Body weight, frailty, and chronic pain in older adults: a cross-sectional study

Body composition and body mass index are independently associated with widespread pain and experimental pain sensitivity in older adults: a pilot investigation

Introduction

Chronic musculoskeletal (MSK) pain is prevalent in older adults and confers significant risk for loss of independence and low quality of life. While obesity is considered a risk factor for developing chronic MSK pain, both high and low body mass index (BMI) have been associated with greater pain reporting in older adults. Measures of body composition that distinguish between fat mass and lean mass may help to clarify the seemingly contradictory associations between BMI and MSK pain in this at-risk group.

Methods

Twenty-four older adults (mean age: 78.08 ± 5.1 years) completed dual-energy x-ray absorptiometry (DEXA), and pain measures (Graded Chronic Pain Scale, number of anatomical pain sites, pressure pain threshold, mechanical temporal summation). Pearson correlations and multiple liner regression examined associations between body mass index (BMI), body composition indices, and pain.

Results

Significant positive associations were found between number of pain sites and BMI (b = 0.37) and total fat mass (b = 0.42), accounting for age and sex. Total body lean mass was associated with pressure pain sensitivity (b = 0.65), suggesting greater lean mass is associated with less mechanical pain sensitivity.

Discussion

The results from this exploratory pilot study indicate lean mass may provide additional resilience to maladaptive changes in pain processing in older adults, and highlights the importance of distinguishing body composition indices from overall body mass index to better understand the complex relationship between obesity and MSK pain in older adults.

Association of night-time sleep and daytime napping with painful temporomandibular disorder

BACKGROUND

Painful temporomandibular disorder (TMD) is the common cause of chronic oro-facial pain, which may interfere with sleep. Previous studies have documented an association between sleep and TMD.

OBJECTIVES

This study aimed to further explore the association of night-time sleep and daytime napping with painful TMD.

METHODS

A total of 419 patients (aged 31.88 ± 11.54 years with women forming 85.4%) from a TMD/Orofacial Pain center were enrolled. Patients' sleep conditions were evaluated with the Pittsburgh Sleep Quality Index (PSQI) questionnaire, and information on night-time sleep duration, napping duration and napping frequency was interviewed. TMD was diagnosed according to the Diagnostic Criteria for TMD protocol and stratified into myalgia (muscle pain), arthralgia (joint pain) and combined (muscle and joint pain) subgroups. The severity of TMD was measured with the Fonseca Anamnestic Index (FAI) questionnaire. Restricted cubic spline (RCS) regression models were established to explore relationships between sleep and painful TMD subgroups.

RESULTS

Patients with poor sleep quality (PSQI≥6) had higher FAI scores (median 60, p < .001) and higher proportions of painful TMDs. The myalgia subgroup had higher PSQI scores (median 8, p < .001) than the arthralgia subgroup. The RCS models indicated a non-linear relationship between night-time sleep duration and myalgia (p < .001), which was not observed in arthralgia. However, there were no significant findings concerning napping and painful TMD subgroups.

CONCLUSION

This study found that the association between sleep and TMD is mainly related to painful TMD conditions, which are associated with night-time sleep duration.

Bidirectional causal relational between frailty and mental illness: a two-sample Mendelian randomization study

Background

Frailty has been associated with mental illness (MI) observational studies, but the causal relationship between these factors remains uncertain. We aimed to assess the bidirectional causality between frailty and MI by two-sample Mendelian randomization (MR) analyses.

Methods

To investigate the causal relationship among them, summary statistics of frailty index (FI) and six types of MI: anxiety, depression, affective disorder, mania, schizophrenia, and obsessive-compulsive disorder (OCD) were included in this MR study. This MR analysis was performed using inverse variance weighting (IVW), MR-Egger regression, and weighted median. The stability of the results was evaluated using Cochran's Q test, MR-Egger intercept test, Funnel Plots, and leave-one-out analysis.

