1
|
Scheliga S, Dohrn MF, Habel U, Lampert A, Rolke R, Lischka A, van den Braak N, Spehr M, Jo HG, Kellermann T. Reduced Gray Matter Volume and Cortical Thickness in Patients With Small-Fiber Neuropathy. THE JOURNAL OF PAIN 2024; 25:104457. [PMID: 38211845 DOI: 10.1016/j.jpain.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 12/08/2023] [Accepted: 01/02/2024] [Indexed: 01/13/2024]
Abstract
Small-fiber neuropathy (SFN) is defined by degeneration or dysfunction of peripheral sensory nerve endings. Central correlates have been identified on the level of gray matter volume (GMV) and cortical thickness (CT) changes. However, across SFN etiologies knowledge about a common structural brain signature is still lacking. Therefore, we recruited 26 SFN patients and 25 age- and sex-matched healthy controls to conduct voxel-based- and surface-based morphometry. Across all patients, we found reduced GMV in widespread frontal regions, left caudate, insula and superior parietal lobule. Surface-based morphometry analysis revealed reduced CT in the right precentral gyrus of SFN patients. In a region-based approach, patients had reduced GMV in the left caudate. Since pathogenic gain-of-function variants in voltage-gated sodium channels (Nav) have been associated with SFN pathophysiology, we explored brain morphological patterns in a homogenous subsample of patients carrying rare heterozygous missense variants. Whole brain- and region-based approaches revealed GMV reductions in the bilateral caudate for Nav variant carriers. Further research is needed to analyze the specific role of Nav variants for structural brain alterations. Together, we conclude that SFN patients have specific GMV and CT alterations, potentially forming potential new central biomarkers for this condition. Our results might help to better understand underlying or compensatory mechanisms of chronic pain perception in the future. PERSPECTIVE: This study reveals structural brain changes in small-fiber neuropathy (SFN) patients, particularly in frontal regions, caudate, insula, and parietal lobule. Notably, individuals with SFN and specific Nav variants exhibit bilateral caudate abnormalities. These findings may serve as potential central biomarkers for SFN and provide insights into chronic pain perception mechanisms.
Collapse
Affiliation(s)
- Sebastian Scheliga
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty RWTH Aachen University, Aachen, Germany
| | - Maike F Dohrn
- Department of Neurology, Medical Faculty RWTH Aachen University, Aachen, Germany
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty RWTH Aachen University, Aachen, Germany; Institute of Neuroscience and Medicine: JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
| | - Angelika Lampert
- Institute of Neurophysiology, Medical Faculty RWTH Aachen University, Aachen, Germany
| | - Roman Rolke
- Department of Palliative Medicine, Medical Faculty RWTH Aachen University, Aachen, Germany
| | - Annette Lischka
- Institute for Human Genetics and Genomic Medicine, Medical Faculty RWTH Aachen University, Aachen, Germany
| | | | - Marc Spehr
- Department of Chemosensation, RWTH Aachen University, Institute for Biology II, Aachen, Germany
| | - Han-Gue Jo
- School of Computer Information and Communication Engineering, Kunsan National University, Gunsan, South Korea
| | - Thilo Kellermann
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty RWTH Aachen University, Aachen, Germany; Institute of Neuroscience and Medicine: JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
| |
Collapse
|
2
|
Davis DL, Almardawi R, Beamer BA, Ryan AS, Terrin ML. Shoulder pain, health-related quality of life and physical function in community-dwelling older adults. FRONTIERS IN AGING 2023; 4:1176706. [PMID: 37483647 PMCID: PMC10359925 DOI: 10.3389/fragi.2023.1176706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/29/2023] [Indexed: 07/25/2023]
Abstract
The impact of shoulder pain on health-related quality of life and physical function among community-dwelling older adults (>60 years) not seeking medical care is not well understood. Forty-four community-dwelling older adult volunteers with low comorbidity were stratified into two groups by the presence (n = 18) or absence (n = 26) of shoulder pain. Participants completed the 36-Item Short Form and American Shoulder and Elbow Surgeon surveys and received shoulder range of motion and magnetic resonance imaging testing. Participants with shoulder pain perceived more difficulty accomplishing usual tasks secondary to their physical and emotion health and displayed inferior shoulder function, relative to participants without shoulder pain. This study suggests that shoulder pain reduces quality of life and physical function in the population of community-dwelling older adults not seeking medical evaluation for their symptoms.
Collapse
Affiliation(s)
- Derik L. Davis
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Ranyah Almardawi
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Brock A. Beamer
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
- Baltimore Geriatric Research and Education Clinical Center (GRECC), Veterans Affairs Medical Center, Baltimore, MD, United States
| | - Alice S. Ryan
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
- Baltimore Geriatric Research and Education Clinical Center (GRECC), Veterans Affairs Medical Center, Baltimore, MD, United States
| | - Michael L. Terrin
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
| |
Collapse
|
3
|
Afunugo WE, Li CY, Chou LN, Ward F, Snih SA. Pain, obesity, and physical function in Mexican American older adults during 20 years of follow-up. PM R 2023; 15:331-341. [PMID: 35322569 PMCID: PMC9500111 DOI: 10.1002/pmrj.12805] [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: 09/09/2021] [Revised: 02/18/2022] [Accepted: 03/16/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Pain remains largely undertreated in older adults irrespective of health care setting. Mexican American adults in the United States have a high age-adjusted prevalence of obesity. However, the association of pain and obesity with physical function is understudied in this population. OBJECTIVE To examine the association of co-occurring pain and obesity with physical function over 20 years of follow-up in a cohort of older Mexican Americans who scored ≥7 (moderate to high) in the Short Physical Performance Battery (SPPB) test and were nondisabled at baseline. DESIGN Longitudinal population-based study. SETTING Community-dwelling older adults from Southwestern United States. PARTICIPANTS Mexican American adults age 65 years and older. INTERVENTIONS Not Applicable. MAIN OUTCOME MEASURES Physical function was assessed with the SPPB test (standing balance, timed 8-ft walk, and five repeated timed chair stands). Participants at baseline were divided into four groups: no pain-no obesity (n = 869), obesity only (n = 282), pain only (n = 216), and pain-obesity (n = 159). Generalized Estimating Equation models were used to estimate the odds ratio (OR) and 95% confidence interval (CI) of lower performance in physical function over 20 years as a function of pain-obesity grouping. RESULTS Participants with pain only (OR = 1.61, 95% CI = 1.34-1.95) and with co-occurring pain and obesity (OR = 2.32, 95% CI = 1.83-2.95) had significantly greater odds of physical function impairment over those with no pain-no obesity or obesity only, after controlling for all covariates. CONCLUSION Older Mexican American adults were at high risk for physical function impairment over time if they had pain or co-occurring pain and obesity. Early assessment and proper pain management as well as maintaining a healthy weight may reduce declines in physical function in older Mexican American adults.
Collapse
Affiliation(s)
- Wilma E. Afunugo
- School of Medicine. The University of Texas Medical Branch, Galveston, TX, USA
| | - Chih-Ying Li
- Department of Occupational Therapy. The University of Texas Medical Branch, Galveston, TX, USA
| | - Lin-Na Chou
- Department of Preventive Medicine and Population Health. The University of Texas Medical Branch, Galveston, TX, USA
| | - Frank Ward
- Department of Nutrition, Metabolism, and Rehabilitation Sciences. The University of Texas Medical Branch, Galveston, TX, USA
| | - Soham Al Snih
- Department of Nutrition, Metabolism, and Rehabilitation Sciences. The University of Texas Medical Branch, Galveston, TX, USA
- Division of Geriatrics & Palliative Medicine/Department of Internal Medicine. The University of Texas Medical Branch, Galveston, TX, USA
- Sealy Center on Aging. The University of Texas Medical Branch, Galveston, TX, USA
| |
Collapse
|
4
|
Martire LM, Zhaoyang R, Marini CM, Nah S. Dyadic Links Between Health Changes and Well-Being: The Role of Non-Spousal Confidants. JOURNAL OF SOCIAL AND PERSONAL RELATIONSHIPS 2022; 39:2617-2638. [PMID: 37033718 PMCID: PMC10079281 DOI: 10.1177/02654075221086509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Although the marital relationship is often the primary source of emotional support in adulthood, sole reliance on the spouse to discuss health-related issues may be harmful to the well-being of both partners. The first aim of this study was to examine whether declines in health during later life would be associated with poorer psychological well-being in self and partner. We further investigated whether declining health would have a stronger impact on own and partner psychological well-being in the absence of non-spousal health confidants. Longitudinal actor-partner interdependence models (APIMs) were used to test both hypotheses with dyadic data from Wave 2 (2010-2011) and Wave 3 (2015-2016) of the National Social Life, Health, and Aging Project (NSHAP). Contrary to prediction, increased anxiety following spousal declines in gait speed and cognitive function occurred for those whose spouse did (rather than did not) have additional health confidants. A much fuller understanding is needed in regard to whether close relationships provide resources or present unwanted complications to dyadic coping, and the processes by which effects occur.
