan Province, China.
| | - Jiping Li
- West China Hospital, Sichuan University, Chengdu City, 610041, Sichuan Province, China.
| | - Chan Huang
- School of Nursing, Chengdu University, Chengdu City, Sichuan Province, China
| | - Fan Yang
- West China Second Hospital, Sichuan University, Chengdu City, Sichuan Province, China
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10
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Merchant RA, Goh J, Chan YH, Lim JY, Vellas B. Slow Gait, Subjective Cognitive Decline and Motoric Cognitive RISK Syndrome: Prevalence and Associated Factors in Community Dwelling Older Adults. J Nutr Health Aging 2021; 25:48-56. [PMID: 33367462 DOI: 10.1007/s12603-020-1525-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Motoric Cognitive Risk Syndrome (MCR), slow gait speed (SG) and subjective cognitive decline (SCD) are known to be harbingers of dementia. MCR is known to be associated with a 3-fold increased risk of future dementia, while SG can precede cognitive impairment. OBJECTIVE We aim to determine the prevalence and demographics of MCR, slow gait alone (SG-A) and subjective cognitive decline alone (SCD-A) in community-dwelling older adults and association with physical, functional, cognition and psychosocial factors. METHODS A total of 509 participants were classified into four groups according to presence of SG and/or SCD. Multinomial logistic regression was used to identify the factors associated with SG-A, SCD-A and MCR. RESULTS The prevalence of MCR was 13.6%, SG-A 13.0% and SCD-A 35.0%. Prevalence of MCR doubled every decade in females with 27.7% of female ≥ 80 years old had MCR. Almost 4 in 10 had no SG or SCD (SG+SCD negative). MCR and SG-A groups were significantly older, had higher body mass index (BMI), lower education, lower global cognition scores especially in non-memory domains, higher prevalence of low grip strength and lower short physical performance battery scores than those with SCD-A and SG+SCD negative. In addition, the SG-A group had significantly higher prevalence of multi-morbidity and diabetes. The prevalence of pain, depression, frailty, social isolation and activity of daily living impairment were significantly higher in MCR. The global cognitive and functional scores for those with SCD-A were comparable to the SG+SCD negative group. The Malay ethnic group had the lowest prevalence of SCD but highest prevalence of SG. After adjusting for confounding factors, age, BMI, frailty status, instrumental activity of daily living, depression and pain remained significantly associated with MCR. For SG-A, age, BMI, education and number of chronic diseases remained significant. CONCLUSION Both MCR and SG-A are associated with global cognitive decline especially in the non-memory domains and lower functional scores. Gait speed is a good predictor of negative outcomes and should be considered as the 'sixth' vital sign. Long term prospective studies are needed to evaluate: i) the conversion to dementia in different ethnic groups and ii) effect of targeted physical and / or dual task exercise on delaying the conversion to dementia and / or improvement in physical measures and reduction of disability.
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Affiliation(s)
- Reshma A Merchant
- Associate Professor Reshma Merchant, Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore 119228, , Telephone number: +65 6779 5555, ORCID iD: 0000-0002-9032-0184
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11
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Lee K, Lewis GN. Short term relief of multisite chronicpain with Bowen Therapy: A double-blind, randomized controlled trial. J Bodyw Mov Ther 2020; 24:271-279. [PMID: 33218522 DOI: 10.1016/j.jbmt.2020.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 02/27/2020] [Accepted: 06/07/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Bowen Therapy, a form of soft tissue manipulation, is commonly used to treat musculoskeletal conditions; yet, there is little evidence for its efficacy. The goal of the study was to investigate the impact of Bowen Therapy on pain and function in people with chronic pain in multiple locations. Additionally, we examined the mechanisms of effect through monitoring the nociceptive and autonomic nervous systems. METHOD The study was a double-blind, randomized controlled trial involving 31 people with chronic pain. Participants were randomized into real and sham therapy groups. Each group received 6 sessions of therapy over 8 weeks. The primary outcome measures of pain and function were assessed using standard questionnaires. Quantitative sensory testing was used to assess the nociceptive system, while recordings of heart rate variability and skin conductance were used to assess the autonomic nervous system. Outcome measures were assessed at baseline and at 1- and 6-weeks following completion of the intervention. RESULTS The real therapy group had a significantly lower pain score 1-week following the intervention compared to the sham group. There were no differences between groups at the final follow-up or in the function measures. There was no significant change in the nociceptive measures but there was evidence of increased activation of the sympathetic nervous system. DISCUSSION Bowen Therapy gave rise to a short-term reduction in pain that was not evident in a sham therapy group. The mechanisms of action of Bowen Therapy remain uncertain but may involve sympathoexcitation.
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Affiliation(s)
- Kiho Lee
- Otago Bowen Therapy, Dunedin, New Zealand
| | - Gwyn N Lewis
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand.
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12
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Ross RD, Shah RC, Leurgans SE, Buchman AS, Bennett DA. Association of Heel Bone Mineral Density With Incident Disability and Mortality in Community-Dwelling Older Adults. JBMR Plus 2020; 4:e10390. [PMID: 32995693 PMCID: PMC7507511 DOI: 10.1002/jbm4.10390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/25/2020] [Accepted: 06/30/2020] [Indexed: 11/25/2022] Open
Abstract
Age‐related bone loss is common in older adults. However, the association of low bone mass with incident disability and mortality is not well established. A sample of 738 participants in the Rush Memory and Aging Project (MAP) was evaluated at baseline for bone mineral density (BMD) using quantitative ultrasound at the calcaneus. An annual interview assessed basic activities of daily living (BADL), instrumental activities of daily living (IADL), mobility disability, and history of hip fracture. The associations between baseline BMD and risk of death; incident BADL, IADL, and mobility disability; and hip fracture were investigated using Cox hazard models, adjusting for age, sex, education, race, and body mass index (BMI). The robustness of our findings was evaluated by adjusting for confounding factors and health conditions including joint pain, musculoskeletal medications, smoking status, motor function, global cognition, falls, cardiovascular events, and diabetes. Participants were on average (mean ± SD) 80.9 ± 7.0 years old, 72% female, and 3.8% black, with a baseline BMI of 27.3 ± 5.4 kg/m2, and a baseline of BMD of 0.44 ± 0.14 g/cm2. In models adjusted for age, sex, education, race, and BMI, lower BMD was associated with a higher rate of death (hazard ratio [HR] 1.20; 95% confidence interval [CI], 1.08–1.33), incident BADL disability (HR 1.20; 95% CI, 1.05–1.37), and hip fracture (HR 2.57; 95% CI, 1.72–3.82), but not of IADL disability (HR 1.00; 95% CI, 0.85–1.17) or mobility disability (HR 1.13; 95% CI, 0.97–1.32). The association between BMD and mortality was not significant in fully adjusted models, but the BMD and BADL associations remained significant in models adjusting for both demographic variables and BMD‐modifying health conditions. BMD is associated with incident disability in older adults. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Ryan D Ross
- Department of Cell & Molecular Medicine Rush University Medical Center Chicago IL USA.,Department of Orthopedic Surgery Rush University Medical Center Chicago IL USA
| | - Raj C Shah
- Rush Alzheimer's Disease Center Rush University Medical Center Chicago IL USA.,Department of Family Medicine Rush University Medical Center Chicago IL USA
| | - Sue E Leurgans
- Rush Alzheimer's Disease Center Rush University Medical Center Chicago IL USA.,Department of Neurological Sciences Rush University Medical Center Chicago IL USA
| | - Aron S Buchman
- Rush Alzheimer's Disease Center Rush University Medical Center Chicago IL USA.,Department of Neurological Sciences Rush University Medical Center Chicago IL USA
| | - David A Bennett
- Rush Alzheimer's Disease Center Rush University Medical Center Chicago IL USA.,Department of Neurological Sciences Rush University Medical Center Chicago IL USA
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Cai Y, Leveille SG, Hausdorff JM, Bean JF, Manor B, McLean RR, You T. Chronic Musculoskeletal Pain and Foot Reaction Time in Older Adults. THE JOURNAL OF PAIN 2020; 22:76-85. [PMID: 32599155 DOI: 10.1016/j.jpain.2020.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 05/08/2020] [Accepted: 05/13/2020] [Indexed: 10/24/2022]
Abstract
This cross-sectional study examines the association between chronic musculoskeletal pain and foot reaction time (RT) among older community-living adults. Participants were 307 adults aged 71 years and older in the MOBILIZE Boston Study II. Pain severity, interference, and location were measured by the Brief Pain Inventory and a joint pain questionnaire. With participants seated, simple foot reaction time was measured as self-selected foot response time to an intermittent light, and choice foot reaction time was measured as response time to the light on the corresponding side of the sensored gait mat. We performed multivariable linear regression to determine associations of pain and foot RT, adjusted for sociodemographic and health characteristics, and serially adjusted for cognitive function (MMSE or Trail Making A). Pain severity and interference were associated with slower simple foot reaction time (P < .05). Pain severity and knee pain were associated with slower choice foot reaction time (P < .05). Adjustment for cognitive measures had little impact on the pain-RT relationship. This significant relationship was only observed among participants with less education. These results support the idea that chronic pain may lead to slower foot RT, thus could represent a fall hazard in older adults. Neuromotor mechanisms underlying the pain-fall relationship warrant further investigation. PERSPECTIVE: This study provides insights on the mechanisms underlying the pain-fall relationship. Chronic pain may contribute to slower foot RT thus increase fall risk in older adults. This may help inform interventions such as stepping training to reduce fall risk in older adults living with chronic pain.
