Pain among older adults from a gender perspective: findings from the Swedish National Study on Aging and Care (SNAC-Blekinge)

Sociodemographic disparities and potential biases in persistent pain estimates: Findings from 5 waves of the Irish Longitudinal Study on Ageing (TILDA)

BACKGROUND

Pain is a prevalent, debilitating condition among older adults. Much evidence on this topic comes from cohort studies, which may be affected by attrition and measurement bias. Little is known about the impact of these biases on pain estimates for European older adults. Additionally, there is a lack of longitudinal research on pain and sociodemographic disparities in Irish older adults.

METHODS

We analysed data from 8171 participants (aged ≥50 at baseline) across five waves of the Irish Longitudinal Study on Ageing. Longitudinal pain severity and sociodemographic disparities in pain were explored visually and using a latent growth curve model. Using multivariate logistic regression, we examined bias due to attrition at later waves associated with reported pain at Wave 1. Measurement biases due to reporting heterogeneity were assessed by investigating associations between sociodemographic factors and pain-related disability for given pain levels.

RESULTS

Wave 1 severe pain was associated with increased odds of attrition due to death by Wave 5 (AOR: 1.63, 95% CI: 1.20, 2.19). Not having private health insurance was associated with increased odds of pain-related disability at Wave 1, controlling for pain severity (AOR: 1.37, 95% CI: 1.15, 1.64). These results suggested mortality bias and reporting heterogeneity measurement bias, respectively. Sex, education level, and private health insurance status disparities in pain were observed longitudinally.

CONCLUSIONS

Mortality bias and reporting heterogeneity measurement bias must be accounted for to improve older adult pain estimates. There is a need for policymakers to address sociodemographic disparities in older adult pain levels.

SIGNIFICANCE

This study highlights a need to address bias in the estimation of pain in observational studies of older adults. Understanding the sources and extent of these biases is important so that health practices and policies to address pain disparities can be guided by accurate estimates. Women, those with lower educational attainment, and those without private health insurance were found to have the highest pain burden longitudinally, suggesting a need for targeted interventions for these groups in Ireland and internationally.

Comprehensive Analysis of Drug Utilization Patterns, Gender Disparities, Lifestyle Influences, and Genetic Factors: Insights from Elderly Cohort Using g-Nomic® Software

Polypharmacy is a global healthcare concern, especially among the elderly, leading to drug interactions and adverse reactions, which are significant causes of death in developed nations. However, the integration of pharmacogenetics can help mitigate these risks. In this study, the data from 483 patients, primarily elderly and polymedicated, were analyzed using Eugenomic®'s personalized prescription software, g-Nomic®. The most prescribed drug classes included antihypertensives, platelet aggregation inhibitors, cholesterol-lowering drugs, and gastroprotective medications. Drug-lifestyle interactions primarily involved inhibitions but also included inductions. Interactions were analyzed considering gender. Significant genetic variants identified in the study encompassed ABCB1, SLCO1B1, CYP2C19, CYP2C9, CYP2D6, CYP3A4, ABCG2, NAT2, SLC22A1, and G6PD. To prevent adverse reactions and enhance medication effectiveness, it is strongly recommended to consider pharmacogenetics testing. This approach shows great promise in optimizing medication regimens and ultimately improving patient outcomes.

Consensus on the detection and management of patients with depression and pain as an associated somatic symptom

INTRODUCTION

Globally, depression is the most common psychiatric disorder and is frequently associated with somatic symptom disorders, including pain as a physical symptom. There is a current need to improve the detection and management of the individuals in which depression and pain coexist. Hence, the aim of this document is to provide recommendations in the diagnosis and management of patients with major depressive disorder (MDD) who have pain as a physical symptom (PPS), in order to reduce the variability of clinical practice.

MATERIAL AND METHODS

The methodology used is based on the internationally recognized RAND/UCLA consensus method. The scientific committee, consisted of a group of eight multidisciplinary experts, defined 12 clinically relevant questions. After the systematic review of the literature, the scientific committee assessed the evidence and developed recommendations. The panel group with 15 participants validated these recommendations using a single Delphi round. To conclude, there was a final consensus meeting held to redefine with minor modifications the final recommendations.