Results

Genetic predisposition to FI was significantly associated with increased anxiety (odds ratio [OR] = 1.62, 95% confidence interval [CI] 1.13-2.33, P = 8.18E-03), depression (OR = 1.88, 95% CI 1.30-2.71, P = 8.21E-04), affective disorder (OR = 1.70, 95% CI 1.28-2.27, P = 2.57E-04). However, our study findings do not demonstrate a causal relationship between FI and mania (OR = 1.02, 95% CI 0.99-1.06, P = 2.20E-01), schizophrenia (OR = 1.02, 95% CI 0.07-0.86, P = 9.28E-01). In particular, although the IVW results suggest a potential causal relationship between FI and OCD (OR = 0.64, 95% CI 0.07-0.86, P = 2.85E-02), the directions obtained from the three methods we employed ultimately show inconsistency. Therefore, the result must be interpreted with caution. The results of the reverse MR analysis indicated a statistically significant and causal relationship between anxiety (OR = 1.06, 95% CI 1.01-1.11, P = 2.00E-02), depression (OR = 1.14, 95% CI 1.04-1.26, P = 7.99E-03), affective disorder (OR = 1.15, 95% CI 1.09-1.21, P = 3.39E-07), and schizophrenia (OR = 1.02, 95% CI 1.01-1.04, P = 1.70E-03) with FI. However, our findings do not provide support for a link between mania (OR = 1.46, 95% CI 0.79-2.72, P = 2.27E-01), OCD (OR = 1.01, 95% CI 1.00-1.02, P = 2.11E-01) and an increased risk of FI.

Conclusion

The MR results suggest a potential bidirectional causal relationship between FI and anxiety, depression, and affective disorder. Schizophrenia was found to be associated with a higher risk of FI. The evidence was insufficient to support a causal relationship between Fl and other Ml. These findings offer new insights into the development of effective management strategies for frailty and MI.

Factors Associated with Frailty in Older Adults in Community and Nursing Home Settings: A Systematic Review with a Meta-Analysis

Background: Frailty is a globally recognized issue. However, there is a lack of evidence exploring factors associated with frailty among older residents in community and nursing-home settings. Methods: To explore the prevalence and factors associated with frailty among older adults in community and nursing-home settings, we conducted a systematic search following the PRISMA guidelines across Web of Science, MEDLINE, EMBASE, PubMed, and Cochrane databases up until January 2024, selecting 38 studies which encompassed 150,642 participants. Results: Our findings showed higher frailty prevalence in nursing homes compared to communities. Frailty was significantly associated with sociodemographic (living alone, poor self-reported health), physiological (poor sleep, low activity of daily living), behavioral (physical inactivity) and disease (chronic conditions, depression) factors in both community and nursing-home settings. Conclusions: There are numerous factors associated with frailty in older adults in nursing-home and community settings. These factors underscore the significance of promptly identifying high-risk individuals and devising appropriate interventions to mitigate frailty among them.

The association of painful and non-painful morbidities with frailty: a cross sectional analysis of a cohort of community dwelling older people in England

INTRODUCTION

The association between chronic pain and frailty might indicate that pain is an independent driver of frailty but might alternatively be explained by inclusion within frailty identification tools of morbidities that commonly lead to chronic pain. This research examines the extent to which the association of pain with frailty might be attributed to morbidities.

METHODS

A cross-sectional analysis of older people in a UK cohort with or at risk of musculoskeletal problems or frailty (Investigating Musculoskeletal Health and Wellbeing study), used multivariable logistic regression and Z-tests to assess the degrees of associations of pain (McGill Pain Rating Index), and painful and non-painful morbidity counts with frailty (modified FRAIL questionnaire).

RESULTS

Data were from 2,185 participants, 56% female, median age 73 (range 60 to 96) years. 430 (20%) participants were classified as frail. In a fully adjusted standardised model, pain (aOR 2.07 (95%CI 1.83 to 2.33) and 'any' morbidity aOR (1.74 (95%CI 1.54 to 1.97) were both significantly associated with frailty. When morbidity was subclassified as painful or non-painful, painful (aOR 1.48 (95%CI 1.30 to 1.68) and non-painful (aOR1.39 (95%CI 1.24 to 1.56)) morbidities each were associated with frailty, as also was pain (aOR 2.07 (95%CI 1.83 to 2.34, p < 0.001).

CONCLUSIONS

Pain is associated with frailty, over and above any effect of painful and non-painful morbidities. This forms the justification for future research which focuses on pain management in the identification, prevention, and treatment of frailty.