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Affiliation(s)
- Yurun Cai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Departments of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts.
| | - Suzanne G Leveille
- Departments of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Physical Therapy, Sagol School of Neuroscience, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan F Bean
- New England Geriatric, Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Brad Manor
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | - Robert R McLean
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | - Tongjian You
- Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
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Cross-sectional study of patient satisfaction with oral analgesics in patients with chronic pain in Japan. Expert Opin Pharmacother 2020; 21:983-991. [PMID: 32252557 DOI: 10.1080/14656566.2020.1743267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Chronic pain is often difficult to treat, and many patients are not satisfied with analgesic treatment. The authors assessed patient satisfaction with oral analgesics in patients with chronic pain in Japan. RESEARCH DESIGN AND METHODS This was an observational cross-sectional study conducted in dispensing pharmacies. A patient satisfaction questionnaire survey was conducted in 781 patients prescribed one nonsteroidal anti-inflammatory drug (NSAID) or neuropathic pain (NeP) drug for at least 90 consecutive days. The primary endpoint was patient satisfaction with analgesics. The secondary endpoints were pain relief, activity of daily living (ADL) improvement and doctor-patient communication. RESULTS The proportions of patients who answered 'satisfied if anything' or better for patient satisfaction in the NSAID and NeP drug groups were 70.0% and 65.2%, respectively, whereas those of patients who answered 'satisfied' were 43.3% and 29.4%, respectively. The proportions of patients with improved pain relief, ADL improvement, and good doctor-patient communication were numerically higher than those of patients who answered 'satisfied if anything' or better. CONCLUSIONS Approximately two-thirds of the patients were satisfied with current analgesics. Patient satisfaction with oral analgesics could be influenced by multiple factors. CLINICAL TRIAL REGISTRATION NUMBER UMIN000036456.
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Hirase T, Makizako H, Okubo Y, Lord SR, Inokuchi S, Okita M. Chronic pain is independently associated with social frailty in community-dwelling older adults. Geriatr Gerontol Int 2019; 19:1153-1156. [PMID: 31646711 DOI: 10.1111/ggi.13785] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/03/2019] [Accepted: 09/06/2019] [Indexed: 11/30/2022]
Abstract
AIM The present study aimed to determine whether measures of chronic pain are associated with social frailty in community-dwelling older adults. METHODS Participants comprised 248 older adults who enrolled for community-based exercise classes. Chronic pain was defined as the presence of significant pain-related symptoms within the past month that had continued for at least 6 months. Social frailty was defined as positive responses to two of the following five questions (going out less frequently, rarely visiting friends, feeling unhelpful to friends or family, living alone and not talking with someone every day). Physical function was assessed using the Chair Stand and Timed Up and Go tests. RESULTS A total of 55 participants (22.2%) met the criteria for social frailty. A total of 28 socially frail participants (50.9%) and 56 of the socially integrated participants (29.0%) reported chronic pain. The presence of chronic pain was significantly associated with social frailty after adjusting for age, sex and physical function measures (odds ratio 2.13, 95% confidence interval 1.01-4.48). Chronic pain was also significantly associated with three social frailty items: going out less frequently, rarely visiting friends and feeling unhelpful to friends or family. CONCLUSIONS Chronic pain was independently associated with social frailty in community-dwelling older adults. Simple assessments of chronic pain and subsequent pain management interventions might be beneficial for older people with social frailty. Geriatr Gerontol Int 2019; 19: 1153-1156.
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Affiliation(s)
- Tatsuya Hirase
- Department of Physical Therapy Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Hyuma Makizako
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Yoshiro Okubo
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Shigeru Inokuchi
- Department of Physical Therapy Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Minoru Okita
- Department of Physical Therapy Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Shaygan M, Böger A, Kröner-Herwig B. How does reduction in pain lead to reduction in disability in patients with musculoskeletal pain? J Pain Res 2019; 12:1879-1890. [PMID: 31354338 PMCID: PMC6580133 DOI: 10.2147/jpr.s197533] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 05/28/2019] [Indexed: 01/21/2023] Open
Abstract
Purpose Reduction in pain following multidisciplinary treatment is most often associated with a reduction in disability. To further elaborate the relationship between pain intensity and disability, the present study investigated three main questions: first, whether multidisciplinary treatment leads to a significant improvement in pain, disability and psychological variables (depression, pain acceptance and catastrophizing). Second, it was examined whether pain reduction may account for significant changes in the psychological variables (pre- to follow-up change scores). Finally, it was analyzed whether the psychological changes mediate the association between reduction in pain and in disability after controlling for age, sex and pain history. Patients and methods Patients suffering from chronic musculoskeletal pain (n=279) attended a German inpatient multidisciplinary program lasting 15 consecutive days on average, with self-report data collected at pretreatment, posttreatment and three-month follow-up. Results Repeated measures ANOVAs showed a significant improvement in pain intensity, disability, pain acceptance, catastrophizing and depression at posttreatment and follow-up. Univariate regression analyses revealed that changes in pain intensity accounted for significant changes in depression, pain catastrophizing and pain acceptance (pre- to follow-up change scores). The results of Multiple Mediation Procedure showed that pain reduction did affect reduction in disability through improvement of depression, catastrophizing and acceptance. Conclusion Our findings support a cognitive-behavioral model of pain that posits an important role for pain-related cognitive and emotional processes in long-term outcomes following multidisciplinary pain treatment, in particular for the modulation of disability due to pain. The results add evidence to the notion that pain-related cognitions are dynamic features varying over time dependent on the internal situation. Perspective The current findings are relevant to the management of patients with musculoskeletal pain. The results support the notion that, in contrast with the view of enduring personality traits, pain-related cognitions and emotions reflect a situational response that varies over time.
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Affiliation(s)
- Maryam Shaygan
- Community Based Psychiatric Care Research Centre, Faculty of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Andreas Böger
- Pain Management Clinic at the Red Cross Hospital, Kassel, Germany
| | - Birgit Kröner-Herwig
- Department of Clinical Psychology and Psychotherapy, Georg-Elias-Müller-Institute of Psychology, Georg-August-University, Göttingen, Germany
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Association between Chronic Pain and Physical Frailty in Community-Dwelling Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16081330. [PMID: 31013877 PMCID: PMC6518051 DOI: 10.3390/ijerph16081330] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/03/2019] [Accepted: 04/10/2019] [Indexed: 02/02/2023]
Abstract
This cross-sectional study investigated the association between chronic pain and physical frailty in community-dwelling older adults. We analyzed data obtained from 323 older adults (women: 74.6%) who participated in a community-based health check survey (the Tarumizu Study, 2017). Physical frailty was defined in terms of five parameters (exhaustion, slowness, weakness, low physical activity, and weight loss). We assessed the prevalence of chronic low back and knee pain using questionnaires. Participants whose pain had lasted ≥two months were considered to have chronic pain. Among all participants, 138 (42.7%) had chronic pain, and 171 (53.0%) were categorized as having physical frailty or pre-frailty. Logistic regression analysis showed that chronic pain was significantly associated with the group combining frailty and pre-frailty (odds ratio 1.68, 95% confidence interval 1.03–2.76, p = 0.040) after adjustment for age, sex, body mass index, score on the 15-item Geriatric Depression Scale, and medications. Comparing the proportions of chronic pain among participants who responded to the sub-items, exhaustion (yes: 65.9%, no: 39.4%) demonstrated a significant association (p < 0.001). Chronic pain could be associated with the group combining frailty and pre-frailty and is particularly associated with exhaustion in community-dwelling older adults. Therefore, there is a need for early intervention and consideration of the role of exhaustion when devising interventions for physical frailty in older individuals with chronic pain.
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Butera KA, Roff SR, Buford TW, Cruz-Almeida Y. The impact of multisite pain on functional outcomes in older adults: biopsychosocial considerations. J Pain Res 2019; 12:1115-1125. [PMID: 30992680 PMCID: PMC6445225 DOI: 10.2147/jpr.s192755] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Multisite pain, or pain that occurs simultaneously at >1 anatomical site, is more prevalent than single-site pain. While multisite pain affects over half of older adults, it remains an understudied pain entity that may have important functional implications in an aging population. Greater understanding of this complex pain entity from a biopsychosocial perspective is critical for optimizing clinical and functional outcomes in older adults with pain. Therefore, the primary purpose of this review is to summarize the relationship between multisite pain and functional outcomes in older adults to further elucidate the impact of multisite pain as a distinct entity within this population. A comprehensive literature search revealed 17 peer-reviewed articles. Multisite pain in older individuals is associated with reductions in several physical function domains: 1) lower-extremity mobility; 2) upper-extremity impairments; 3) balance and increased fall risk; and 4) general disability and poor physical function. Further, multisite pain in older individuals is associated with psychological dysfunction (eg, anxiety and depressive symptoms) and social factors (eg, income and education). Overall, this review highlights the scant literature investigating the functional implications of multisite pain in an aging population. Further, while multisite pain appears to have functional consequences, the neurobiological mechanisms contributing to this relationship are unknown. Thus, how this pain characteristic may contribute to the variability in pain-related functional outcomes among older adults is not clear. Future investigations are strongly warranted to advance the understanding of multisite pain and its broad impact on physical and psychosocial function in older adults.