RESULTS

The scientific committee developed a total of 19 recommendations on the diagnosis and detection, impact of PPS in MDD, treatment of MDD with associated PPS, use of healthcare resources, additional recommendations, and care coordination of these patients. Globally, a substantial level of agreement (≥80%) was reached on all items during the Delphi round. All the 19 achieved consensus, seven of them (37%) were agreed with unanimity during the Delphi round. The recommendations with higher consensus were in relation to diagnosis, impact of PPS in MDD, treatment and use of healthcare resources.

CONCLUSIONS

Currently, the evidence base for patients with MDD and PPS is still being developed and this consensus statement aims to bridge that gap by providing practical recommendations.

The Effect of a Non-Pharmacological Multicomponent Pain Management Program on Pain Intensity and Quality of Life in Community-Dwelling Elderly Men With Chronic Musculoskeletal Pain

BACKGROUND AND AIM

Improving the level of care for the elderly with musculoskeletal pain requires pharmacological and non-pharmacological pain control methods. This study aimed to investigate the effect of a non-pharmacological pain management intervention on pain intensity and quality of life in community-dwelling older men with musculoskeletal pain who were referred to comprehensive healthcare centers in the city of Ilam, Iran.

MATERIALS AND METHODS

A quasi-experimental study with pre and post-test design was performed on 65 older men with chronic musculoskeletal pain. The samples were selected regarding inclusion criteria as available and randomly assigned to either the control (usual care) or the experimental group (educational intervention plus physical exercises). Baseline characteristics of participants, the Visual Analogue Scale, and the CASP-19 Quality of Life were used to collect data. Data were analyzed by SPSS software using the ANCOVA, independent and paired t-test, and chi-square test at the statistically significant level of 5 %.

RESULTS

According to the findings, there was a significant difference between the experimental and control groups in terms of quality of life (p < .05) and pain intensity (p < .05) after the intervention. No relevant differences were found between groups regarding demographic characteristics at baseline.

CONCLUSIONS

A six-week physical activity and education program for community-dwelling older men with chronic musculoskeletal pain could improve quality of life and decrease pain intensity after a one-month follow-up compared with usual care. Therefore, it seems necessary to consider pain management programs in the elderly care program and familiarize health care professionals with these pain control methods.

Physical functioning as a predictor of retirement: Has its importance changed over a thirty-year period in Sweden?

Many countries, including Sweden, are implementing policies aimed at delaying retirement and encouraging older workers to remain on the labour market for longer. During recent decades, there have been several major reforms to the pension and social security systems in Sweden. Moreover, the nature of occupations has shifted towards more non-manual and sedentary activities, older women are today almost as active in the labour market as men in Sweden, and physical functioning has improved over time. In this study, we investigate whether the importance of physical functioning as a predictor for retirement has changed over time, for women and men, respectively. We used four waves of nationally representative data from The Swedish Level of Living Survey from 1981, 1991, 2000, and 2010, together with income register data. We found that greater severity of musculoskeletal pain and mobility limitations increased the likelihood of retirement in all waves. Results from logistic regression models with average marginal effects and predictive margins showed that there is a trend towards physical functioning becoming less important for retirement towards the end of the study period, especially for women, when controlling for occupational-based social class, age, adverse physical working conditions, and job demands. People, especially women, reporting impaired physical functioning did not retire to the same extent as in previous decades. This indicates that people stayed longer in the labour market despite impaired physical functioning, which may have repercussions on well-being and quality of life.

Prescription opioids among older adults: ten years of data across five countries

BACKGROUND

Opioid use has increased globally in the recent decade. Although pain remains a significant problem among older adults, susceptibility to opioid-related harms highlights the importance of careful opioid therapy monitoring on individual and societal levels. We aimed to describe the trends of prescription opioid utilisation among residents aged ≥65 in all Nordic countries during 2009-2018.

METHODS

We conducted cross-sectional measurements of opioid utilisation in 2009-2018 from nationwide registers of dispensed drugs in Denmark, Finland, Iceland, Norway, and Sweden. The measures included annual opioid prevalence, defined daily doses (DDDs) per 1000 inhabitants per day (DIDs), and morphine milligram equivalents (MMEs) per user per day.