Collapse
Affiliation(s)
- Lynn M Martire
- Department of Human Development and Family Studies and Center for Healthy Aging, The Pennsylvania State University
| | | | | | - Suyoung Nah
- Department of Human Development and Family Studies and Center for Healthy Aging, The Pennsylvania State University
| |
Collapse
|
5
|
Davis DL, Almardawi R, Terrin ML. Identification of Community-Dwelling Older Adults With Shoulder Dysfunction: A Pilot Study to Evaluate the Disabilities of the Arm, Shoulder and Hand Survey. Geriatr Orthop Surg Rehabil 2022; 13:21514593221129177. [PMID: 36250187 PMCID: PMC9554132 DOI: 10.1177/21514593221129177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/16/2022] [Accepted: 09/09/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction The Disabilities of the Arm, Shoulder and Hand (DASH) survey estimates the upper limbs' dysfunction in one score, but limited evidence exists to justify use of DASH to screen older adults for shoulder dysfunction at routine health maintenance primary care visits. We sought (1) to determine if the DASH, American Shoulder and Elbow Surgeons (ASES) and Simple Shoulder Test (SST) surveys are related to one another and (2) to determine the relationship of DASH, ASES and SST scores with 36-Item Short Form (SF-36) subscales, shoulder forward flexion range of motion (FF-ROM) and abduction (ABD-ROM) in older adults. Methods Prospective pilot study of 23 community-dwelling adult volunteers [mean age (± standard deviation), 69.3 ± 6.7 years; range, 61-84 years, with no rotator cuff repair or joint replacement. Shoulder MRI, ROM testing, DASH, ASES, SST, SF-36, Katz activities of daily living (ADLs), and Lawton-Brody instrumental ADLs (IADLs) were completed at one time point. Descriptive and correlation analyses were performed. Results Means: DASH, 17.4 ± 19.5; ASES, 81.3 ± 19.7; SST, 71.7 ± 28.5; Katz ADLs, 5.9 ± .3; Lawton-Brody IADLs, 8.0 ± .0; FF-ROM, 140.2° ± 31.5°; and ABD-ROM, 128.3° ± 31.9°. Nearly 48% had supraspinatus tendon tear. Correlation among DASH, ASES, and SST was strong (|rho ≥.88|; P < .001). DASH, ASES, and SST had strong correlation (|rho ≥.71|;P < .001) with shoulder FF-ROM and ABD-ROM. DASH had near equivalent or slightly stronger correlation for all SF-36 subscales relative to ASES and SST. DASH showed strong or moderate correlation (P < .05) to most SF-36 subscales. Conclusion DASH, ASES and SST strongly correlated with one another. DASH, relative to ASES and SST, has similar correlation to shoulder FF-ROM, ABD-ROM and SF-36 subscales in older adults. Our pilot study suggests that the DASH survey has potential utility to identify occult shoulder dysfunction in community-dwelling older adults who have normal Katz ADLs and Lawton-Brody IADLs if administered during routine health maintenance primary care visits.
Collapse
Affiliation(s)
- Derik L Davis
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ranyah Almardawi
- Department of Epidemiology and Public Health, Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael L Terrin
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
6
|
Bedree H, Miller SA, Buscemi J, Greenley RN, Tran ST. Using Technology to Assess Bidirectionality between Daily Pain and Physical Activity: The Role of Marginalization during Emerging Adulthood. CHILDREN-BASEL 2021; 8:children8090756. [PMID: 34572188 PMCID: PMC8472665 DOI: 10.3390/children8090756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/20/2021] [Accepted: 08/27/2021] [Indexed: 11/16/2022]
Abstract
Emerging adulthood is often overlooked as a developmental time period critical to shaping future health outcomes. Recurrent pain is a commonly experienced health concern within this age group, particularly headaches and low back pain, and early experiences of recurrent pain are related to subsequent chronic pain and disability. Furthermore, adults from marginalized populations report more frequent and severe recurrent pain. Many studies have demonstrated the therapeutic effect of physical activity on pain relief; however, others have demonstrated that physical activity can also exacerbate pain symptoms. Therefore, the current study aimed to (1) assess a bidirectional relationship between reported pain and engagement in physical activity among an emerging adult sample (N = 265) and (2) determine whether sociodemographic factors moderate this relationship. Using longitudinal daily reported pain and ActiGraph monitor data collected over two weeks, a novel dynamic structural equation modeling approach was employed. Results indicated no significant cross-lagged relationships between pain and physical activity, and no significant moderation effects. These findings suggest that a bidirectional relationship does not exist among a diverse college sample of emerging adults even after considering sociodemographic moderators. Excellent retention and few missing data suggest that using accelerometers and daily diaries are feasible methods to collect data in this population. Sample considerations and future analytical approaches are discussed.
Collapse
Affiliation(s)
- Helen Bedree
- Department of Psychology, DePaul University, Chicago, IL 60614, USA; (J.B.); (S.T.T.)
- Correspondence:
| | - Steven A. Miller
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA; (S.A.M.); (R.N.G.)
| | - Joanna Buscemi
- Department of Psychology, DePaul University, Chicago, IL 60614, USA; (J.B.); (S.T.T.)
| | - Rachel Neff Greenley
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA; (S.A.M.); (R.N.G.)
| | - Susan T. Tran
- Department of Psychology, DePaul University, Chicago, IL 60614, USA; (J.B.); (S.T.T.)
| |
Collapse
|
7
|
D'Aiuto C, Gamm S, Grenier S, Vasiliadis HM. The association between chronic pain conditions and subclinical and clinical anxiety among community-dwelling older adults consulting in primary care. PAIN MEDICINE 2021; 23:1118-1126. [PMID: 34260733 DOI: 10.1093/pm/pnab213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine associations between chronic pain conditions, pain level, and subclinical/clinical anxiety in community-dwelling older adults. DESIGN Cross-sectional associations were analyzed using multinomial logistic regression to compare the odds of having subclinical/clinical anxiety by painful condition and pain level, controlling for confounders. SETTING Participants were recruited in primary care waiting rooms to take part in the first wave of the Étude sur la Santé des Aînés (ESA)-Services study. SUBJECTS 1608 older adults aged 65+. METHODS Clinical anxiety was assessed using DSM-IV criteria. Subclinical anxiety was considered present when participants endorsed symptoms of anxiety but did not fulfill clinical diagnostic criteria for an anxiety disorder. Painful chronic conditions included arthritis, musculoskeletal conditions, gastrointestinal problems, and headaches/migraines. Presence of painful conditions was assessed using combined self-report and health administrative data sources. Pain level was self-reported on an ordinal scale. Physical comorbidities were identified from ICD-9/10 diagnostic codes and depression was evaluated based on the DSM-IV. RESULTS Sixty-six percent of home-living older adults suffer from a chronic pain condition. Older adults with clinical anxiety are more likely to experience musculoskeletal pain, gastrointestinal problems, headaches/migraines, and higher pain levels compared to those with no anxiety. Also, those with ≥3 painful conditions are at greater risk for subclinical and clinical anxiety compared to those with no painful condition. CONCLUSIONS These results emphasize the need for assessing anxiety symptoms in older adults with chronic pain conditions. Comprehensive management of comorbid chronic pain and psychopathology might help reduce the burden for patients and the healthcare system.