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Affiliation(s)
- Katie A Butera
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32610, USA
| | - Shannon R Roff
- Charles River Laboratories Inc., Frederick, MD 21701, USA
| | - Thomas W Buford
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Yenisel Cruz-Almeida
- Department of Aging & Geriatric Research, Institute on Aging, Pain Research & Intervention Center of Excellence, Center for Cognitive Aging & Memory, University of Florida, Gainesville, FL 32610, USA,
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Salman Roghani R, Delbari A, Asadi-Lari M, Rashedi V, Lökk J. Neuropathic Pain Prevalence of Older Adults in an Urban Area of Iran: A Population-Based Study. PAIN RESEARCH AND TREATMENT 2019; 2019:9015695. [PMID: 30719350 PMCID: PMC6334371 DOI: 10.1155/2019/9015695] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 11/02/2018] [Accepted: 11/22/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pain prevalence would increase as the population grows older, but the exact prevalence rate is not apparent in Iran. OBJECTIVES This study, therefore, set out to reveal the prevalence of pain, especially neuropathic type and explore its associated comorbidities among Iranian older adults in a large urban population-based survey. METHODS 5326 older people, aged ≥ 60 years, were randomly chosen by a multistage, cluster sampling method. The selected people then were interviewed by using the following instruments: a standard questionnaire about pain, questions of interview part of Douleur Neuropathique 4 Questions (DN4) and its comorbidities, GHQ-28, and a sociodemographic checklist. Descriptive statistics and multiple regression analysis were conducted to analyze the gathered data. RESULTS The average of the participants' age was 68.92 ± 7.02 years. Of 5326 participants, 2529 (47.5%) of participants were male. About one-third of this population had chronic pain. Chronic neuropathic pain prevalence was 13.7% and nociceptive in 30%. Knee pain (20.6%) and feet dysesthesia (7.8%) were the most common sites of nociceptive and neuropathic pain, respectively. Results of multiple regression analysis revealed that the major comorbidities of chronic pain were osteoporosis, disability, diabetes mellitus, and stroke. Neuropathic pain experiences were significantly associated with GHQ-28 scores (t=-11.42, P<0.001). CONCLUSIONS In addition to neuropathic pain, other subtypes of pain prevalence and the comorbidities are determined in the community-dwelling elder adults. This study highlights the importance of neuropathic pain and its adverse consequences and can be used to manage this populations' needs in Iran effectively.
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Affiliation(s)
- Reza Salman Roghani
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institute, Stockholm, Sweden
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Delbari
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institute, Stockholm, Sweden
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohsen Asadi-Lari
- Department of Epidemiology, School of Public Health, Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Vahid Rashedi
- School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Johan Lökk
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institute, Stockholm, Sweden
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Leonhardt C, Kuss K, Becker A, Basler HD, de Jong J, Flatau B, Laekeman M, Mattenklodt P, Schuler M, Vlaeyen J, Quint S. Graded Exposure for Chronic Low Back Pain in Older Adults: A Pilot Study. J Geriatr Phys Ther 2018; 40:51-59. [PMID: 27058216 DOI: 10.1519/jpt.0000000000000083] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Fear-avoidance beliefs in older adults with chronic low back pain (CLBP) can lead to disability. Graded exposure-based active physical therapy could be an option to enhance physical ability in older patients with CLBP. The purpose of this study was to develop a standardized graded exposure treatment according to the fear-avoidance model of musculoskeletal pain for older patients with CLBP and to examine its effectiveness and feasibility in the German health care system. METHODS The study represents a phase I/phase II trial of a complex intervention. Taking a first step into the hierarchy of growing empirical evidence, a prospective 1-factor observational study was conducted with repeated measurements 1 week before and within 2 weeks after the intervention. Three physical therapists, who completed an introductory workshop, provided the treatment in the form of individual therapies. Sixteen participants 65 years or older with CLBP and perceived physical limitations were recruited. Four patient-reported outcome measures and semistructured interviews were conducted. The primary outcome was physical ability measured with the Hanover Functional Ability Questionnaire. Secondary outcomes were the numerical pain rating scale, and an age-specific and adapted 11-item short-form of the Patient Anxiety Symptom Scale, the KVS-D 65+, which quantified catastrophizing and avoidance beliefs. Fear of falling was measured with the Falls Efficacy Scale-International. For the analysis, Wilcoxon signed-rank test for paired samples and an α level of .05 were chosen. For the qualitative evaluation, semistructured interviews were conducted with the patients and physical therapists explored indicators of feasibility such as demands, acceptability, satisfaction, adaptation needs, and implementation. For content analysis, codes were primarily derived deductively and complemented by inductively derived new themes. RESULTS A significant increase in physical ability after the treatment was observed with an effect size (ES) of 0.95 (P = .008). With regard to secondary outcomes, there was a statistically significant decrease in pain intensity (P = .029) and a reduction in catastrophizing (ES = 0.91; P = .021) and avoidance beliefs (ES = 1.37; P = .001). The interviews revealed good acceptance and satisfaction of the treatment by the patients and physical therapists. CONCLUSION On the whole, the treatment appears effective and feasible. Apart from the benefits achieved by the participants, the study provides a basis for designing future studies at a higher level of evidence.
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Affiliation(s)
- Corinna Leonhardt
- 1Department of General Practice/Family Medicine, Philipps-University Marburg, Marburg, Germany. 2Department of Medical Psychology, Philipps-University Marburg, Marburg, Germany. 3Department of Rehabilitation, University Hospital Maastricht/Maastricht University, Maastricht, the Netherlands. 4"medi train"-Center for Health, Sports Therapy and Physical Therapy, Erlangen, Germany. 5Department Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany. 6Interdisciplinary Pain Center, University Hospital Erlangen, Erlangen, Germany. 7Diakonissenkrankenhaus Mannheim, Clinic for Geriatrics, Mannheim, Germany. 8Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands. 9Research Group on Health Psychology, KU Leuven, Leuven, Belgium
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Multimorbidity patterns and associations with functional limitations among an aging population in prison. Arch Gerontol Geriatr 2018; 77:115-123. [DOI: 10.1016/j.archger.2018.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 01/31/2018] [Accepted: 03/23/2018] [Indexed: 11/18/2022]
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Thakral M, Shi L, Foust JB, Patel KV, Shmerling RH, Bean JF, Leveille SG. Persistence of pain quality in community-dwelling older adults with chronic non-cancer pain. Geriatr Nurs 2018; 39:450-456. [PMID: 29477646 DOI: 10.1016/j.gerinurse.2018.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 02/06/2023]
Abstract
Longitudinal assessment of chronic geriatric pain is complicated by an age-associated plateau in pain severity and increase in widespread pain, calling for innovative measures such as pain quality descriptors that characterize how pain may feel. We characterized persistence of pain quality and its relation to severity, activity interference and distribution of sites, in a population-based sample of adults aged≥70 years with chronic pain (n = 398). Persistent pain quality was defined as reporting descriptors within the same category: sensory, cognitive/affective, or neuropathic at baseline and 18 months. A count variable indicated number of persistent categories. Pain quality was highly persistent. Adjusted for baseline covariates, individuals endorsing 3 persistent categories were 2-2.5x more likely to experience more widespread pain at 18 months compared to fewer persistent categories. No associations were noted in changes in pain severity or interference. A comprehensive pain assessment that includes diverse pain quality descriptors may improve individualized pain management.
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Affiliation(s)
- Manu Thakral
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA; Department of Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, WA, USA.
| | - Ling Shi
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Janice B Foust
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Kushang V Patel
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Robert H Shmerling
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Division of Rheumatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jonathan F Bean
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA; Spaulding Rehabilitation Hospital, Boston, MA, USA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Suzanne G Leveille
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
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23
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Bennett DA, Buchman AS, Boyle PA, Barnes LL, Wilson RS, Schneider JA. Religious Orders Study and Rush Memory and Aging Project. J Alzheimers Dis 2018; 64:S161-S189. [PMID: 29865057 PMCID: PMC6380522 DOI: 10.3233/jad-179939] [Citation(s) in RCA: 642] [Impact Index Per Article: 107.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Religious Orders Study and Rush Memory and Aging Project are both ongoing longitudinal clinical-pathologic cohort studies of aging and Alzheimer's disease (AD). OBJECTIVES To summarize progress over the past five years and its implications for understanding neurodegenerative diseases. METHODS Participants in both studies are older adults who enroll without dementia and agree to detailed longitudinal clinical evaluations and organ donation. The last review summarized findings through the end of 2011. Here we summarize progress and study findings over the past five years and discuss new directions for how these studies can inform on aging and AD in the future. RESULTS We summarize 1) findings on the relation of neurobiology to clinical AD; 2) neurobiologic pathways linking risk factors to clinical AD; 3) non-cognitive AD phenotypes including motor function and decision making; 4) the development of a novel drug discovery platform. CONCLUSION Complexity at multiple levels needs to be understood and overcome to develop effective treatments and preventions for cognitive decline and AD dementia.
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Affiliation(s)
- David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL., USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL., USA
| | - Aron S. Buchman
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL., USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL., USA
| | - Patricia A. Boyle
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL., USA
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL., USA
| | - Lisa L. Barnes
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL., USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL., USA
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL., USA
| | - Robert S. Wilson
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL., USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL., USA
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL., USA
| | - Julie A Schneider
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL., USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL., USA
- Department of Pathology (Neuropathology), Rush University Medical Center, Chicago, IL., USA
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24
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James EG, Leveille SG, Hausdorff JM, Travison T, Kennedy DN, Tucker KL, Al Snih S, Markides KS, Bean JF. Rhythmic Interlimb Coordination Impairments and the Risk for Developing Mobility Limitations. J Gerontol A Biol Sci Med Sci 2017; 72:1143-1148. [PMID: 27927763 PMCID: PMC5861956 DOI: 10.1093/gerona/glw236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 11/05/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The identification of novel rehabilitative impairments that are risk factors for mobility limitations may improve their prevention and treatment among older adults. We tested the hypothesis that impaired rhythmic interlimb ankle and shoulder coordination are risk factors for subsequent mobility limitations among older adults. METHODS We conducted a 1-year prospective cohort study of community-dwelling older adults (N = 99) aged 67 years and older who did not have mobility limitations (Short Physical Performance Battery score > 9) at baseline. Participants performed antiphase coordination of the right and left ankles or shoulders while paced by an auditory metronome. Using multivariable logistic regression, we determined odds ratios (ORs) for mobility limitations at 1-year follow-up as a function of coordination variability and asymmetry. RESULTS After adjusting for age, sex, body mass index, Mini-Mental State Examination score, number of chronic conditions, and baseline Short Physical Performance Battery score, ORs were significant for developing mobility limitations based on a 1 SD difference in the variability of ankle (OR = 1.88; 95% confidence interval [CI]: 1.16-3.05) and shoulder (OR = 1.96; 95% CI: 1.17-3.29) coordination. ORs were significant for asymmetry of shoulder (OR = 2.11; 95% CI: 1.25-3.57), but not ankle (OR = 0.95; 95% CI: 0.59-1.55) coordination. Similar results were found in unadjusted analyses. CONCLUSIONS The results support our hypothesis that impaired interlimb ankle and shoulder coordination are risk factors for the development of mobility limitations. Future work is needed to further examine the peripheral and central mechanisms underlying this relationship and to test whether enhancing coordination alters mobility limitations.
