Frailty is associated with pain and cognitive function in older people in post-acute care settings

Preoperative frailty predicts postoperative pain after total knee arthroplasty in older patients: a prospective observational study

PURPOSE

Frailty is reportedly associated with postoperative adverse outcomes and may increase the risk of post-surgical pain. Our study aimed to explore whether frailty was an independent risk factor for pain after total knee arthroplasty (TKA) in older patients.

METHODS

Included in this prospective observational study were patients aged 65 or older who underwent primary TKA. Frailty of the patients was assessed before surgery using the comprehensive geriatric assessment-frailty index and pain was evaluated before and after surgery using the Numerical Rating Scale.

RESULTS

Of the 164 patients including 125 females with a mean age of 71.4 ± 4.6 years, 51 patients were identified as being frail. Patients with chronic post-surgical pain had a significantly higher frailty index than those without chronic post-surgical pain, which was the same in patients with acute post-surgical pain. After adjusting for other confounding factors, frailty was shown to be an independent risk factor for both acute (OR: 13.23, 95% CI 3.73-46.93, P < 0.001) and chronic post-surgical pain (OR: 4.24, 95% CI 1.29-14.00, P = 0.02). The area under the receiver operating characteristic curve for frailty predicting chronic post-surgical pain was 0.73 (P < 0.001, 95% CI 0.65-0.81).

CONCLUSIONS

Our findings demonstrated that preoperative frailty in older patients was a predictor of acute and chronic post-surgical pain after TKA, suggesting that frailty assessment should become a necessary procedure before operations, especially in older patients.

The Influencing Factors of Frailty and Quality of Life in Elderly Patients After Spinal Surgery

Background

To study the related factors of frailty and quality of life in elderly patients after spinal surgery.

Methods

The anxiety, depression, frailty, and quality of life of all patients were assessed by the Anxiety screening scale (GAD-7), Depression screening scale (PHQ-9), Frailty screening scale (FRAIL), and European five-dimensional health scale (EQ-5D-5L) 1 day before surgery (DAY-0). A numeric rating scale (NRS) was used to evaluate patients' pain during activities on the 1st day (POD-1), 3rd day (POD-3), and 30th day (POD-30) after operation. FRAIL scale and EQ-5D-5L were used to evaluate patients' frailty and quality of life on POD-30 and 90th day (POD-90) after the operation.

Results

There were significant differences in age, body mass index (BMI), preoperative serum albumin level (ALB), and NRS score on POD-1 between the two groups (P<0.05). Age and PHQ-9 score were positively correlated with EQ-5D-5L score (P<0.05, r Age=0.245, rPHQ-9=0.217), and preoperative ALB level was negatively correlated with EQ-5D-5L score (P<0.05, r ALB=-0.274).

Conclusion

The older the age, the larger the BMI and the higher the NRS score on the first day after surgery, the more prone to frailty in elderly patients after spinal surgery; The older age and the lower the preoperative ALB level, the worse the quality of life in elderly patients after spinal surgery.

Does depression mediate the pain-frailty relationship? Latent variables approach

Frailty is highly prevalent among older adults. This study aims to add evidence to the mediational role of depression in the pain-frailty relationship. Data came from a sample of 2578 Spanish older adults recruited from the Survey of Health, Aging, and Retirement in Europe (SHARE). A set of competing structural equation models were performed: (a) independent prediction, (b) full mediation, and (c) partial mediation. Results showed a better fit for the partial mediation model. This model was extended including covariates. The effects of pain and depression remained relevant in the final model, which explained 91% of the frailty variance. These findings support the relevance of the pain-depression dyad in frailty development. Although the pain shows a direct impact on frailty, this association is partially mediated by depression. The interplay of these conditions could be crucial for treatment effectiveness.

The prevalence and intensity of pain in older people living in retirement villages in Auckland, New Zealand

Chronic pain is common in older people. However, little is known about how pain is experienced in residents of retirement villages ('villages'), and how pain intensity and associations are experienced in relation to characteristics of residents and village living. We thus aimed to examine pain levels, prevalence and associated factors in village residents. The current paper is a cross-sectional analysis of baseline data from the 'Older People in Retirement Villages' study in Auckland, New Zealand. Between July 2016 and August 2018, 578 village residents were interviewed face-to-face by gerontology nurse specialists, using interRAI Community Health Assessment (CHA) and customised survey. We used a validated pain scale and multivariable logistic regression analyses adjusted for pre-specified confounders. Residents' median age was 82 years; 420 (73%) were female; 270 (47%) exhibited/reported daily pain, and in 11% this was severe. After controlling for confounders, daily pain was positively associated with self-reported arthritis (OR = 3.88, 95% CI = 2.57-5.87), poor/fair self-reported health (OR = 3.19, 95% CI = 1.29-7.93), having no health clinic on-site (OR = 1.76, 95% CI = 1.10-2.83), and minimal fatigue (diminished energy but completes normal day-to-day activities) (OR = 1.77, 95% CI = 1.11-2.81). Similar associations were observed for levels of pain. We conclude that levels of pain and prevalence of daily pain are high in village residents. Self-reported arthritis, self-reported poor/fair health, no health clinic on-site and minimal fatigue are all independently associated with a higher risk of daily pain and with levels of pain. This study suggests potential opportunities for villages to better provide on-site support to decrease prevalence and severity of pain for their residents, and thus potentially increase wellbeing and quality-of-life, though as we cannot prove causality, more research is needed.