RESULTS

From 2009 to 2018, an average of 808,584 of adults aged ≥65 used opioids yearly in all five countries; an average annual prevalence of 17.0%. During this time period, the prevalence decreased in Denmark, Norway, and Sweden due to declining codeine and/or tramadol use. Iceland had the highest opioid prevalence in 2009 (30.2%), increasing to 31.7% in 2018. In the same period, DIDs decreased in all five countries, and ranged from 28.3 in Finland to 58.5 in Denmark in 2009, and from 23.0 in Finland to 54.6 in Iceland in 2018. MMEs/user/day ranged from 4.4 in Iceland to 19.6 in Denmark in 2009, and from 4.6 in Iceland to 18.8 in Denmark in 2018. In Finland, Norway, and Sweden, MMEs/user/day increased from 2009 to 2018, mainly due to increasing oxycodone utilisation.

CONCLUSIONS

The stable or decreasing opioid utilisation prevalence among a majority of older adults across the Nordic countries coincides with an increase in treatment intensity in 2009-2018. We found large cross-national differences despite similarities across the countries' cultures and healthcare systems. For the aged population, national efforts should be placed on improving pain management and monitoring future trends of especially oxycodone utilisation.

Pain prevalence among residents living in nursing homes and its association with quality of life and well-being

BACKGROUND

Pain is common and often more complex to assess among nursing homes residents with cognitive impairments. Thus, more research is needed of different pain assessment methods in elderly care and how these assessments outcomes are related to quality of life, as there mostly should be a negative relationship. There is a risk that pain are under diagnosed among persons with cognitive impairment.

AIM

The aim was to describe and compare pain prevalence among nursing home residents (1) using different pain assessment methods (2) in relation to cognitive status and to (3) examine associations between pain and quality of life or well-being.

METHODS

A cross-sectional correlational design was used, participants were 213 nursing home residents and data were collected through interviews using standardised protocols. Instrument used were Katz index of ADL, Mini-Mental-State-Examination, Quality of Life in Late-Stage Dementia scale, WHO-5 well-being index, Numeric Rating Scale and Doloplus-2 scale.

RESULTS

The results showed high pain prevalence, but no significant difference based on cognitive level. Pain classification at the individual level varied somewhat when different instruments are used. The results indicated that use of a single-item proxy-measure for pain tends to show higher pain prevalence and was not statistically significant related to quality of life. The relationship with quality of life was statistically significant when self-rated pain instruments or multi-component observation were used.

CONCLUSIONS

The study shows that it is difficult to estimate pain in residents living at nursing homes and that it continues to be a challenge to solve. Self-rated pain should be used primarily to assess pain, and a multi-component observation scale for pain should be used when residents are cognitively impaired. Both self-rated pain and multi-component observation also support the well-known link between pain and quality of life. Single-item proxy assessments should only be used in exceptional cases.

Persistent pain associated with socioeconomic and personal factors in a Sami and Non-Sami population in Norway: an analysis of SAMINOR 2 survey data

In international studies, higher prevalence of persistent pain has been reported in indigenous populations compared to majority populations. The present study aimed to determine the prevalence of persistent pain within a Sami and a non-Sami population in northern Norway, with adjustment for the confounding factors of age, sex, marital status, education, income, mental health, smoking status and ethnic background. Using SAMINOR 2 survey data including Sami and non-Sami populations, we analysed 5,546 responses, from individuals aged 40-79 years, to questions concerning persistent pain (≥ 3 months). In total, 2,426 (43.7%) participants reported persistent pain with differences between Sami women and non-Sami women (44.1% versus 51.1%, respectively), but none between Sami men and non-Sami men (38.7% versus 38.2%, respectively). Elderly Sami women were less likely to report persistent pain than were elderly non-Sami women. In men, no ethnic differences in pain were observed according to age-group. Marital status, education levels, household income, psychological distress, and smoking status did not influence the association between ethnicity and pain. Pain severity and location did not differ between Sami and non-Sami participants. In this study, we found only minor ethnic differences in persistent pain. Similar living conditions and cultural features may explain these findings.