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Affiliation(s)
- Eric G James
- Department of Physical Therapy, University of Massachusetts, Lowell
| | - Suzanne G Leveille
- College of Nursing and Health Sciences, University of Massachusetts, Boston
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel
- Sagol School of Neuroscience, Tel Aviv University, Israel
- Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Thomas Travison
- Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts
| | - David N Kennedy
- Department of Psychiatry, University of Massachusetts Medical School, Worcester
| | - Katherine L Tucker
- Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts, Lowell
| | - Soham Al Snih
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston
| | | | - Jonathan F Bean
- New England GRECC, VA Boston Healthcare System, Massachusetts
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
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25
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Impact of Pain on Incident Risk of Disability in Elderly Japanese: Cause-specific Analysis. Anesthesiology 2017; 126:688-696. [PMID: 28182584 DOI: 10.1097/aln.0000000000001540] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although several cross-sectional studies have reported that pain is associated with functional disability in the elderly, data regarding a longitudinal association between pain and disability are inconsistent. This study aimed to investigate the association of pain severity with subsequent functional disability due to all causes as well as stroke, dementia, and joint disease/fracture. METHODS The authors conducted a prospective cohort study of 13,702 Japanese individuals aged 65 yr or older. Information regarding pain severity during the previous 4 weeks and other lifestyle factors was collected via questionnaire in 2006. Data on the incidence of functional disability were retrieved from the Long-term Care Insurance database. Cox proportional hazards regression analysis was used to estimate the multivariate-adjusted hazard ratios for incident functional disability. RESULTS The authors documented 2,686 (19.6%) cases of incident functional disability. The multivariate hazard ratio of functional disability was 1.15 (95% CI, 1.02 to 1.31) among respondents with moderate pain and 1.31 (95% CI, 1.12 to 1.54) among respondents with severe pain in comparison with those without pain (P trend < 0.001). These positive associations were particularly remarkable for disability due to joint disease/fracture: the multivariate hazard ratio was 1.88 (95% CI, 1.37 to 2.58) for moderate pain and 2.76 (95% CI, 1.93 to 3.95) for severe pain (P trend < 0.001). There was a negative association between pain severity and disability due to dementia (P trend = 0.041) and no significant association between pain severity and disability due to stroke. CONCLUSIONS Among elderly Japanese individuals, the authors found a significant positive association between pain severity and future incident functional disability.
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26
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Hirase T, Kataoka H, Inokuchi S, Nakano J, Sakamoto J, Okita M. Factors associated with chronic musculoskeletal pain in Japanese community-dwelling older adults: A cross-sectional study. Medicine (Baltimore) 2017; 96:e7069. [PMID: 28591044 PMCID: PMC5466222 DOI: 10.1097/md.0000000000007069] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Identifying older adults with chronic musculoskeletal pain (CMP) earlier is urgent because CMP is reportedly associated with deterioration in physical function, poor psychological status, and low physical activity level. The objective of this study was to identify factors that were most strongly associated with CMP in Japanese community-dwelling older adults.Using a cross-sectional design, we assessed 263 older adults (mean age = 79.1 ± 5.9 years, 85.9% women) who participated in community exercise classes. Participants' physical function, psychological status, and activity levels were evaluated as outcome measures using a variety of tests and instruments. These assessments were conducted prior to beginning the exercise intervention program and compared participants with and without CMP. Additionally, relevant participant characteristics were collected and analyzed. In this study, CMP was defined as the presence of related symptoms within the past month that continued for at least 6 months and corresponded to a numerical rating scale of at least 5 or more at the site of maximum pain.A total of 143 (54.4%) participants met the criteria for CMP, and a high number of them had chronic lower back pain (64.3%). Outcome measures for the CMP group were significantly worse than for the non-CMP group (P < .05). Logistic regression analysis revealed that the Pain Catastrophizing Scale helplessness domain scores (odds ratio: 1.20, 95% confidence interval: 1.09-1.32) with an estimated value of 10 points was the factor most significantly associated with the presence of CMP.These findings suggest that assessment of the helplessness associated with pain-related catastrophizing is important for identification and the creation of interventions for older adults with CMP.
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Affiliation(s)
- Tatsuya Hirase
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences
| | - Hideki Kataoka
- Department of Locomotive Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto
- Department of Rehabilitation, Nagasaki Memorial Hospital, Hukahori, Nagasaki, Japan
| | - Shigeru Inokuchi
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences
| | - Jiro Nakano
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences
| | - Junya Sakamoto
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences
| | - Minoru Okita
- Department of Locomotive Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto
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27
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Patel KV, Cochrane BB, Turk DC, Bastian LA, Haskell SG, Woods NF, Zaslavsky O, Wallace RB, Kerns RD. Association of Pain With Physical Function, Depressive Symptoms, Fatigue, and Sleep Quality Among Veteran and non-Veteran Postmenopausal Women. THE GERONTOLOGIST 2017; 56 Suppl 1:S91-101. [PMID: 26768395 DOI: 10.1093/geront/gnv670] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF STUDY To characterize the prevalence and longitudinal effects of pain in older Veteran and non-Veteran women. DESIGN AND METHODS Data on 144,956 participants in the Women's Health Initiative were analyzed. At baseline, Veteran status, pain severity, and pain interference with activity were assessed. Outcomes of physical function, depressive symptoms, fatigue, and sleep quality were reported at baseline by all study participants and longitudinally on two follow-up occasions (3 years and 13-18 years after baseline) in the observational study participants (n = 87,336). RESULTS At baseline, a total of 3,687 (2.5%) had a history of military service and 22,813 (15.8%) reported that pain limited their activity level moderately to extremely during the past 4 weeks. Prevalence of pain interference did not differ in Veterans and non-Veterans (16.8% and 15.7%, respectively; p= .09). At baseline, women with moderate-to-extreme pain interference had substantially worse physical function and greater symptoms of depression, fatigue, and insomnia than those with less pain (p < .001 for all comparisons), adjusting for several social, behavioral, and health related factors. There were no significant military service by pain interference interactions for any of the outcomes (p > .2), indicating that the effect of pain interference on outcomes at baseline did not vary between Veterans and non-Veterans. Moderate-to-extreme pain interference was associated with a greater rate of decline in physical function over time (p < .001) and higher incidence of limited physical functioning (p < .001), but these effects did not vary by Veteran status. Similar results were observed with pain severity as the exposure variable. IMPLICATIONS As the Veteran population ages and the number of women exposed to combat operations grows, there will be an increased need for health care services that address not only pain severity and interference but also other disabling comorbid symptoms.
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Affiliation(s)
- Kushang V Patel
- Center for Pain Research on Impact, Measurement, and Effectiveness, Department of Anesthesiology and Pain Medicine, University of Washington, Seatle. Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Seattle.
| | - Barbara B Cochrane
- de Tornyay Center for Healthy Aging, University of Washington School of Nursing, Seattle. Fred Hutchinson Cancer Research Center, Public Health Sciences, Seattle, Washington
| | - Dennis C Turk
- Center for Pain Research on Impact, Measurement, and Effectiveness, Department of Anesthesiology and Pain Medicine, University of Washington, Seatle
| | - Lori A Bastian
- VA Connecticut, Newington. Division of General Internal Medicine, University of Connecticut, Farmington
| | - Sally G Haskell
- VA Office of Patient Care, Women's Health Services, Washington, District of Columbia. VA Connecticut Health Care System, West Haven. Department of Internal Medicine, Yale University, New Haven, Connecticut
| | - Nancy F Woods
- de Tornyay Center for Healthy Aging, University of Washington School of Nursing, Seattle. Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle
| | - Oleg Zaslavsky
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle
| | | | - Robert D Kerns
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven. Department of Psychiatry and Department of Neurology, Yale University, New Haven, Connecticut
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28
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Lyons JG, Ensrud KE, Schousboe JT, McCulloch CE, Taylor BC, Heeren TC, Stuver SO, Fredman L. Slow Gait Speed and Risk of Long-Term Nursing Home Residence in Older Women, Adjusting for Competing Risk of Mortality: Results from the Study of Osteoporotic Fractures. J Am Geriatr Soc 2016; 64:2522-2527. [PMID: 27874194 DOI: 10.1111/jgs.14346] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine whether slow gait speed increases the risk of costly long-term nursing home residence when accounting for death as a competing risk remains unknown. DESIGN Longitudinal cohort study using proportional hazards models to predict long-term nursing home residence and subdistribution models with death as a competing risk. SETTING Community-based prospective cohort study. PARTICIPANTS Older women (mean age 76.3) participating in the Study of Osteoporotic Fractures who were also enrolled in Medicare fee-for-service plans (N = 3,755). MEASUREMENTS Gait speed was measured on a straight 6-m course and averaged over two trials. Long-term nursing home residence was defined using a validated algorithm based on Medicare Part B claims for nursing home-related care. RESULTS Participants were followed until long-term nursing home residence, disenrollment from Medicare plan, death, or December 31, 2010. Over the follow-up period (median 11 years), 881 participants (23%) experienced long-term nursing home residence, and 1,013 (27%) died before experiencing this outcome. Slow walkers (55% of participants with gait speed <1 m/s) were significantly more likely than fast walkers to reside in a nursing home long-term (adjusted hazards ratio (aHR) = 1.79, 95% confidence interval (CI) = 1.54-2.09). Associations were attenuated in subdistribution models (aHR = 1.52, 95% CI = 1.30-1.77) but remained statistically significant. CONCLUSION Older community-dwelling women with slow gait speed are more likely to experience long-term nursing home residence, as well as mortality without long-term residence. Ignoring the competing mortality risk may overestimate long-term care needs and costs.