Collapse
Affiliation(s)
- Carina D'Aiuto
- Faculty of Medicine and Health Sciences, Campus de Longueuil - Université de Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, Quebec, Canada J4K 0A8.,Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les Innovations en Santé, 150 Place Charles-Le Moyne, Longueuil, Quebec, Canada J4K 0A8
| | - Simone Gamm
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, 4565 Queen Mary Rd, Montreal, Quebec, Canada H3W 1W5.,Department of Psychology, Université de Montréal, 90 Vincent D'Indy Ave, Montreal, Quebec, Canada H2V 2S9
| | - Sébastien Grenier
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, 4565 Queen Mary Rd, Montreal, Quebec, Canada H3W 1W5.,Department of Psychology, Université de Montréal, 90 Vincent D'Indy Ave, Montreal, Quebec, Canada H2V 2S9
| | - Helen-Maria Vasiliadis
- Faculty of Medicine and Health Sciences, Campus de Longueuil - Université de Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, Quebec, Canada J4K 0A8.,Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les Innovations en Santé, 150 Place Charles-Le Moyne, Longueuil, Quebec, Canada J4K 0A8
| |
Collapse
|
8
|
Atalla SW, Cowan RL, Anderson AR, Dietrich MS, Iversen L, Beth Kalvas L, Moss KO, Wright K, Monroe TB. Determining the impact of age and sex on the psychophysical and neurophysiological response to thermal pain across the adult lifespan. J Adv Nurs 2021; 77:1546-1555. [PMID: 33450111 PMCID: PMC7898385 DOI: 10.1111/jan.14514] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/19/2020] [Accepted: 07/07/2020] [Indexed: 01/07/2023]
Abstract
AIMS Determine sex- and age-associated psychophysical and neurophysiological differences in the processing of pain across the adult lifespan. DESIGN Preliminary, exploratory, cross-sectional study. METHODS Using psychophysics (to measure intensity and unpleasantness) and functional magnetic resonance imaging blood oxygenation level dependent methods (to measure stimulus-evoked brain activation), we will examine sex- and age-associated differences in thermal pain processing and their underlying neurophysiology in a broad range of healthy adults (ages 30-89). We will acquire resting state functional connectivity data for secondary analyses exploring whether resting state connectivity predicts psychophysical and neurophysiological responses to thermal pain. To examine the effects of altered blood flow, we will acquire resting-state arterial spin labeling magnetic resonance imaging data to quantify resting cerebral blood flow. We will interpret findings in the context of a proposed neural model of pain, ageing, and sex. Study funding was received in June of 2014. Ethical approval was obtained from the Vanderbilt University IRB prior to study initiation. CONCLUSION Exploring the biological reasons for age- and sex-associated differences in pain processing will increase our understanding of pain in older adults. The paucity of neurobiological evidence to support best practice pain management in older adults places these individuals at risk for poor pain management. IMPACT Poorly treated pain in older adults is a critical public health problem associated with a poor quality of life and increased healthcare costs. Understanding how age and sex have an impact on central processing of pain across the lifespan is a critical step toward improving personalized pain medicine.
Collapse
Affiliation(s)
- Sebastian W. Atalla
- The Ohio State University College of NursingColumbusOHUSA
- Vanderbilt University Medical Center Psychiatric Neuroimaging ProgramNashvilleTNUSA
| | - Ronald L. Cowan
- Vanderbilt University Medical Center Psychiatric Neuroimaging ProgramNashvilleTNUSA
- Vanderbilt University Medical Center Institute of Imaging ScienceNashvilleTNUSA
- Vanderbilt University Department of Psychiatry and Behavioral SciencesNashvilleTNUSA
| | - Alison R. Anderson
- Vanderbilt University Medical Center Psychiatric Neuroimaging ProgramNashvilleTNUSA
- Vanderbilt University School of NursingNashvilleTNUSA
| | | | - Larkin Iversen
- The Ohio State University College of NursingColumbusOHUSA
| | | | - Karen O. Moss
- The Ohio State University College of NursingColumbusOHUSA
| | - Kathy Wright
- The Ohio State University College of NursingColumbusOHUSA
| | - Todd B. Monroe
- The Ohio State University College of NursingColumbusOHUSA
| |
Collapse
|
9
|
Wettstein M, Spuling SM, Cengia A, Nowossadeck S, Tesarz J. Associations of Age and Pain With 9-Year Functional Health Trajectories. GEROPSYCH 2020. [DOI: 10.1024/1662-9647/a000221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract. We investigated whether information-processing speed and accommodative coping moderate associations of age and pain with 9-year functional health trajectories. Our sample consisted of 5,254 participants of the German Ageing Survey aged 40 years and older ( M = 62.33 years) who participated in up to four measurement occasions. After controlling for sex, chronic diseases, and education, our longitudinal multilevel regression models revealed that the association of older age and higher pain severity with lower functional health was weaker in individuals with higher processing speed. The relationship between pain and functional health was weaker in individuals with higher scores on accommodative coping. Our findings suggest that processing speed and accommodative coping may be important compensatory resources buffering negative associations of age and pain with functional health.
Collapse
Affiliation(s)
| | | | - Anja Cengia
- German Centre of Gerontology, Berlin, Germany
| | | | - Jonas Tesarz
- Medical Hospital, Heidelberg University, Heidelberg, Germany
| |
Collapse
|
10
|
Nanda A, Baptist AP, Divekar R, Parikh N, Seggev JS, Yusin JS, Nyenhuis SM. Asthma in the older adult. J Asthma 2019; 57:241-252. [PMID: 30656998 DOI: 10.1080/02770903.2019.1565828] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective: The older adult population is increasing worldwide, and a significant percentage has asthma. This review will discuss the challenges to diagnosis and management of asthma in older adults. Data Sources: PubMed was searched for multiple terms in various combinations, including asthma, older adult, elderly, comorbid conditions, asthma diagnosis, asthma treatment, biologics and medication side effects, and adverse events. From the search, the data sources that were utilized included peer reviewed scholarly review articles, peer reviewed scientific research articles, and peer reviewed book chapters. Study Selections: Study selections that were utilized included peer reviewed scholarly review articles, peer reviewed scientific research articles, and peer reviewed book chapters. Results: Asthma in older adults is frequently underdiagnosed and has higher morbidity and mortality rates compared to their younger counterparts. A detailed history and physical examination as well as judicious testing are essential to establish the asthma diagnosis and exclude alternative ones. Medical comorbidities, such as cardiovascular disease, cognitive impairment, depression, arthritis, gastroesophageal reflux disease (GERD), rhinitis, and sinusitis are common in this population and should also be assessed and treated. Non-pharmacologic management, including asthma education on inhaler technique and self-monitoring, is vital. Pharmacologic management includes standard asthma therapies such as inhaled corticosteroids (ICS), inhaled corticosteroid-long acting β-agonist combinations (ICS-LABA), leukotriene antagonists, long acting muscarinic antagonists (LAMA), and short acting bronchodilators (SABA). Newly approved biologic agents may also be utilized. Older adults are more vulnerable to polypharmacy and medication adverse events, and this should be taken into account when selecting the appropriate asthma treatment. Conclusions: The diagnosis and management of asthma in older adults has certain challenges, but if the clinician is aware of them, the morbidity and mortality of this condition can be improved in this growing population.