Pain in low-income older women with disabilities: a qualitative descriptive study

The purpose of this qualitative study was to identify how low-income older women with disabilities perceive pain, pain management, and communication with healthcare providers. We interviewed 26 low-income women (average age 75 years; SD 7.0), eliciting the following overarching themes: "Invisibility of Pain: Unnoticed or Undetected," "Escalating Pain Leads to Help Seeking," "Communication with Healthcare Providers and Outcomes," "Pain Management Facilitates Function and Accomplishment," and "The Intersection of Pain, Disability, and Depressive Symptoms." Study findings support the ways in which behavior changes from pain can impede pain management.

Analyzing the situation of older family caregivers with a focus on health-related quality of life and pain: a cross-sectional cohort study

Background

For a significant proportion of the older population, increasing age is associated with health problems and worsening health. Older family caregivers are largely responsible for care of next-of-kin living at home, which impacts their own physical and mental health both positively and negatively. However, evidence is insufficient regarding the health situation of older caregivers. The aim of this study was to investigate health-related quality of life (HRQoL) and pain, and their associations, among caregivers aged ≥60 years.

Methods

The participants (n = 3444) were recruited from the Swedish National Study on Aging and Care-Blekinge and Good Aging in Skåne during 2001–2004. Participants aged ≥60 years were selected randomly and underwent cognitive tests, with demographic information obtained through questionnaires. The response rate was 60%. A predefined research protocol was used. HRQoL was measured with the Short-Form Health Survey, dimension mental health. Logistic regression models were used to investigate the associations between HRQoL and pain as well as control factors.

Results

Family caregiving was reported by 395 (11.5%) of the participants, and 56.7% of the caregivers reported pain. Family caregivers reported lower pain intensity on the Visual Analogue Scale and were younger, on median, than non-caregivers. Irrespective of caregiver status, pain was associated with mental HRQoL. Concerns about personal health and financial status had the strongest associations with mental HRQOL in both groups, but the levels were higher among caregivers.

Conclusion

Pain was one factor associated with low HRQoL regardless of family caregiver status and remained important when controlling for factors related to advanced age. This finding remained among family caregivers, though they reported lower pain intensity. Factors other than pain were shown to be important to mental HRQoL and should also be taken into consideration when discussing actions for family caregivers to maintain and improve health and HRQoL.

Trial registration number

Not applicable.

The prevalence and impact of self-reported foot and ankle pain in the over 55 age group: a secondary data analysis from a large community sample

Background

While the prevalence and impact of musculoskeletal problems are high, most attention has been directed towards the back, knee and hip disorders. Foot pain is known to be common in older adults and accounts for a significant burden on health services. The aim of this study was to assess the impact of foot and ankle joint pain, considering age, presence of co-morbidities and other site joint pain, in a large community sample.

Methods

In the North Yorkshire Health study, 16,222 people over 55 years participated in a detailed survey of the prevalence and impact of lower limb joint problems. Self-assessment of overall body pain and functional activities of daily living were assessed. Participants indicated the presence of joint pain, stiffness or swelling during the last 3 months which had lasted for more than 6 weeks on a manikin: data were captured on the foot and the ankle.

Results

The prevalence of self-reported foot and ankle joint pain was substantial: 184.33 per 1000, second only to knee problems. While foot pain was common, it was mostly associated with joint pain at other sites; only 1 in 11 of those with foot and ankle pain reported it only in the foot. Logistic regression modeling revealed while established factors such as co-morbidities, knee and hip problems contributed to functional impairment, foot and ankle problems contributed to an additional increased risk of having difficulty standing and walking by two fold (OR = 2.314, 95%CI 2.061–2.598), going up and down stairs by 71% (OR = 1.711, 95%CI 1.478–1.980) and getting up from a seated position by 44% (OR = 1.438, 95%CI 1.197–1.729).

Conclusion

These results suggest that not only are foot problems in the over 55 age group extremely prevalent, they have a considerable impact on functional abilities.