A genome-wide association study of frailty identifies significant genetic correlation with neuropsychiatric, cardiovascular, and inflammation pathways

Frailty is an aging-related clinical phenotype defined as a state in which there is an increase in a person's vulnerability for dependency and/or mortality when exposed to a stressor. While underlying mechanisms leading to the occurrence of frailty are complex, the importance of genetic factors has not been fully investigated. We conducted a large-scale genome-wide association study (GWAS) of frailty, as defined by the five criteria (weight loss, exhaustion, physical activity, walking speed, and grip strength) captured in the Fried Frailty Score (FFS), in 386,565 European descent participants enrolled in the UK Biobank (mean age 57 [SD 8] years, 208,481 [54%] females). We identified 37 independent, novel loci associated with the FFS (p < 5 × 10-8), including seven loci without prior described associations with other traits. The variants associated with FFS were significantly enriched in brain tissues as well as aging-related pathways. Our post-GWAS bioinformatic analyses revealed significant genetic correlations between FFS and cardiovascular-, neurological-, and inflammation-related diseases/traits, and subsequent Mendelian Randomization analyses identified causal associations with chronic pain, obesity, diabetes, education-related traits, joint disorders, and depressive/neurological, metabolic, and respiratory diseases. The GWAS signals were replicated in the Health and Retirement Study (HRS, n = 9,720, mean age 73 [SD 7], 5,582 [57%] females), where the polygenic risk score built from UKB GWAS was significantly associated with the FFS in HRS individuals (OR per SD of the score 1.27, 95% CI 1.22-1.31, p = 1.3 × 10-11). These results provide new insight into the biology of frailty by comprehensively evaluating its genetic architecture.

Relationship Between Chronic Pain Types (Nociceptive and Neuropathic-Like Symptoms) and Frailty in Community-Dwelling Japanese Older Adults: A Cross-Sectional Study

Purpose

Chronic pain may accelerate the development of frailty in older adults through a variety of mechanisms. There are no published investigations of the influence of neuropathic-like symptoms on physical frailty. We investigated the association between chronic pain types (nociceptive and neuropathic-like symptoms) and frailty in community-dwelling Japanese older adults.

Participants and Methods

This was a population-based cross-sectional study conducted in 2017 in the city of Itoshima, Japan of 917 participants aged 65-75 years, not in need of long-term care, who had completed the physical function tests and questionnaires administered at measurement sessions held at community centers at three sites over a 1- to 2-month period. Their chronic pain types were classified as no-chronic pain, nociceptive pain, and neuropathic-like symptoms according to their painDETECT scores. Frailty phenotypes were defined by the following five components: unintentional weight loss, low grip strength, exhaustion, slow gait speed, and low physical activity. A logistic regression model was used to compute the odds ratios (ORs) and 95% confidence interval (CIs) for frailty status outcomes.

Results

The prevalence of pre-frailty was 51.9%, and that of frailty was 5.1%. In multinomial logistic regression analyses, compared to the no-chronic pain group, the OR for the presence of pre-frailty among the participants with nociceptive pain was 1.54 (95% CI: 1.04-2.30, p=0.03), and the OR for the presence of frailty among the participants with neuropathic-like symptoms was 4.37 (95% CI: 1.10-17.37, p=0.04). The neuropathic sensory symptoms of burning, tingling/prickling, and numbness were each associated with frailty, but not with the risk of pre-frailty.

Conclusion

Neuropathic-like symptoms were significantly associated with the presence of frailty in community-dwelling Japanese older adults. Chronic pain types might have different effects on frailty status.

Trends of underweight, overweight, and obesity among older adults in China from 2008 to 2018: a national observational survey

OBJECTIVE

This study aims to investigate the 10-year trends and disparities in underweight, overweight, and obesity among older adults aged 65 years and older in China from 2008 to 2018.

METHODS

We used four waves (2008, 2011, 2014, and 2018) of data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a national community-based cross-sectional survey conducted every 2-3 years. Body weight and height were measured by trained assessors following standardized procedures. BMI was calculated and divided into underweight (< 18.5 kg/m²), normal (18.5-24.9 kg/m²), overweight (25.0-29.9 kg/m²), obese (≥ 30.0 kg/m²) according to WHO reference. Multinomial logistic regression models were used to examine factors related with abnormal BMI groups, after adjusting for potential confounders.