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Affiliation(s)
- Jennifer G Lyons
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts
| | - Kristine E Ensrud
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota.,Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.,Center for Chronic Disease Outcomes Research, Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - John T Schousboe
- Park Nicollet Institute for Research and Education, Health Partners, Minneapolis, Minnesota.,Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Brent C Taylor
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota.,Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.,Center for Chronic Disease Outcomes Research, Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - Timothy C Heeren
- Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts
| | - Sherri O Stuver
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts
| | - Lisa Fredman
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts
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Abstract
Pharmacologic management of chronic pain in older adults is one component of the multimodal, interdisciplinary management of this complex condition. In this article, we summarize several of the key barriers to effective pharmacologic management in older adults and review the existing (albeit limited) evidence for its effectiveness and safety, especially in a medically complex population with multimorbidity. This review covers topical formulations, acetaminophen, oral nonsteroidal antiinflammatory drugs, and adjuvant therapies. The article concludes with a suggested approach to managing chronic pain in the older patient, incorporating goals and expectations for treatment as well as careful monitoring of medication adjustments.
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Affiliation(s)
- Zachary A Marcum
- Department of Pharmacy, University of Washington School of Pharmacy, 1959 Northeast Pacific Avenue, Box 357630, Seattle, WA 98195, USA
| | - Nakia A Duncan
- Texas Tech University Health Sciences Center School of Pharmacy, 4500 South Lancaster Street, Building 7, Room 215, Dallas, TX, USA
| | - Una E Makris
- Division of Rheumatic Diseases, Department of Internal Medicine, VA North Texas Health Care System, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9169, USA.
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30
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Hermsen LAH, van der Wouden JC, Leone SS, Smalbrugge M, van der Horst HE, Dekker J. The longitudinal association of cognitive appraisals and coping strategies with physical functioning in older adults with joint pain and comorbidity: a cohort study. BMC Geriatr 2016; 16:29. [PMID: 26818402 PMCID: PMC4730621 DOI: 10.1186/s12877-016-0204-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 01/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Substantial variation exists in physical functioning (PF) among patients with comparable pain severity, which may be partly explained by underlying psychological processes, like cognitive appraisal of pain and coping with pain. It remains unclear to what extent such determinants contribute to changes in PF over time, especially in older populations. Therefore, we examined longitudinal associations of cognitive appraisals and coping strategies with PF, in older adults with joint pain and comorbidity. METHODS A prospective cohort study among 407 older adults with joint pain and comorbidity provided data over 18 months, with 6 month time-intervals. We measured PF (RAND-36), five cognitive appraisals (consequences, concerns, emotional representations, self-efficacy, catastrophizing), four coping strategies (ignoring pain, positive self-statement, increasing activity levels, activity avoidance) and three time-dependent covariates; pain intensity, anxiety and depressive symptoms. Longitudinal associations were analyzed with Generalized Estimated Equations (GEE), by testing auto-regressive models, adjusted for covariates. RESULTS More negative thoughts about consequences of pain (β = -0.54, 95% CI = -1.02; -0.06), more catastrophizing (β = -0.67, 95% CI = -1.26; -0.07) and more activity avoidance (β = -0.32, 95% CI = -0.57; -0.08) were significantly associated with subsequent deterioration in PF, whereas higher perceived self-efficacy (β = 0.22, 95% CI = 0.12; 0.31) was associated with subsequent improvement in PF. Neither concerns, emotional representations, ignoring pain, positive self-statement nor increasing activity levels were longitudinally related to PF. CONCLUSIONS More negative thoughts about consequences of pain, more catastrophizing and more activity avoidance contributed to deteriorated PF, whereas higher perceived self-efficacy contributed to improved PF. This knowledge may contribute to future management of functional limitations in older adults with joint pain and comorbidity.
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Affiliation(s)
- Lotte A H Hermsen
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Johannes C van der Wouden
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Stephanie S Leone
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.,Public Mental Health, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Henriëtte E van der Horst
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Joost Dekker
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
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31
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Berglund M, Nässén K, Gillsjö C. Fluctuation between Powerlessness and Sense of Meaning--A Qualitative Study of Health Care Professionals' Experiences of Providing Health Care to Older Adults with Long-Term Musculoskeletal Pain. BMC Geriatr 2015; 15:96. [PMID: 26238106 PMCID: PMC4524008 DOI: 10.1186/s12877-015-0088-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 07/16/2015] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND There is an increasing number of older adults living with long-term musculoskeletal pain and related disabilities. These problems are frequently unrecognized, underreported, and inadequately treated. Since many older adults desire to remain at home for as long as possible, it is important that individualized and holistically tailored care is provided in these settings. However, there is a complexity in providing care in this context. The aim of this study was to describe health care professionals' experiences of providing health care to older adults living with long-term musculoskeletal pain at home. METHODS The phenomenon, "To provide health care to older adults living with long-term musculoskeletal pain at home", was studied using reflective lifeworld research (RLR) which is based on phenomenological epistemology. Ten health care providers (nurse, physiotherapists, and occupational therapists) were interviewed and data was analysed. RESULTS The health care professional's emotions fluctuated between powerlessness and meaningfulness. Needs, opportunities, understanding and respect had to be balanced in the striving to do good in the provision of health care in differing situations. Caring for older adults with long-term pain required courage to remain in the encounter despite feelings of insecurity and uncertainty about the direction of the dialogue. The essence of caring for older adults with long-term pain consisted of the following constituents: Sense of powerlessness; striving to provide good health care; and understanding and respect. CONCLUSIONS The findings indicated that the health care professionals strived to do good and to provide health care that was holistic and sensitive to the older adults' needs. A significant sense of powerlessness in the situation was experienced by the health care professionals. These findings address and support the need to develop methods that can be used to guide health care providers who support older adults in the context of their homes.
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Affiliation(s)
- Mia Berglund
- School of Health and Education, Health and Learning Research Centre: Aging and Long-Term Health Problems, University of Skövde, Skövde, Sweden.
| | - Kristina Nässén
- Academy of Care, Working Life and Social Welfare, University of Borås, Borås, Sweden.
| | - Catharina Gillsjö
- School of Health and Education, Health and Learning Research Centre: Aging and Long-Term Health Problems, University of Skövde, Skövde, Sweden.
- College of Nursing, University of Rhode Island, Kingston, USA.
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32
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Leung YY, Teo SL, Chua MB, Raman P, Liu C, Chan A. Living arrangements, social networks and onset or progression of pain among older adults in Singapore. Geriatr Gerontol Int 2015; 16:693-700. [PMID: 26081796 DOI: 10.1111/ggi.12539] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2015] [Indexed: 11/28/2022]
Abstract
AIMS We aimed to evaluate the relationship between living arrangements, and strength of social network with onset and progression of chronic pain over 2 years in elderly Singaporeans. METHODS We used data from the Social Isolation Health and Lifestyles Survey, a nationally representative survey of community-dwelling older Singaporeans aged >60 years (n = 4990) in 2009 and follow up in 2011. We used binomial logistic regression models to examine factors associated with self-reported onset and progression of chronic pain over time. RESULTS A total of 3103 participants (53.8% women) completed both surveys (weighted response rate 63.7%). The mean age (SD) was 69.4 (0.5) years. The prevalence of mild and moderate-extreme chronic pain at baseline were 27.7% and 12.8%. A total of 20.1% and 3.9% of the participants reported having chronic pain onset and progression over 2 years, respectively. In the binomial regression models, lower education level, living alone and poorer self-rated health were predictors for onset of chronic pain in women. Weak social networks and disability were associated with progression of chronic pain in women. CONCLUSIONS Chronic pain is common in Singaporean older adults. Living alone and weak social network were sociopsychological factors associated with the onset or progression of chronic pain. Geriatr Gerontol Int 2015; ●●: ●●-●●.