Pain and alcohol: a comparison of two cohorts of 60 year old women and men: findings from the Good Aging in Skåne study

Background and aims Pain, use of painkillers and alcohol are highly prevalent in the general population. Aims of the study were to describe differences in pain, alcohol consumption and use of painkillers among two 60 year old birth cohorts stratified by gender. Methods Participants were recruited from the Skåne centre of The Swedish National study on Aging and Care, a multicentre, prospective, longitudinal study. The sample comprised 60 year old men and women born between 1941 and 1943 and recruited to the study between 2001 and 2004 (n=663) and 60 year old men and women born in the period 1952-1954 and recruited to the study between 2013 and 2015 (n=924). Specially trained research staff conducted the interviews. For descriptive statistics the variables were presented in total numbers, percentages, mean and standard deviation, and 1st and 3rd quartile are also shown. The sample was divided into four groups: men and women born in the period 1941-1943, men and women born in the period 1952-1954, respectively. Results No difference in alcohol intake was detected between the two birth cohorts. All participants, regardless of pain or not, reported alcohol use below the specified risk level for both sexes. Teetotallers were more common in the 1952-1954 male cohort, 128 (29%), p<0.029. Two hundred and eighty one Men born between 1952 and 1954 reported pain (59.0%), compared to 173 men born between 1941 and 1943 (51.6%), p<0.034. There was no difference between the male cohorts in use of painkillers, p<0.062. No difference was found between the two female cohorts in terms of pain, p<0.144. One hundred and ten women in the 1941-43 cohort used painkillers (53.1%) compared to 119 women born between 1952 and 1954 (40.1%), p<0.004. When comparing men and women with pain born between 1941 and 1942, men with moderate pain use more alcohol, 157 g/month (q1 10, q3 365) than women, 44 g/month (q1 0, q3 134), p<0.001. Men with severe pain also use more alcohol, 96 g/month (q1 17, q3 324) than women, 27 g/month (q1 0, q1 118), p<0.030, and when those with pain were merged into a group, men use more alcohol, 175 g/month (q1 31, q3 356), than women, 68 g/month (q1 1, q3 207), p<0.001. This also applies to the later cohort; men, 132 g/month (q1 22, q3 270), compared to women, 76 g/month (q1 8, q3 182), p<0.001. When merging all pain into one group women use more painkillers both in the 1941-43 cohort, men (39.9%) compared to women (53.1%), p<0.010 and in the 1952-54 cohort, men (18.5%) compared to women (26.6%), p<0.003. Use of analgesics and alcohol is common but the highest percentage is among women born between 1941 and 1943, 45 (48.9%). Conclusions Pain and alcohol use are common among 60 year old women and men. A gender difference is that women use more painkillers. In the 1941-43 cohort almost every second woman with moderate pain who took painkillers also consumed alcohol. Implications It is time to alert prescribers that a large section of the population uses alcohol combined with painkillers. More research is needed to better understand the long-term perspective on health when using both painkillers and alcohol.

Pain and Pain Medication among Older People with Intellectual Disabilities in Comparison with the General Population

Little is known about pain and pain treatment among people with intellectual disabilities (IDs). We aimed to describe pain and pain medications among older people with ID compared to the general population. Data on diagnoses and prescriptions were collected from national registers for the period between 2006 and 2012 for 7936 people with an ID and a referent cohort from the general population. IDs were associated with a decreased risk of being diagnosed with headaches, musculoskeletal pain, and pain related to the circulatory and respiratory systems, but they were associated with increased risk of being diagnosed with pain related to the urinary system. Among men, IDs were associated with an increased risk of being diagnosed with visceral pain. People with IDs were more likely to be prescribed paracetamol and fentanyl regardless of the type of pain but were less likely to be prescribed COX(1+2) and COX2 inhibitors and weak opioids. Healthcare staff and caregivers must be made aware of signs of pain among people with IDs who may not be able to communicate it themselves. Further research is needed to investigate whether people with IDs are prescribed paracetamol rather than other pain drugs due to physicians trying to avoid polypharmacy or if there are other reasons not to prescribe a greater range of pain treatments.

Gender difference in long-term use of opioids among Taiwan officially registered patients with chronic noncancer pain