Collapse
Affiliation(s)
- Anil Nanda
- Asthma and Allergy Center, Lewisville and Flower Mound, TX, USA.,Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alan P Baptist
- Division of Allergy and Immunology, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Rohit Divekar
- Division of Allergy and Immunology, Mayo Clinic, Rochester, MN, USA
| | - Neil Parikh
- Capital Allergy and Respiratory Disease Center, Sacramento, CA, USA
| | - Joram S Seggev
- Department of Internal Medicine, Roseman University College of Medicine, Las Vegas, NV, USA
| | - Joseph S Yusin
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Sharmilee M Nyenhuis
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
11
|
Ojagbemi A, Bello T, Luo Z, Gureje O. Chronic Conditions, New Onset, and Persistent Disability in the Ibadan Study of Aging. J Gerontol A Biol Sci Med Sci 2017; 72:997-1005. [PMID: 27038233 DOI: 10.1093/gerona/glv188] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/24/2015] [Indexed: 11/13/2022] Open
Abstract
Background. Information about the contribution of chronic conditions to disability in the sub-Saharan African older persons is derived from implicit data. We investigated the association of chronic conditions with incident and persistent disability among community-dwelling elderly Nigerians. Methods. We followed disability-free participants in a household cluster randomized sample of 2,149 Nigerians, aged 65 years or older, in three waves over 5 years (2003-2009). Disability was measured using culturally adapted tools. Dementia and depression were ascertained using validated interviewer-administered measures. The presence of pain in six sites, angina, systemic hypertension, diabetes, heart and respiratory disease, and vision and hearing impairment were assessed using standardized self-report of clinician diagnoses. Independent predictors of disability were investigated using separate multivariate binomial and multinomial regression models with Bonferroni corrections. Results. Among 1,887 disability-free participants, 457 (24.2%) had incident disability over 5 years; there were 234 (12.4%), 177 (9.4%), and 106 (5.6%) new cases in each of the waves. A total of 181 (10.0%) persons had disability persistently. Having a pain condition (relative risk ratio [RRR] = 4.7, 95% confidence interval [CI] = 2.0-11.0), especially when nonlocalizing (RRR = 1.5, 95% CI = 1.0-2.2), was the main predictor of incident disability in the study. Dementia was associated with cumulative deaths over 5 years (RRR = 3.5, 95% CI = 2.3-5.3). There were no significant associations between having a chronic condition and persistent disability following correction for false discovery rates. Conclusion. Using direct measurements, musculoskeletal pain appears to be the most disabling condition in this sub-Saharan African elderly cohort surviving for up to 5 years with chronic conditions. Dementia may be associated with early death.
Collapse
Affiliation(s)
- Akin Ojagbemi
- World Health Organization (WHO) Collaborating Centre for Research and Training in Mental Health, Neuroscience, and Substance Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Toyin Bello
- World Health Organization (WHO) Collaborating Centre for Research and Training in Mental Health, Neuroscience, and Substance Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Zhehui Luo
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing
| | - Oye Gureje
- World Health Organization (WHO) Collaborating Centre for Research and Training in Mental Health, Neuroscience, and Substance Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Abstract
Given the current demographic changes there are an increasing number of elderly and very elderly patients in outpatient and inpatient care. Elderly and very elderly patients often suffer from pain and musculoskeletal conditions are a common cause of pain in the elderly. An effective pain management should not be withheld from elderly patients with rheumatic diseases. Untreated pain in elderly patients leads to functional impairment and immobility. In addition, the quality of life of patients is negatively affected and can lead to a loss of autonomy and/or social withdrawal. The treatment of elderly and very elderly patients is particularly challenging. There are special features that need to be considered in the choice of treatment. Altered pain presentation, comorbidities, nonadherence, polypharmacy and side effects of pain medications require a critical risk-benefit assessment and ongoing treatment monitoring of this special group of patients.
Collapse
|
14
|
Abstract
Locomotive syndrome is a condition of reduced mobility due to impairment of locomotive organs. Since upright bipedal walking involves minutely controlled movement patterns, impairment of any aspect of the locomotive organs has the potential to adversely affect it. In addition to trauma, chronic diseases of the locomotive organs, which progress with repeated bouts of acute exacerbations, are common causes of the locomotive syndrome. In Japan's super-aging society, many people are likely to experience locomotive syndrome in the later part of their lives. Exercise intervention is effective in improving motor function, but because the subjects are elderly people with significant degenerative diseases of the locomotor organs, caution should be taken in choosing the type and intensity of exercise. The present review discusses the definition, current burden, diagnosis and interventions pertaining to the locomotive syndrome. The concept and measures are spreading throughout Japan as one of the national health policy targets.
Collapse
|
15
|
Krebs EE, Paudel M, Taylor BC, Bauer DC, Fink HA, Lane NE, Ensrud KE. Association of Opioids with Falls, Fractures, and Physical Performance among Older Men with Persistent Musculoskeletal Pain. J Gen Intern Med 2016; 31:463-9. [PMID: 26754689 PMCID: PMC4835377 DOI: 10.1007/s11606-015-3579-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 08/04/2015] [Accepted: 11/10/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although older adults are disproportionately affected by painful musculoskeletal conditions and receive more opioid analgesics than persons in other age groups, insufficient evidence is available regarding opioid harms in this age group. OBJECTIVE To examine longitudinal relationships between opioid use and falls, clinical fractures, and changes in physical performance. We hypothesized that opioid use would be associated with greater risks of falling and incident clinical fractures and greater declines in physical performance. DESIGN We analyzed data from the Osteoporotic Fractures in Men Study (MrOS), a large prospective longitudinal cohort study. Participants completed baseline visits from 2000 to 2002 and were followed for 9.1 (SD 4.0) years. PARTICIPANTS MrOS enrolled 5994 community-dwelling men ≥ 65 years of age. The present study included 2902 participants with back, hip, or knee pain most or all of the time at baseline. MAIN MEASURES The exposure of interest was opioid use, defined at each visit as participant-reported daily or near-daily use of any opioid-containing analgesic. Among patients, 309 (13.4 %) reported opioid use at one or more visits. Participants were queried every 4 months about falls and fractures. Physical performance scores were derived from tests of grip strength, chair stands, gait speed, and dynamic balance. KEY RESULTS In the main analysis, the adjusted risk of falling did not differ significantly between opioid use and non-use groups (RR 1.10, 95% CI 0.99, 1.24). Similarly, adjusted rates of incident clinical fracture did not differ between groups (HR 1.13, 95% CI 0.94, 1.36). Physical performance was worse at baseline for the opioid use group, but annualized change in physical performance scores did not differ between groups (-0.022, 95% CI -0.138, 0.093). CONCLUSIONS Additional research is needed to determine whether opioid use is a marker of risk or a cause of falls, fractures, and progressive impairment among older adults with persistent pain.
Collapse
Affiliation(s)
- Erin E Krebs
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA.