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Affiliation(s)
- Ying-Ying Leung
- Clinical Sciences, Duke-NUS Graduate Medical School, Singapore.,Department of Rheumatology & Immunology, Singapore General Hospital, Singapore
| | - Suat Lay Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ming Boon Chua
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore
| | - Prassanna Raman
- Clinical Sciences, Duke-NUS Graduate Medical School, Singapore
| | - Chang Liu
- Clinical Sciences, Duke-NUS Graduate Medical School, Singapore
| | - Angelique Chan
- Clinical Sciences, Duke-NUS Graduate Medical School, Singapore
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Shega JW, Tiedt AD, Grant K, Dale W. Pain measurement in the National Social Life, Health, and Aging Project: presence, intensity, and location. J Gerontol B Psychol Sci Soc Sci 2015; 69 Suppl 2:S191-7. [PMID: 25360020 DOI: 10.1093/geronb/gbu101] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To describe the rationale for the pain presence, location, and intensity measures in the National Social Life, Health and Aging Project (NSHAP). METHOD Responses to the pain presence, location (pain map), and intensity (verbal descriptor scale) items were analyzed by gender and age (62-69, 70-79, and 80-91). Pain intensity was dichotomized (none to mild vs moderate or higher) and compared by demographics, physical function, mood, and self-rated health. All analyses used Wald tests to compare sample means. RESULTS Participants completed the pain presence (n = 2,430/2,799), location (n = 2,558/2,799), and intensity (n = 2,589/2,799) items. Pain items varied by gender with women reporting more head, arm, hip/buttock, leg, and foot pain compared to men, (p < .05) at each individual site. Women also reported more intense pain compared to men-2.13 versus 1.94, respectively (p < .05). Pain items demonstrated remarkable similarity among age cohorts. Health indicators were significant and in the expected direction (p < .001). An increase in comorbidity, ADL and IADL dependence, worse self-rated health, and more depressive symptoms were each significantly more common among participants who reported moderate or greater pain compared to none to mild pain. DISCUSSION Pain presence, location, and intensity measures were successfully integrated into NSHAP Wave 2 and exhibit construct and external validity.
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Affiliation(s)
| | - Andrew D Tiedt
- Department of Justice, Bureau of Justice Statistics, Washington, District of Columbia
| | - Kaelin Grant
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - William Dale
- Department of Medicine, University of Chicago, Chicago, Illinois
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Makris UE, Fraenkel L, Han L, Leo-Summers L, Gill TM. Restricting back pain and subsequent mobility disability in community-living older persons. J Am Geriatr Soc 2014; 62:2142-7. [PMID: 25366926 DOI: 10.1111/jgs.13089] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To evaluate the relationship between back pain severe enough to restrict activity (restricting back pain) and subsequent mobility disability in community-living older persons. DESIGN Prospective cohort study. SETTING Greater New Haven, Connecticut. PARTICIPANTS Community-living men and women aged 70 and older (n = 709). MEASUREMENTS Restricting back pain and mobility disability (defined as needing help with or unable to walk one-quarter of a mile, climb a flight of stairs, or lift and carry 10 pounds) were assessed during monthly telephone interviews for up to 159 months. The association between restricting back pain and subsequent mobility disability was evaluated using a recurrent-events Cox model. Secondary analyses evaluated the association between restricting back pain and mobility disability for two or more consecutive months (persistent mobility disability). Additional analyses were repeated in participants without baseline mobility disability. RESULTS The event rate for mobility disability was 7.26 per 100-person months (95% confidence interval (CI) = 6.89-7.64). Mobility disability episodes lasted for a median of 2 months (interquartile range (IQR) 1-4). In a recurrent-event Cox regression analysis, after adjusting for 11 covariates, restricting back pain was strongly associated with mobility disability (hazard ratio (HR) = 3.23, 95% CI = 2.87-3.64). The association was maintained when the outcome was defined as persistent mobility disability (adjusted HR = 3.63, 95% CI = 3.15-4.20) and when participants with baseline mobility disability were omitted (adjusted HR = 3.71, 95% CI = 3.22-4.28). CONCLUSION Restricting back pain was strongly associated with mobility disability. Interventions that prevent or ameliorate restricting back pain may be effective for reducing the burden of mobility disability in older persons.
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Affiliation(s)
- Una E Makris
- Department of Medicine, UT Southwestern Medical Center, Dallas, Texas; Department of Internal Medicine, Veterans Administration Medical Center, Dallas, Texas
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Danno K, Joubert C, Duru G, Vetel JM. Physician practicing preferences for conventional or homeopathic medicines in elderly subjects with musculoskeletal disorders in the EPI3-MSD cohort. Clin Epidemiol 2014; 6:333-41. [PMID: 25298739 PMCID: PMC4186571 DOI: 10.2147/clep.s64049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Musculoskeletal pain is common in elderly persons. Analgesic use is high in the elderly and may involve unacceptable risk in individuals with chronic pain. Our aim was to compare the socio-demographic characteristics of elderly subjects with musculoskeletal disorders (MSD) and to assess medication use and clinical evolution of musculoskeletal pain according to physician prescribing preference: homeopathy (Ho) group, conventional medicine (CM) group, or mixed prescription (MX) group. Methods The EPI3 study was a 1 year observational survey carried out among general practitioners in France between March 2007 and July 2008. This sub-analysis was carried out on elderly subjects aged ≥70 years from the original EPI3 cohort. Socio-demographic data were collected at inclusion using a self-administered patient questionnaire and medical data were recorded for each patient. Quality of life was measured using the Short Form-12 questionnaire. Patients completed a structured telephone interview on their functional status (evaluated with the QuickDash questionnaire, EIFEL scale or Lequesne index) within 72 hours of inclusion. This telephone interview was repeated at 1, 3, and 12 months. Drug exposure was also assessed during these interviews. Results 146 patients (mean age ± standard deviation: 75.8±4.8 years) were analyzed (80.1% female, 74.7% MSD of the spine or lower limbs, 64.4% chronic MSD). Patients in the CM and MX groups were 3.7 times or 2.5 times more likely (odds ratio [OR] =3.71, 95% confidence interval [CI]: 1.12–12.30; OR =2.52, 95% CI: 1.05–6.05; respectively) to have used non-steroidal anti-inflammatory drugs (NSAIDs) than those in the Ho group. In contrast, analgesic use was comparable in the three groups (OR =1.06 [CM versus Ho], 95% CI: 0.09–12.11; OR =0.34 [MX versus Ho], 95% CI: 0.07–1.57). Overall functional score evolution was similar in the three groups over time (P=0.16). Conclusion NSAID use was significantly higher in elderly MSD patients consulting a conventional practice general practitioner. In contrast, analgesic use and MSD evolution were similar in the three groups. Consulting a homeopathic physician for MSD management does not appear to represent a loss of therapeutic opportunity, and decreases the use of NSAIDs.
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Weigel PAM, Hockenberry JM, Wolinsky FD. Chiropractic use in the Medicare population: prevalence, patterns, and associations with 1-year changes in health and satisfaction with care. J Manipulative Physiol Ther 2014; 37:542-51. [PMID: 25233887 DOI: 10.1016/j.jmpt.2014.08.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 05/30/2014] [Accepted: 06/10/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The purpose of this study was to examine how chiropractic care compares to medical treatments on 1-year changes in self-reported function, health, and satisfaction with care measures in a representative sample of Medicare beneficiaries. METHODS Logistic regression using generalized estimating equations is used to model the effect of chiropractic relative to medical care on decline in 5 functional measures and 2 measures of self-rated health among 12170 person-year observations. The same method is used to estimate the comparative effect of chiropractic on 6 satisfaction with care measures. Two analytic approaches are used, the first assuming no selection bias and the second using propensity score analyses to adjust for selection effects in the outcome models. RESULTS The unadjusted models show that chiropractic is significantly protective against 1-year decline in activities of daily living, lifting, stooping, walking, self-rated health, and worsening health after 1 year. Persons using chiropractic are more satisfied with their follow-up care and with the information provided to them. In addition to the protective effects of chiropractic in the unadjusted model, the propensity score results indicate a significant protective effect of chiropractic against decline in reaching. CONCLUSION This study provides evidence of a protective effect of chiropractic care against 1-year declines in functional and self-rated health among Medicare beneficiaries with spine conditions, and indications that chiropractic users have higher satisfaction with follow-up care and information provided about what is wrong with them.
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Affiliation(s)
- Paula A M Weigel
- Research Associate, Department of Health Management and Policy, College of Public Health, The University of Iowa, Iowa City, IA.
| | - Jason M Hockenberry
- Assistant Professor, Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Fredric D Wolinsky
- Professor, John W. Colloton Chair of Health Management and Policy, Department of Health Management and Policy, College of Public Health, The University of Iowa, Iowa City, IA
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Abstract
IMPORTANCE Persistent pain is highly prevalent, costly, and frequently disabling in later life. OBJECTIVE To describe barriers to the management of persistent pain among older adults, summarize current management approaches, including pharmacologic and nonpharmacologic modalities; present rehabilitative approaches; and highlight aspects of the patient-physician relationship that can help to improve treatment outcomes. This review is relevant for physicians who seek an age-appropriate approach to delivering pain care for the older adult. EVIDENCE ACQUISITION Search of MEDLINE and the Cochrane database from January 1990 through May 2014, using the search terms older adults, senior, ages 65 and above, elderly, and aged along with non-cancer pain, chronic pain, persistent pain, pain management, intractable pain, and refractory pain to identify English-language peer-reviewed systematic reviews, meta-analyses, Cochrane reviews, consensus statements, and guidelines relevant to the management of persistent pain in older adults. FINDINGS Of the 92 identified studies, 35 evaluated pharmacologic interventions, whereas 57 examined nonpharmacologic modalities; the majority (n = 50) focused on older adults with osteoarthritis. This evidence base supports a stepwise approach with acetaminophen as first-line therapy. If treatment goals are not met, a trial of a topical nonsteroidal anti-inflammatory drug, tramadol, or both is recommended. Oral nonsteroidal anti-inflammatory drugs are not recommended for long-term use. Careful surveillance to monitor for toxicity and efficacy is critical, given that advancing age increases risk for adverse effects. A multimodal approach is strongly recommended-emphasizing a combination of both pharmacologic and nonpharmacologic treatments to include physical and occupational rehabilitation, as well as cognitive-behavioral and movement-based interventions. An integrated pain management approach is ideally achieved by cultivating a strong therapeutic alliance between the older patient and the physician. CONCLUSIONS AND RELEVANCE Treatment planning for persistent pain in later life requires a clear understanding of the patient's treatment goals and expectations, comorbidities, and cognitive and functional status, as well as coordinating community resources and family support when available. A combination of pharmacologic, nonpharmacologic, and rehabilitative approaches in addition to a strong therapeutic alliance between the patient and physician is essential in setting, adjusting, and achieving realistic goals of therapy.