Research regarding sex or gender difference in chronic pain proliferated in this decade. This study was to analyze gender difference in Taiwan patients receiving long-term opioids for chronic noncancer pain.An observational cross-sectional survey was conducted among the registered outpatients by the Taiwan Food and Drug Administration. Participants completed a self-report questionnaire, including the Taiwanese version of Brief Pain Inventory and enquiry regarding sexual activities, depressive symptoms, and misuse behaviors.In total, 68 female and 142 male patients were analyzed. Both pain intensity and daily function interference reduced comparably (around 50%) between women and men after taking opioids in the past 1 week. The opioid-related adverse effects, including constipation, decreased sexual desire and satisfaction, and misuse behaviors were not significantly different. Women were exceedingly diagnosed with depression (67.7% vs 49.3%, P = .012) and had a higher mean depressive symptom score in the past 1 month, especially among those age <40 years (23.3 vs 11.9, P = .009), as compared with men. In addition, women had a lower mean self-rated health score (37.9 vs 44.3, P = .047). The mean morphine equivalent dose was significantly lower in women (131.6 vs 198.2 mg/day, P = .008), which was not correlated with their depressive scores.Gender differences in the effectiveness and adverse effects of long-term opioids were not found among Taiwan registered outpatients with chronic noncancer pain. However, more female patients inclined to have a coexisting depression diagnosis, depressive symptoms, and a lower perceived health score, needing regular screening and closer monitoring.

Frequent pain in older people with and without diabetes - Finnish community based study

Background

The association between pain and diabetes in older people has been largely unexplored. The aim of this survey was to analyze the prevalence and characteristics of pain among Finnish men and women 65 or older with and without diabetes in primary care.

Methods

All home-dwelling persons 65 years or older with diabetes (N = 527) and age and gender matched controls (N = 890) were identified from electronic patient records. Frequent pain was regarded as any pain experienced more often than once a week, and it was divided into pain experienced several times a week but not daily and pain experienced daily or continuously. The Numeric Rating Scale (0–10) (NRS) was used to assess the intensity and interference of the pain.

Results

The number of subjects who returned the questionnaire was 1084 (76.5%). The prevalence of frequent pain in the preceding week was 50% among women without diabetes and 63% among women with diabetes (adjusted, p = 0.22). In men, the corresponding proportions were 42% without diabetes and 47% with diabetes (adjusted, p = 0.58). In both genders, depressive symptoms and the number of comorbidities were associated with pain experienced more often than once a week and with daily pain. Diabetes was not associated with pain intensity or pain interference in either women or men.

Conclusions

Pain in older adults is associated with depressive symptoms and the number of comorbidities more than with diabetes itself.

Persistence of pain quality in community-dwelling older adults with chronic non-cancer pain

Longitudinal assessment of chronic geriatric pain is complicated by an age-associated plateau in pain severity and increase in widespread pain, calling for innovative measures such as pain quality descriptors that characterize how pain may feel. We characterized persistence of pain quality and its relation to severity, activity interference and distribution of sites, in a population-based sample of adults aged≥70 years with chronic pain (n = 398). Persistent pain quality was defined as reporting descriptors within the same category: sensory, cognitive/affective, or neuropathic at baseline and 18 months. A count variable indicated number of persistent categories. Pain quality was highly persistent. Adjusted for baseline covariates, individuals endorsing 3 persistent categories were 2-2.5x more likely to experience more widespread pain at 18 months compared to fewer persistent categories. No associations were noted in changes in pain severity or interference. A comprehensive pain assessment that includes diverse pain quality descriptors may improve individualized pain management.

Sex Differences in the Association Between Pain and Injurious Falls in Older Adults: A Population-Based Longitudinal Study

We investigated whether there are sex differences in the association between pain and incident injurious falls. A total of 2,934 people (ages ≥60 years) from the population-based Swedish National Study on Aging and Care in Kungsholmen (2001-2004) participated. Participants were followed up for 3 and 10 years for falls leading to hospitalization or outpatient care. Data were analyzed with flexible parametric survival models that adjusted for potential confounders. During the first 3 years of follow-up, 67 men and 194 women experienced an injurious fall, and over 10 years of follow up, 203 men and 548 women experienced such a fall. In men, the presence of pain, having pain that was at least mild, having pain that affected several daily activities, and having daily pain all significantly increased the likelihood of incurring an injurious fall during the 3-year follow-up period. The multivariate-adjusted hazard ratios ranged from 1.78 (95% confidence interval: 1.00, 3.15) for the presence of pain to 2.89 (95% confidence interval: 1.41, 5.93) for several daily activities' being affected by pain. Results for the 10-year follow-up period were similar. No significant associations were detected in women. Although pain is less prevalent in men than in women, its impact on risk of injurious falls seems to be greater in men.