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Misti Paudel
- Department of Epidemiology, University of Minnesota School of Public Health, Minneapolis, MN, USA
- NORC at the University of Chicago, Bethesda, MD, USA
| | - Brent C Taylor
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
- Department of Epidemiology, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | | | - Howard A Fink
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
- Geriatric Research Education and Clinical Center, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Nancy E Lane
- University of California at San Francisco, San Francisco, CA, USA
| | - Kristine E Ensrud
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
- Department of Epidemiology, University of Minnesota School of Public Health, Minneapolis, MN, USA
| |
Collapse
|
16
|
Tomioka K, Harano A, Hazaki K, Morikawa M, Iwamoto J, Saeki K, Okamoto N, Kurumatani N. Walking speed is associated with self-perceived hearing handicap in high-functioning older adults: The Fujiwara-kyo study. Geriatr Gerontol Int 2014; 15:745-54. [DOI: 10.1111/ggi.12344] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Kimiko Tomioka
- Department of Community Health and Epidemiology; Nara Medical University; Kashihara Japan
| | - Akihiro Harano
- Department of Orthopedic Surgery; Nara Medical University; Kashihara Japan
| | - Kan Hazaki
- Department of Physical Therapy; Osaka Electro-Communication University; Shijonawate Japan
| | | | - Junko Iwamoto
- Department of Nursing; Tenri Health Care University; Tenri Japan
| | - Keigo Saeki
- Department of Community Health and Epidemiology; Nara Medical University; Kashihara Japan
| | - Nozomi Okamoto
- Department of Community Health and Epidemiology; Nara Medical University; Kashihara Japan
| | - Norio Kurumatani
- Department of Community Health and Epidemiology; Nara Medical University; Kashihara Japan
| |
Collapse
|
17
|
Gnjidic D, Blyth FM, Le Couteur DG, Cumming RG, McLachlan AJ, Handelsman DJ, Seibel M, Waite L, Naganathan V. Nonsteroidal anti-inflammatory drugs (NSAIDs) in older people: prescribing patterns according to pain prevalence and adherence to clinical guidelines. Pain 2014; 155:1814-1820. [PMID: 24954164 DOI: 10.1016/j.pain.2014.06.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 06/12/2014] [Accepted: 06/16/2014] [Indexed: 01/21/2023]
Abstract
The evidence on the patterns of nonsteroidal anti-inflammatory drug (NSAID) use according to pain prevalence and clinical guidelines in older people is sparse. This cross-sectional study examined the patterns of NSAID use according to pain prevalence and concordance with clinical guideline recommendations for safe NSAID use in older people, in relation to duration of use, patterns of use, concomitant use of proton pump inhibitors (PPIs), and prevalence of specific drug interactions. Community-dwelling men (n=1696) age ≥ 70 years living in Sydney were studied. 8.2% (n=139) of participants reported regular NSAID use compared with 2.9% (n=50) reporting as-needed use. The mean treatment duration for regular NSAID use was 4.9 years, suggesting long-term rather than short-term use as recommended by the guidelines. Although guidelines recommend use of PPIs together with an NSAID, only 25.2% of regular NSAID users reported PPI use. Regular NSAID users were significantly more likely to report use of opioid analgesics (P<.0001) compared with nonregular users. In relation to pain prevalence, regular NSAID users were significantly more likely to report chronic pain (P<.0001), recent pain (P=.0001), and chronic intrusive pain (P<.0001) compared with nonregular users. The findings of this study indicate that NSAID prescribing practices do not align with clinical guidelines for safe use in older people. This difference between the guideline recommendations and what is happening in the real world should be explored further.
Collapse
Affiliation(s)
- Danijela Gnjidic
- Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia Sydney Medical School, University of Sydney, Sydney, NSW, Australia Centre for Education and Research on Ageing and Concord RG Hospital, Sydney, NSW, Australia ANZAC Research Institute, Concord Hospital, Sydney, NSW, Australia Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Pereira LSM, Sherrington C, Ferreira ML, Tiedemann A, Ferreira PH, Blyth FM, Close JCT, Taylor M, Lord SR. Self-reported chronic pain is associated with physical performance in older people leaving aged care rehabilitation. Clin Interv Aging 2014; 9:259-65. [PMID: 24523583 PMCID: PMC3921084 DOI: 10.2147/cia.s51807] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background/objectives The impact of pain on the physical performance of patients in aged care rehabilitation is not known. The study sought to assess 1) the prevalence of pain in older people being discharged from inpatient rehabilitation; 2) the association between self-reported pain and physical performance in people being discharged from inpatient rehabilitation; and 3) the association between self-reported pain and physical performance in this population, after adjusting for potential confounding factors. Methods This was an observational cross-sectional study of 420 older people at two inpatient aged care rehabilitation units. Physical performance was assessed using the Lower Limb Summary Performance Score. Pain was assessed with questions about the extent to which participants were troubled by pain, the duration of symptoms, and the impact of chronic pain on everyday activity. Depression and the number of comorbidities were assessed by questionnaire and medical file audit. Cognition was assessed with the Mini-Mental State Examination. Results Thirty percent of participants reported chronic pain (pain lasting more than 3 months), and 17% reported that this pain interfered with daily activities to a moderate or greater extent. Chronic pain (P=0.013) and chronic pain affecting daily activities (P<0.001) were associated with a poorer Lower Limb Summary Performance Score. The relationship between chronic pain affecting daily activities and Lower Limb Summary Performance Score remained significant (P=0.001) after adjusting for depression, age, comorbidities, and Mini-Mental State Examination score. This model explained 10% of the variability in physical performance. Conclusion One-third of participants reported chronic pain, and close to one-fifth reported that this pain interfered with daily activities. Chronic pain was associated with impaired physical performance, and this relationship persisted after adjusting for likely confounding factors.
Collapse
Affiliation(s)
- Leani Souza Máximo Pereira
- Department of Physiotherapy, School of Physical Education, Physiotherapy, and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil ; Musculoskeletal Division, The George Institute for Global Health, The University of Sydney, Sydney, Australia
| | - Catherine Sherrington
- Musculoskeletal Division, The George Institute for Global Health, The University of Sydney, Sydney, Australia ; Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - Manuela L Ferreira
- Musculoskeletal Division, The George Institute for Global Health, The University of Sydney, Sydney, Australia
| | - Anne Tiedemann
- Musculoskeletal Division, The George Institute for Global Health, The University of Sydney, Sydney, Australia ; Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - Paulo H Ferreira
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Fiona M Blyth
- Pain Management and Research Institute, Royal North Shore Hospital, The University of Sydney, Sydney, Australia
| | - Jacqueline C T Close
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia ; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Morag Taylor
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia ; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| |
Collapse
|
19
|
Monroe TB, Misra SK, Habermann RC, Dietrich MS, Cowan RL, Simmons SF. Pain reports and pain medication treatment in nursing home residents with and without dementia. Geriatr Gerontol Int 2013; 14:541-8. [PMID: 24020433 DOI: 10.1111/ggi.12130] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2013] [Indexed: 11/27/2022]
Abstract
AIM The purpose of this pilot study was to determine if a diagnosis of dementia influenced pain self-reports and pain medication use in a group of verbally communicative nursing home (NH) residents. METHODS The study design was a between groups, cross-sectional chart audit and a seven-question structured pain interview comparing outcomes in residents with and without a diagnosis of dementia. The study was carried out at a large metropolitan NH in the southern USA. The participants consisted of 52 long-stay NH residents capable of self-consent with at least one order for pain medication (opioid or non-narcotic) either pro re nata, scheduled or both. Approximately 40% (n = 20) had a diagnosis of dementia. RESULTS Although each group had similar pain-related diagnoses, residents without a dementia diagnosis were significantly more likely to have a medication order for an opioid (OR 4.37,95% CI 1.29-14.73, P = 0.018). Based on self-reported pain interview responses, no statistically significant differences were identified between the groups for chronic pain symptoms. However, among residents who reported current pain, those with a dementia diagnosis reported greater pain intensity (based on a 0-10 numeric rating scale) than did those without dementia (median 8.0 vs 6.0, respectively; P = 0.010). CONCLUSIONS Verbally communicative NH residents with mild and moderate cognitive impairment can report their pain symptoms and pain intensity. Nurses in long-term care might assume that residents with dementia cannot reliably self-report their pain; however, suffering from untreated severe pain could exacerbate cognitive impairment, worsen functional impairment and severely impair sleep. A brief, focused pain interview might be one method for increasing the detection of moderate to severe pain in verbally communicative NH residents with dementia.
Collapse
Affiliation(s)
- Todd B Monroe
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA; Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee, USA
| | | | | | | | | | | |
Collapse
|
20
|
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.
Collapse
Affiliation(s)
- M Mänty
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Denmark; Center for Healthy Aging, University of Copenhagen, Denmark
| | | | | | | |
Collapse
|
21
|
Therapy Students’ Recommendations of Physical Activity for Managing Persistent Low Back Pain in Older Adults. J Aging Phys Act 2013; 21:309-18. [PMID: 23006453 DOI: 10.1123/japa.21.3.309] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Negative views of older adults can lead to suboptimal care. For older adults with persistent low back pain (LBP), promotion of physical activity by health care professionals is important. Health care professionals’ views of older adults are influenced by their training. This study aimed to compare recommendations for physical activity for managing persistent LBP offered by students in physiotherapy and occupational therapy to an older person vs. a younger person. In a cross-sectional online survey, participants (N = 77) randomly received a vignette of either a 40-yr-old or 70-yr-old patient with persistent LBP. Other than age, the vignettes were identical. There was no difference between the younger and older vignettes in the likelihood of participants making overall appropriate physical activity recommendations—63% vs. 59%, OR (95%CI) = 1.19 (0.48–2.99), p = .71—although there was a trend toward age bias on recommendations specific to daily activity. Postqualification education may be where ageist views need to be addressed.