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Affiliation(s)
- Una E Makris
- Department of Internal Medicine, Division of Rheumatic Diseases, UT Southwestern Medical Center, Dallas, Texas2Department of Medicine, Division of Rheumatology, Veterans Administration Medical Center, Dallas, Texas
| | - Robert C Abrams
- Department of Psychiatry, Weill Cornell Medical College, New York, New York4Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York
| | - Barry Gurland
- Stroud Center, Columbia University, New York, New York
| | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York
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Hermsen LA, Leone SS, Smalbrugge M, Dekker J, van der Horst HE. Frequency, severity and determinants of functional limitations in older adults with joint pain and comorbidity: Results of a cross-sectional study. Arch Gerontol Geriatr 2014; 59:98-106. [DOI: 10.1016/j.archger.2014.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 02/13/2014] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
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Eggermont LHP, Leveille SG, Shi L, Kiely DK, Shmerling RH, Jones RN, Guralnik JM, Bean JF. 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. J Am Geriatr Soc 2014; 62:1007-16. [PMID: 24823985 DOI: 10.1111/jgs.12848] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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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Affiliation(s)
- Laura H P Eggermont
- Department of Clinical Neuropsychology, VU University, Amsterdam, the Netherlands
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Cederbom S, Wågert PVH, Söderlund A, Söderbäck M. The importance of a daily rhythm in a supportive environment – promoting ability in activities in everyday life among older women living alone with chronic pain. Disabil Rehabil 2014; 36:2050-8. [PMID: 24517866 DOI: 10.3109/09638288.2014.887795] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Sara Cederbom
- School of Health, Care and Social Welfare, Mälardalens University , Västerås , Sweden and
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Hermsen LAH, Leone SS, Smalbrugge M, Knol DL, van der Horst HE, Dekker J. Exploring the aggregation of four functional measures in a population of older adults with joint pain and comorbidity. BMC Geriatr 2013; 13:119. [PMID: 24192234 PMCID: PMC3827990 DOI: 10.1186/1471-2318-13-119] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 10/29/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In clinical settings, it is important for health care providers to measure different aspects of functioning in older adults with joint pain and comorbidity. Besides the use of distinct measures, it could also be attractive to have one general measure of functioning that incorporates several distinct measures, but provides one summary score to quantify overall level of functioning, for example for the identification of older adults at risk of poor functional outcome. Therefore, we selected four measures of functioning: Physical Functioning (PF), Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL) and participation, and tested the possibility to aggregate these measures into one general measure of functioning. METHODS A prospective cohort study of older adults (≥65 years) with joint pain and comorbidity provided baseline data (n = 407) consisting of PF (PF subscale, RAND-36; 10 items), ADL (KATZ index; 6 items), IADL (Lawton index; 7 items) and participation (KAP; 6 items). We tested two models with confirmatory factor analysis: first, a bifactor model with all four measures and second, a bifactor model with PF, ADL and IADL and a correlated but distinct subgroup factor for participation. Several model fit indexes and reliability coefficients, such as explained common variance (ECV) and omegas were computed for both models. RESULTS The first model fitted the data well, but the reliability analysis indicated multidimensionality and unique information in the subgroup factor participation. The second model showed similar model fits, but better reliability; ECV = 0.67, omega-t = 0.94, low omega-s = 0.18-0.22 on the subgroup factors and high omega of 0.82 on participation, which all were in favour of the second model. CONCLUSIONS The results indicate that PF, ADL and IADL could be aggregated into one general measure of functioning, whereas participation should be considered as a distinct measure.
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Affiliation(s)
- Lotte A H Hermsen
- Department of General Practice and Elderly Care Medicine and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands.
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Mänty M, Thinggaard M, Christensen K, Avlund K. Musculoskeletal pain and physical functioning in the oldest old. Eur J Pain 2013; 18:522-9. [PMID: 24039015 DOI: 10.1002/j.1532-2149.2013.00386.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND Little is known about the impact of pain on physical functioning among the oldest-old subjects. In this study, we first examined the associations between the number of painful sites and measures of physical functioning reflecting different stages of the disablement process (physical impairment, functional limitation and disability) among nonagenarians (more than ninety years old persons). Second, we described the effect of painful sites on disability during a 2-year follow-up period. METHODS This study is based on baseline (n = 1177) and 2-year follow-up (n = 709) data of the nationwide Danish 1905 cohort study. Musculoskeletal pain was assessed as reported pain in back, hips or knees when moving or resting. Physical performance measures included maximum grip strength and habitual walking speed. Disability in performing activities of daily living was defined as the need for assistive device or personal help in transferring, dressing, washing, using toilet and/or walking indoors. RESULTS At baseline, the number of painful sites was significantly associated with measured grip strength and walking speed as well as self-reported disability in a stepwise manner; the more sites with pain, the poorer the physical functioning. The follow-up analyses showed corresponding but slightly weaker stepwise associations between baseline pain and disability level at follow-up, and indicated that although on the whole, single or multi-site pain did not predict the onset of disability, multi-site pain increased the risk of developing severe disability. CONCLUSIONS The findings of this study suggest that musculoskeletal pain in nonagenarians is highly prevalent and is associated with poor physical performance and disability.
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Affiliation(s)
- M Mänty
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Denmark; Center for Healthy Aging, University of Copenhagen, Denmark
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Han SD, Buchman AS, Arfanakis K, Fleischman DA, Bennett DA. Functional connectivity networks associated with chronic musculoskeletal pain in old age. Int J Geriatr Psychiatry 2013; 28:858-67. [PMID: 23124844 PMCID: PMC3594549 DOI: 10.1002/gps.3898] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 10/10/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Musculoskeletal disorders are common and often lead to chronic pain in older adults. Because the efficacy of interventions varies with the duration of pain, the identification of early biomarkers for chronic pain would have important public health consequences. Imaging of functional connectivity differences between brain regions might identify some of the earliest functional consequences of a disease process. We tested the hypothesis that chronic musculoskeletal pain in older persons is associated with changes in functional brain connectivity. METHOD We used resting-state functional magnetic resonance imaging and a spherical seed-based region of interest approach to assess functional connectivity of brain regions on a sample of 128 (64 who reported chronic musculoskeletal pain and 64 demographically matched, pain free) nondemented older adults from the Memory and Aging Project, a clinical-pathological cohort study of aging and dementia. RESULTS Older adults with chronic pain showed greater functional connectivity between the posterior cingulate and left insula, left superior temporal gyrus, and left cerebellum. CONCLUSION Chronic musculoskeletal pain is associated with a specific pattern of functional connectivity between brain regions among older adults.
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Affiliation(s)
- S. Duke Han
- Department of Behavioral Sciences, Rush University Medical Center,Rush Alzheimer’s Disease Center, Rush University Medical Center,Mental Health Care Group, VA Long Beach Healthcare System
| | - Aron S. Buchman
- Rush Alzheimer’s Disease Center, Rush University Medical Center,Department of Neurological Sciences, Rush University Medical Center
| | - Konstantinos Arfanakis
- Department of Biomedical Engineering, Illinois Institute of Technology,Rush Alzheimer’s Disease Center, Rush University Medical Center,Department of Radiology, Rush University Medical Center
| | - Debra A. Fleischman
- Department of Behavioral Sciences, Rush University Medical Center,Rush Alzheimer’s Disease Center, Rush University Medical Center,Department of Neurological Sciences, Rush University Medical Center
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center,Department of Neurological Sciences, Rush University Medical Center
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Shah RC, Janos AL, Kline JE, Yu L, Leurgans SE, Wilson RS, Wei P, Bennett DA, Heilman KM, Tsao JW. Cognitive decline in older persons initiating anticholinergic medications. PLoS One 2013; 8:e64111. [PMID: 23741303 PMCID: PMC3669362 DOI: 10.1371/journal.pone.0064111] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 04/10/2013] [Indexed: 12/14/2022] Open
Abstract
Background This study examines the effect of initiating medications with anticholinergic activity on the cognitive functions of older persons. Methods Participants were 896 older community-dwelling, Catholic clergy without baseline dementia. Medication data was collected annually. The Anticholinergic Cognitive Burden Scale was utilized to identify use of a medication with probable or definite anticholinergic activity. Participants had at least two annual cognitive evaluations. Results Over a mean follow-up of 10 years, the annual rate of global cognitive function decline for never users, prevalent users, and incident users was −0.062 (SE = 0.005), −0.081(SE = 0.011), and −0.096 (SE = 0.007) z-score units/year, respectively. Compared to never users, incident users had a more rapid decline (difference = −0.034 z-score units/year, SE = 0.008, p<0.001) while prevalent users did not have a significantly more rapid decline (p = 0.1). Conclusions Older persons initiating a medication with anticholinergic activity have a steeper annual decline in cognitive functioning than those who are not taking these medications.