Collapse
|
22
|
Abstract
OBJECTIVE The objective of this study is to examine the strategies used to manage chronic pain from the perspective of the individual in group interviews. METHODS Sixteen low-income overweight Latino adults participated in two group interviews facilitated by a trained moderator who inquired about the type of chronic pain suffered by participants, followed by more specific questions about pain management. Interviews were audio-recorded, transcribed verbatim (Spanish), back-translated into English, and analyzed using thematic analysis. RESULTS Participants' pain varied in type, location, and intensity. Participants discussed pain-related changes in activities and social life, and difficulties with health care providers, and as a result, we discovered five major themes: pain-related life alterations, enduring the pain, trying different strategies, emotional suffering, and encounters with health care system/providers. DISCUSSION Findings indicated that there are opportunities for providers to improve care for low-income overweight Latinos with chronic pain by listening respectfully to how pain alters their daily lives and assisting them in feasible self-management strategies.
Collapse
Affiliation(s)
- Dana N Rutledge
- School of Nursing, California State University, Fullerton, CA 92831, USA.
| | | | | |
Collapse
|
23
|
The Initial Anatomical Severity in Patients With Hand Injuries Predicts Future Health-Related Quality of Life. ACTA ACUST UNITED AC 2011; 71:1352-8. [DOI: 10.1097/ta.0b013e318216a56e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
24
|
Reid MC, Bennett DA, Chen WG, Eldadah BA, Farrar JT, Ferrell B, Gallagher RM, Hanlon JT, Herr K, Horn SD, Inturrisi CE, Lemtouni S, Lin YW, Michaud K, Morrison RS, Neogi T, Porter LL, Solomon DH, Von Korff M, Weiss K, Witter J, Zacharoff KL. Improving the pharmacologic management of pain in older adults: identifying the research gaps and methods to address them. PAIN MEDICINE 2011; 12:1336-57. [PMID: 21834914 DOI: 10.1111/j.1526-4637.2011.01211.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE There has been a growing recognition of the need for better pharmacologic management of chronic pain among older adults. To address this need, the National Institutes of Health Pain Consortium sponsored an "Expert Panel Discussion on the Pharmacological Management of Chronic Pain in Older Adults" conference in September 2010 to identify research gaps and strategies to address them. Specific emphasis was placed on ascertaining gaps regarding use of opioid and nonsteroidal anti-inflammatory medications because of continued uncertainties regarding their risks and benefits. DESIGN Eighteen panel members provided oral presentations; each was followed by a multidisciplinary panel discussion. Meeting transcripts and panelists' slide presentations were reviewed to identify the gaps and the types of studies and research methods panelists suggested could best address them. RESULTS Fifteen gaps were identified in the areas of treatment (e.g., uncertainty regarding the long-term safety and efficacy of commonly prescribed analgesics), epidemiology (e.g., lack of knowledge regarding the course of common pain syndromes), and implementation (e.g., limited understanding of optimal strategies to translate evidence-based pain treatments into practice). Analyses of data from electronic health care databases, observational cohort studies, and ongoing cohort studies (augmented with pain and other relevant outcomes measures) were felt to be practical methods for building an age-appropriate evidence base to improve the pharmacologic management of pain in later life. CONCLUSION Addressing the gaps presented in the current report was judged by the panel to have substantial potential to improve the health and well-being of older adults with chronic pain.
Collapse
Affiliation(s)
- M Cary Reid
- Division of Geriatrics and Gerontology, Weill Cornell Medical Center, 525 East 68th Street, Box 39, New York, NY 10065, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Pain, physical performance and balance in the elderly at hospital. Arch Gerontol Geriatr 2011; 52:e103-5. [DOI: 10.1016/j.archger.2010.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Revised: 07/29/2010] [Accepted: 08/02/2010] [Indexed: 11/19/2022]
|
26
|
The relationship of demographic and psychosocial variables to pain-related outcomes in a rural chronic pain population. Pain 2011; 151:467-474. [PMID: 20817401 DOI: 10.1016/j.pain.2010.08.015] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2010] [Revised: 08/04/2010] [Accepted: 08/04/2010] [Indexed: 11/23/2022]
Abstract
Rural residency and low socioeconomic status (SES) are associated with increased likelihood of chronic pain. Other demographics are also differentially associated with the experience of pain. This study examines the relations between demographic and pain-related variables in a virtually unstudied population of rural Alabama chronic pain patients. One hundred and fifteen patients completed validated measures of pain catastrophizing, depression, pain intensity, pain interference, perceived disability, and life satisfaction. Average age of study participants was 52-years, 79% were female, 74% were African-American, 72% reported annual income between 00,000-12,999, and 61% were unemployed. Although average years of reported education was 12.26, reading level percentile (primary literacy indicant) was 17.33. Cross-sectional multivariate and univariate analyses were conducted to examine associations among demographic and psychosocial variables in relation to various pre-treatment pain-related variables. The mediating role of pain catastrophizing and depression was investigated. Results indicate that race was significantly associated with pain intensity and pain interference, such that African-Americans reported higher scores than White-Americans. Pain catastrophizing was uniquely associated with pain intensity, pain interference, and perceived disability; depression was uniquely associated with pain interference and life satisfaction. Pain catastrophizing mediated the relation between primary literacy and pain intensity; age effects were differentially mediated by either pain catastrophizing or depression. These analyses provide an insight into the specific demographic and psychosocial factors associated with chronic pain in a low-literacy, low-SES rural population.
Collapse
|
27
|
Buchman AS, Shah RC, Leurgans SE, Boyle PA, Wilson RS, Bennett DA. Musculoskeletal pain and incident disability in community-dwelling older adults. Arthritis Care Res (Hoboken) 2010; 62:1287-93. [PMID: 20853470 DOI: 10.1002/acr.20200] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To test the hypothesis that the number of areas of musculoskeletal pain reported is related to incident disability. METHODS Subjects included 898 older persons from the Rush Memory and Aging Project without dementia, stroke, or Parkinson's disease at baseline. All participants underwent detailed baseline evaluation of self-reported pain in the neck or back, hands, hips, knees, or feet, as well as annual self-reported assessments of instrumental activities of daily living (IADLs), basic activities of daily living (ADLs), and mobility disability. Mobility disability was also assessed using a performance-based measure. RESULTS The average followup was 5.6 years. Using a series of proportional hazards models that controlled for age, sex, and education, the risk of IADL disability increased by ∼10% for each additional painful area reported (hazard ratio [HR] 1.10, 95% confidence interval [95% CI] 1.01-1.20) and the risk of ADL disability increased by ∼20% for each additional painful area (HR 1.20, 95% CI 1.11-1.31). The association with self-report mobility disability did not reach significance (HR 1.09, 95% CI 0.99-1.20). However, the risk of mobility disability based on gait speed performance increased by ∼13% for each additional painful area (HR 1.13, 95% CI 1.04-1.22). These associations did not vary by age, sex, or education and were unchanged after controlling for several potential confounding variables including body mass index, physical activity, cognition, depressive symptoms, vascular risk factors, and vascular diseases. CONCLUSION Among nondisabled community-dwelling older adults, the risk of disability increases with the number of areas reported with musculoskeletal pain.
Collapse
Affiliation(s)
- Aron S Buchman
- Rush University Medical Center, Chicago, Illinois 60612, USA.
| | | | | | | | | | | |
Collapse
|
28
|
Papaleontiou M, Henderson CR, Turner BJ, Moore AA, Olkhovskaya Y, Amanfo L, Reid MC. Outcomes associated with opioid use in the treatment of chronic noncancer pain in older adults: a systematic review and meta-analysis. J Am Geriatr Soc 2010; 58:1353-69. [PMID: 20533971 DOI: 10.1111/j.1532-5415.2010.02920.x] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This systematic review summarizes existing evidence regarding the efficacy, safety, and abuse and misuse potential of opioids as treatment for chronic noncancer pain in older adults. Multiple databases were searched to identify relevant studies published in English (1/1/80-7/1/09) with a mean study population age of 60 and older. Forty-three articles were identified and retained for review (40 reported safety and efficacy data, the remaining 3 reported misuse or abuse outcome data). The weighted mean subject age was 64.1 (mean age range 60-73). Studies enrolled patients with osteoarthritis (70%), neuropathic pain (13%), and other pain-producing disorders (17%). The mean duration of treatment studies was 4 weeks (range 1.5-156 weeks), and only five (12%) lasted longer than 12 weeks. In meta-analyses, effect sizes were -0.557 (P<.001) for pain reduction, -0.432 (P<.001) for physical disability reduction, and 0.859 (P=.31) for improved sleep. The effect size for the Medical Outcomes Study 36-item Health Survey was 0.191 (P=.17) for the physical component score and -0.220 (P=.04) for the mental component score. Adults aged 65 and older were as likely as those younger than 65 to benefit from treatment. Common adverse events included constipation (median frequency of occurrence 30%), nausea (28%), and dizziness (22%) and prompted opioid discontinuation in 25% of cases. Abuse and misuse behaviors were negatively associated with older age. In older adults with chronic pain and no significant comorbidity, short-term use of opioids is associated with reduction in pain intensity and better physical functioning but poorer mental health functioning. The long-term safety, efficacy, and abuse potential of this treatment practice in diverse populations of older persons remain to be determined.
Collapse
Affiliation(s)
- Maria Papaleontiou
- Department of Medicine, Saint Peter's University Hospital, New Brunswick, NJ, USA
| | | | | | | | | | | | | |
Collapse
|
29
|
Cervia LD, McGowan JP, Weseley AJ. Clinical and Demographic Variables Related to Pain in HIV-Infected Individuals Treated with Effective, Combination Antiretroviral Therapy (cART). PAIN MEDICINE 2010; 11:498-503. [DOI: 10.1111/j.1526-4637.2010.00802.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
30
|
Hayes KC, Wolfe DL, Trujillo SA, Burkell JA. On the interaction of disability and aging: Accelerated degradation models and their influence on projections of future care needs and costs for personal injury litigation. Disabil Rehabil 2009; 32:424-8. [PMID: 19968570 DOI: 10.3109/09638280903168515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Accelerated degradation models are emerging as ways to characterize the interaction between disability and the functional decline of aging and to provide insights about the processes of aging with disability. Typically the models employ sophisticated mathematical treatments that are beyond the scope of many clinicians, lawyers, and others who might benefit from the information they contain. The purpose of this report is to characterize some rudimentary features of the models, in more readily understandable language, and illustrate how understanding of the underlying constructs can influence decisions regarding resource allocation and other projections of future care needs. METHODS A literature review of longitudinal aging and disability studies was completed and simplified mathematical modeling undertaken, with hypothetical data, to illustrate various outcomes of the interaction of disability with the functional decline of aging. A specific example, drawn from personal injury litigation, i.e. projection of future care costs, was used to illustrate the practical applicability of this conceptual model. CONCLUSION Awareness of the accelerated functional decline brought about by the superimposition of age-related functional losses on pre-existing disability reveals a need to provide for aids and personnel supports at an earlier age than might be expected because of the multiplicative interaction and the inadequacy of functional reserves to compensate for the disability.
Collapse
Affiliation(s)
- Keith C Hayes
- Department of Physical Medicine & Rehabilitation, University of Western Ontario, Parkwood Hospital/SJHC, London, Ontario, Canada.
| | | | | | | |
Collapse
|
31
|
Brega AG, Reynolds A, Bennett RE, Leehey MA, Bounds LS, Cogswell JB, Hagerman RJ, Hagerman PJ, Grigsby J. Functional status of men with the fragile X premutation, with and without the tremor/ataxia syndrome (FXTAS). Int J Geriatr Psychiatry 2009; 24:1101-9. [PMID: 19404994 PMCID: PMC4414034 DOI: 10.1002/gps.2231] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Fragile X-associated tremor/ataxia syndrome (FXTAS), which occurs in some premutation carriers of the fragile X mental retardation 1 (FMR1) gene, is a neurodegenerative disorder characterized by action tremor, gait ataxia, and impaired executive cognitive functioning. OBJECTIVE To evaluate the nature and severity of functional limitations among male carriers of the fragile X premutation, both with and without FXTAS. METHODS Forty-two subjects with FXTAS and 24 asymptomatic premutation carriers were compared to 32 control subjects on measures of physical functioning, activities of daily living (ADLs; e.g. eating, bathing), and instrumental activities of daily living (IADLs; e.g. shopping, managing medications). Ordinary least squares regression, controlling for age, education, medical comorbidity, and pain, was used to examine group differences in physical and functional performance. RESULTS Men with FXTAS performed significantly worse than control subjects on all dependent measures, showing greater limitations in physical functioning, as well as ADL and IADL performance (p < 0.05). Subsequent analyses suggested that physical and functional impairments among men with FXTAS result largely from deficits in motor and executive functioning and that CGG repeat length is associated with functional impairment. Asymptomatic carriers of the fragile X premutation performed similarly to control subjects on all measures. CONCLUSIONS This study provides the first comprehensive evaluation of functional status among male premutation carriers. Although carriers without FXTAS performed similarly to control subjects, men with FXTAS showed evidence of significant physical and functional impairment, which appears to result largely from motor and executive deficits characteristic of the syndrome.
Collapse
Affiliation(s)
- Angela G. Brega
- Department of Medicine, University of Colorado Denver, Aurora, CO
| | - Ann Reynolds
- Department of Pediatrics, University of Colorado Denver, Aurora, CO
| | | | | | - Lanee S. Bounds
- Department of Medicine, University of Colorado Denver, Aurora, CO
| | | | - Randi J. Hagerman
- M.I.N.D. Institute, University of California, Davis, Sacramento, CA,Department of Pediatrics, University of California, Davis, Medical Center, Sacramento, CA
| | - Paul J. Hagerman
- Department of Biochemistry and Molecular Medicine, University of California, Davis, School of Medicine, Davis, CA
| | - Jim Grigsby
- Department of Medicine, University of Colorado Denver, Aurora, CO,Corresponding author: Jim Grigsby, PhD, Department of Medicine, University of Colorado Denver, 13611 East Colfax Avenue, #100, Aurora, CO 80045-5701, Phone: 303-724-2415; Fax: 303-724-2530,
| |
Collapse
|
32
|
Cecchi F, Molino-Lova R, Di Iorio A, Conti AA, Mannoni A, Lauretani F, Benvenuti E, Bandinelli S, Macchi C, Ferrucci L. Measures of physical performance capture the excess disability associated with hip pain or knee pain in older persons. J Gerontol A Biol Sci Med Sci 2009; 64:1316-24. [PMID: 19797345 DOI: 10.1093/gerona/glp125] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Hip pain (HP) and knee pain (KP) may specifically affect function and performance; few studies investigate the functional impact of HP or KP in the same population. METHODS Population-based sample of older individuals living in the Chianti area (Tuscany, Italy) (1998-2000); 1006 persons (564 women and 442 men) were included in this analysis; 11.9% reported HP and 22.4% reported KP in the past 4 weeks. Self-reported disability and lower extremity performance, measured by 400-m walk test and by the short physical performance battery (SPPB, including standing balance, chair raising, and 4-m walk test), were compared in participants reporting HP or KP versus those free of these conditions; the relationship of HP or KP with performance and self-reported disability was studied, adjusting for age, sex, hip or knee flexibility, muscle strength, multiple joint pain, major medical conditions, and depression. RESULTS Participants reporting HP were more likely to report disability in shopping, cutting toenails, carrying a shopping bag, and using public transportation; those with KP reported more disability in cutting toenails and carrying a shopping bag. Participants reporting HP or KP had significantly lower SPPB scores. Adjusting by SPPB, pain no longer predicted self-reported disability, except for "HP-carrying a shopping bag." CONCLUSIONS In our cohort of older persons, those with HP reported disability in a wider range of activities than those with KP. Physical performance measured by SPPB was impaired in both conditions. Reduced lower extremity performance captures the excess disability associated with either HP or KP.