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Affiliation(s)
- Raj C. Shah
- Rush Alzheimer's Disease Center (RADC), Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Family Medicine, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Alicia L. Janos
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
| | - Julia E. Kline
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
| | - Lei Yu
- Rush Alzheimer's Disease Center (RADC), Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Sue E. Leurgans
- Rush Alzheimer's Disease Center (RADC), Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Robert S. Wilson
- Rush Alzheimer's Disease Center (RADC), Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Peter Wei
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
| | - David A. Bennett
- Rush Alzheimer's Disease Center (RADC), Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Kenneth M. Heilman
- Department of Neurology, University of Florida and Malcom Randall Veterans Affairs Medical Center, Gainesville, Florida, United States of America
| | - Jack W. Tsao
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- United States Navy Bureau of Medicine and Surgery, Washington, DC, United States of America
- * E-mail:
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Nelson AE, Elstad E, DeVellis RF, Schwartz TA, Golightly YM, Renner JB, Conaghan PG, Kraus VB, Jordan JM. Composite measures of multi-joint symptoms, but not of radiographic osteoarthritis, are associated with functional outcomes: the Johnston County Osteoarthritis Project. Disabil Rehabil 2013; 36:300-6. [PMID: 23639066 DOI: 10.3109/09638288.2013.790490] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To determine associations between multiple joint symptoms and radiographic osteoarthritis (rOA) and functional outcomes. METHOD Complete cross-sectional data for multi-joint symptoms and radiographs, Health Assessment Questionnaire (HAQ) scores, and gait speed were available for 1307 Johnston County Osteoarthritis Project participants (34% men, 32% African American, mean age 66 years). Factor analysis of symptom scores and radiographic grades for the lumbosacral spine, bilateral hands, knees, and hips provided composite scores. Regression models were used to determine associations between composite scores, HAQ, and gait speed, adjusting for age, body mass index, gender, and race. RESULTS Five rOA factors were identified: (1) IP/CMC factor (carpometacarpal [CMC] and all interphalangeal [IP] joints); (2) MCP factor (metacarpophalangeal joints 2-5); (3) Knee factor (tibiofemoral and patellofemoral joints); (4) Spine factor (L1/2 to L5/S1); and (5) Symptom factor. After adjustment, only the Symptom composite was significantly associated with HAQ and gait speed; a 1-standard deviation increase in Symptom score was associated with 9 times higher odds of having poorer function on the HAQ (odds ratio 9.32, 95% confidence interval [CI] 6.80, 12.77), and a clinically significant decline in gait speed (0.06 m/s, 95% CI -0.07, -0.05). CONCLUSIONS A novel Symptom composite score was associated with poorer functional outcomes. IMPLICATIONS FOR REHABILITATION Osteoarthritis (OA) commonly affects multiple joints and is the most common form of arthritis. Symptomatic assessments, which can be easily executed by rehabilitation practitioners, are more closely related to self-reported and performance-based functional status than are less accessible and more costly radiographs. Symptomatic assessments are likely to be more informative for understanding, treating, and potentially preventing functional limitations than radiographic assessments.
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Abstract
OBJECTIVES To determine whether pain predicts future activity of daily living (ADL) disability or death in individuals aged 60 and older. DESIGN Prospective cohort study. SETTING The 1998 to 2008 Health and Retirement Study (HRS), a nationally representative study of older community-living individuals. PARTICIPANTS Twelve thousand six hundred thirty-one participants in the 1998 HRS aged 60 and older who did not need help in any ADL. MEASUREMENTS Participants reporting that they had moderate or severe pain most of the time were defined as having significant pain. The primary outcome was time to development of ADL disability or death over 10 yrs, assessed at five successive 2-year intervals. ADL disability was defined as needing help performing any ADL: bathing, dressing, transferring, toileting, eating, or walking across a room. A discrete hazards survival model was used to examine the relationship between pain and incident disability over each 2-year interval using only participants who started the interval with no ADL disability. Several potential confounders were adjusted for at the start of each interval: demographic factors, seven chronic health conditions, and functional limitations (ADL difficulty and difficulty with five measures of mobility). RESULTS At baseline, 2,283 (18%) participants had significant pain. Participants with pain were more likely (all P < .001) to be female (65% vs 54%), have ADL difficulty (e.g., transferring 12% vs 2%, toileting 11% vs 2%), have difficulty walking several blocks (60% vs 21%), and have difficulty climbing one flight of stairs (40% vs 12%). Over 10 years, participants with pain were more likely to develop ADL disability or death (58% vs 43%, unadjusted hazard ratio (HR) = 1.67, 95% confidence interval (CI) = 1.57-1.79), although after adjustment for confounders, participants with pain were not at greater risk for ADL disability or death (HR = 0.98, 95% CI = 0.91-1.07). Adjustment for functional status almost entirely explained the difference between the unadjusted and adjusted results. CONCLUSION Although there are strong cross-sectional relationships between pain and functional limitations, individuals with pain are not at higher risk of subsequent disability or death after accounting for functional limitations. Like many geriatric syndromes, pain and disability may represent interrelated phenomena that occur simultaneously and require unified treatment paradigms.
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Affiliation(s)
- James S Andrews
- School of Medicine, Division of Geriatrics, University of California at San Francisco, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
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Serum hyaluronan levels increase with the total number of osteoarthritic joints and are strongly associated with the presence of knee and finger osteoarthritis. INTERNATIONAL ORTHOPAEDICS 2013; 37:925-30. [PMID: 23508866 DOI: 10.1007/s00264-013-1849-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 02/19/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Although serum hyaluronan (HA) levels increase in patients with osteoarthritis (OA), the association between OA severity and elevation of serum HA levels is not clear. Our purpose was to investigate the relationship between serum HA levels and OA in various anatomical sites and to detect which joints are strongly correlated with elevated serum HA levels. METHODS Seven hundred and ten individuals from the general population who participated in the Iwaki Health Promotion Project in 2008 were involved. Kellgren-Lawrence grade 2 or higher in the knee, hip, lumbar spine, finger and wrist was defined as OA. Serum HA levels were determined on the same day. Spearman's correlation coefficients between serum HA levels and total number of joints affected by OA were calculated. Linear regression was analysed with serum HA levels as the independent variable; age, gender, presence of OA and intake of supplements were used as dependent variables. RESULTS Prevalence of knee OA was 30.7 %, hip 16.8 %, lumbar spine 65.1 %, wrist 9.0 % and finger 22.0 %. Serum HA levels had a positive correlation with the number of involved joints, and the correlation coefficient was 0.410 (p < 0.001). Serum HA was significantly affected by age (β = 0.382), knee OA (β = 0.163) and finger OA (β = 0.164). CONCLUSION Although this biomarker reflects a systemic condition, higher serum HA levels were associated with total number of OA joints. Knee and finger OA were key joints related to increased serum HA levels. These results are valuable in understanding characteristics of serum HA levels as a biomarker for osteoarthritis.
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Sasaki E, Ishibashi Y, Tsuda E, Ono A, Yamamoto Y, Inoue R, Takahashi I, Umeda T, Nakaji S. Evaluation of locomotive disability using loco-check: a cross-sectional study in the Japanese general population. J Orthop Sci 2013; 18:121-9. [PMID: 23114857 DOI: 10.1007/s00776-012-0329-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 10/12/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND The purposes of this study were to reveal the prevalence of locomotive syndrome (LS) evaluated by loco-check in the Japanese general population and to analyze the relationship between radiographic knee osteoarthritis (OA) and lumbar spondylosis, metabolic syndrome and LS. Furthermore, we evaluated LS according to functional examinations. METHODS Seven hundred twenty-two volunteers aged 56.6 ± 13.6 years participated in the Iwaki Health Promotion Project in 2010 and were classified into two groups: LS (one or more disabilities) or non-LS (no disability) according to the criteria of LS proposed by the Japanese Orthopaedic Association. Radiographic knee OA and lumbar spondylosis were defined according to the Kellgren-Lawrence grade. Metabolic syndrome was defined as the presence of two or more risk factors in addition to visceral obesity. The prevalence of LS associated with knee OA, lumbar spondylosis and metabolic syndrome was compared statistically. Also, data of six functional examinations were compared between the non-LS and LS groups. RESULTS The prevalence of LS was 21.2 % in males and 35.6 % in females and increased with aging regardless of gender. The prevalence of LS with knee OA was 48.7 %, with lumbar spondylosis was 33.8 %, and with metabolic syndrome was 43.4 %. The non-LS group had significantly better performance in the functional reach and sit and reach tests than the LS group in males and females by age-adjusted comparison. CONCLUSION The prevalence of LS in the general population was higher in females than in males. A strong risk factor for LS was radiographic knee OA. Also, those with LS had loss of skeletal muscle mass, balancing and flexibility. This study showed that evaluation by loco-check was an acceptable tool to detect the early stage of locomotive disability for LS, and interventional prevention for strength, balancing and flexibility would be helpful for those with LS.
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Affiliation(s)
- Eiji Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan.
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Bennett DA, Schneider JA, Buchman AS, Barnes LL, Boyle PA, Wilson RS. Overview and findings from the rush Memory and Aging Project. Curr Alzheimer Res 2012; 9:646-63. [PMID: 22471867 DOI: 10.2174/156720512801322663] [Citation(s) in RCA: 621] [Impact Index Per Article: 51.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 12/28/2011] [Accepted: 01/31/2012] [Indexed: 12/29/2022]
Abstract
The Memory and Aging Project is a longitudinal, epidemiologic clinical-pathologic cohort study of common chronic conditions of aging with an emphasis on decline in cognitive and motor function and risk of Alzheimer's disease (AD). In this manuscript, we first summarize the study design and methods. Then, we present data on: (1) the relation of motor function to cognition, disability, and death; (2) the relation of risk factors to cognitive and motor outcomes, disability and death; (3) the relation of neuropathologic indices to cognitive outcomes; (4) the relation of risk factors to neuropathologic indices; and (5) additional study findings. The findings are discussed and contextualized.
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Affiliation(s)
- David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, 600 S. Paulina, Suite 1028, Chicago, IL 60612, USA.
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