Collapse
Affiliation(s)
- Francesca Cecchi
- Fondazione Don Gnocchi, Presidio V. Caccini, V. Caccini 18, 50141 Florence, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Thomas E, Croft PR, Dziedzic KS. Hand problems in community-dwelling older adults: onset and effect on global physical function over a 3-year period. Rheumatology (Oxford) 2009; 48:183-7. [PMID: 19141575 DOI: 10.1093/rheumatology/ken452] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To determine the impact of the onset of hand problems on global physical functioning in community-dwelling older adults. METHODS Three-year follow-up postal survey of a population sample of older adults (50 yrs and over) previously recruited to the North Staffordshire Osteoarthritis Project. Questionnaires at baseline and 3-yr collected data on joint pain in the past 12 months in the hands and lower limbs, and physical functioning [SF-36 subscale (PF-10)]. Onset of hand problems at 3 yrs was determined in two subgroups: (i) those free from hand problems and lower limb pain at baseline (n = 762) and (ii) those free from hand problems but with lower limb pain at baseline (n = 754). Changes in PF-10 scores from baseline to 3 yrs were examined in these two subgroups. RESULTS Onset of hand problems was similar in the two subgroups (20.6 and 24.3% in those without and with baseline lower limb pain, respectively). Females had a higher onset than males but age had little influence. Significantly greater mean change in PF-10 scores was seen in those who reported hand problem onset compared with persons who remained free of hand problems; 8.47 vs 4.62 and 4.78 vs 1.08 in those without and with baseline lower limb pain, respectively. CONCLUSIONS The development of hand problems has a detrimental effect on global physical functioning even in the absence of concurrent lower limb problems. The assessment and effective treatment of hand problems could prove to be important components of maintaining function in the older adult with joint pain and OA.
Collapse
Affiliation(s)
- E Thomas
- Arthritis Research Campaign National Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST55BG, UK.
| | | | | |
Collapse
|
34
|
Weaver GD, Kuo YF, Raji MA, Al Snih S, Ray L, Torres E, Ottenbacher KJ. Pain and disability in older Mexican-American adults. J Am Geriatr Soc 2009; 57:992-9. [PMID: 19453304 DOI: 10.1111/j.1532-5415.2009.02263.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine an association between pain severity and functional disability in older Mexican Americans. DESIGN Cross-sectional study (2005/06), a subsample of the Hispanic Established Population for Epidemiologic Study of the Elderly. SETTING Community. PARTICIPANTS One thousand thirteen Mexican American aged 74 to 100. MEASUREMENTS Bilingual interviewers administered structured questionnaires and assessed physical measures of mobility and frailty (exhaustion, weight loss, walking speed, grip strength, and self-reported physical activity). Two items from the SF-36 questionnaire assessed pain experiences in the previous 4 weeks. RESULTS Chi-square one-way analysis of variance and least square and negative binomial regressions were computed for 744 participants with complete data to investigate experience of pain and other dimensions of health and functioning. Close to two-thirds (64.7%) reported pain within 4 weeks of the interview, and 49.7% reported that pain interfered with performance of daily activities. Female sex; low education; frailty; reduced mobility; disability; and high comorbidity, body mass index, and depressive symptomatology were significantly associated with pain severity and interference. Regression coefficients revealed that pain severity was significantly related to disability in activities of daily living (0.22, P<.001) and instrumental activities of daily living (0.23, P<.01) after controlling for sociodemographic and health status characteristics. CONCLUSION The findings expand the pain literature on older Mexican Americans. High pain rates were most prevalent in women and subjects with high comorbidity, high depressive symptomatology, poor mobility, and frailty. Pain also plays a significant role in disability status. In-depth research is needed to understand the pain experiences of older Mexican Americans and their effect on health and well-being.
Collapse
Affiliation(s)
- Gayle D Weaver
- Division of Rehabilitation Sciences, School of Health Professions, School of Medicine, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA.
| | | | | | | | | | | | | |
Collapse
|
35
|
Eggermont LHP, Bean JF, Guralnik JM, Leveille SG. Comparing pain severity versus pain location in the MOBILIZE Boston study: chronic pain and lower extremity function. J Gerontol A Biol Sci Med Sci 2009; 64:763-70. [PMID: 19228782 DOI: 10.1093/gerona/glp016] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND This study compared measures of chronic pain, for example, number of pain sites and overall pain severity, in relation to lower extremity function in the older population. METHODS Six hundred older adults (mean age 77.9 years, 64% female) were queried about presence of chronic pain. Number of pain sites was categorized as none, single site, multisite, or widespread. Pain severity was measured in quartiles of the Brief Pain Inventory pain severity subscale. Lower extremity function was assessed by the Short Physical Performance Battery (SPPB), a composite measure of gait speed, balance, and chair stands. RESULTS Many older persons reported multisite or widespread pain (40%). Increased pain sites and pain severity were associated with poorer SPPB performance after adjusting for age, sex, height, and weight. With further adjustment for education, comorbid conditions, and depressive symptoms, multisite pain (p < .001) and most severe pain (p < .05) were associated with poorer SPPB performance, but assessed together in the same model, only the association with multisite/widespread pain remained significant (p < .01). When specific joint pain sites were evaluated together, only knee pain was associated with lower SPPB score. Pain severity was independently associated with slower gait, pain location was associated with poorer balance, and chair stands performance was associated with both pain measures. CONCLUSIONS Although multisite pain rather than pain severity was more strongly associated with overall lower extremity function, differences emerged with specific SPPB subtests. Longitudinal studies are needed to understand risk for lower extremity function decline related to chronic pain characteristics in older adults.
Collapse
Affiliation(s)
- Laura H P Eggermont
- Alzheimer's Disease Center, Boston University School of Medicine, Massachusetts, USA.
| | | | | | | |
Collapse
|
36
|
Rosso AL, Gallagher RM, Luborsky M, Mossey JM. Depression and self-rated health are proximal predictors of episodes of sustained change in pain in independently living, community dwelling elders. PAIN MEDICINE 2009; 9:1035-49. [PMID: 19067830 DOI: 10.1111/j.1526-4637.2008.00533.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify, in community dwelling elders, the determinants of sustained pain improvement or worsening. DESIGN A longitudinal study with two baseline and 11 monthly follow-up interviews was conducted. Pain was assessed monthly using the Parmelee adaptation of the McGill Pain Inventory. SUBJECTS Subjects included 109 Caucasian and 132 African American, Philadelphia residing Medicare recipients (65-74 years of age). OUTCOME MEASURES To identify sustained pain change (> or =2 months), the data for each subject were reconfigured to yield 10 overlapping 3-month data segments. Each segment was classified as improved or worsened pain. Other variables included: the Geriatric Depression Scale (GDS), self-rated health (SRH), physical functioning, and number of improved or worsened medical conditions. RESULTS Pain experienced (over 3-month periods) was typically stable. Sustained improved pain was more likely than worsened pain. Odds ratios obtained through Generalized Estimation Equation analyses showed that a 1-point increase in GDS scores increased the odds of worsened pain by 1.18 (1.11-1.30). Fair/poor SRH, being female, and having medical conditions worsen increased the odds of worsened pain by 4.04 (2.12-7.70), 1.63 (1.11-2.38), and 2.12 (1.42-3.16), respectively. Observed, statistically significant associations between these variables, except gender, and improved pain were in the opposite direction. CONCLUSIONS With a 1-month time lag between predictor variable assessment and follow-up pain measures, the study supports temporal associations between depressive symptoms and SRH and subsequent pain change. Clinicians providing care to community dwelling elders are advised to evaluate and attend to both the depressive symptoms and SRH of their patients.
Collapse
Affiliation(s)
- Andrea L Rosso
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania 19072, USA
| | | | | | | |
Collapse
|