RESULTS

Among 46,543 older adults in China, the prevalence rates of underweight decreased with each survey year from 2008 to 2018, declining from 20.05 to 7.87% (p < 0.001). In contrast, the prevalence rates of overweight and obesity showed an increasing trend (all p < 0.001). Specifically, the prevalence of overweight rose from 12.82% to 2008 to 28.45% in 2018, and the prevalence of obesity increased from 1.62% to 2008 to 4.95% in 2018. In the multinomial logistic regression model, survey year, gender, residence, marital status, economic status, numbers of chronic diseases, smoking status, sleep quality, and functional disability were factors related with obesity.

CONCLUSION

The prevalence rates of overweight and obesity were increasing while the prevalence of underweight and normal weight significantly decreased from 2008 to 2018 among older adults in China, which poses a huge challenge for chronic disease. There is an urgent need for intervention policy planning and early prevention of abnormal body weight for the preparation of an aging society.

eHealth in obesity care

Obesity in adults is a growing health concern. Although effective, current treatment options have not been able to overcome the various factors that contribute toward rising obesity rates. eHealth might hold the capacity to improve the effectiveness, delivery and flexibility of some of these treatments. Here, we show that eHealth lifestyle change interventions delivered through smartphones (mHealth) can facilitate significant weight loss, making mHealth an attractive adjunct to clinical obesity care. However, evidence is currently limited to short-term effects, and is also lacking with regards to effectiveness based on socioeconomic status and ethnic group. This raises concerns around the potential and inadvertent widening of obesity prevalence disparities between groups as mHealth lifestyle change interventions are increasingly used in obesity care. Thus, we also describe opportunities to address these concerns and gaps in evidence.

Molecular Mechanisms and Pathophysiological Pathways of High-Fat Diets and Caloric Restriction Dietary Patterns on Pain

Pain perception provides evolutionary advantages by enhancing the probability of survival, but chronic pain continues to be a significant global health concern in modern society. Various factors are associated with pain alteration. Accumulating evidence has revealed that obesity correlates with enhanced pain perception, especially in chronic pain individuals. Existing dietary patterns related to obesity are primarily high-fat diets (HFD) and calorie restriction (CR) diets, which induce or alleviate obesity separately. HFD has been shown to enhance nociception while CR tends to alleviate pain when measuring pain outcomes. Herein, this review mainly summarizes the current knowledge of the effects of HFD and CR on pain responses and underlying molecular mechanisms of the immunological factors, metabolic regulation, inflammatory processes, Schwann cell (SC) autophagy, gut microbiome, and other pathophysiological signaling pathways involved. This review would help to provide insights on potential nonpharmacological strategies of dietary patterns in relieving pain.

Association of a mixture of phthalates and phenols with frailty among middle-aged and older adults: A population-based cross-sectional study

BACKGROUND

Frailty is a complex geriatric syndrome caused by degenerative changes in the body or various chronic diseases. The use of personal care and consumer products is associated with a wide range of health outcomes, but its relationship with frailty remains unknown. Therefore, our primary aim was to explore the potential links between exposure to phenols and phthalates, either separately or in combination, and frailty.

METHODS

The exposure levels of phthalates and phenols were evaluated through the measurement of metabolites in urine samples. Frailty state was assessed by a 36-item frailty index with values ≥ 0.25 indicating frailty. Weighted logistic regression was used to explore the relationship between individual chemical exposure and frailty. In addition, multi-pollutant strategies (WQS, Qgcomp, BKMR) were used to examine the joint effect of chemical mixture on frailty. A series of subgroup analyses and sensitivity analyses were conducted as well.

RESULTS

In the multivariate logistic regression model, each unit increase in natural log-transformed BPA (OR: 1.21; 95%CI: 1.04, 1.40), MBP (OR: 1.25; 95%CI: 1.07, 1.46), MBzP (OR: 1.18; 95%CI: 1.03, 1.36), and MiBP (OR: 1.19; 95%CI: 1.03, 1.37) were significantly associated with higher odds of frailty. The results of the WQS and Qgcomp indicated that increasing quartiles of chemical mixture was associated with odds of frailty with ORs of 1.29 (95%CI: 1.01, 1.66) and 1.37 (95%CI: 1.06, 1.76). The weight of MBzP is dominant in both the WQS index and the positive weight of Qgcomp. In the BKMR model, the cumulative effect of chemical mixture was positively correlated with the prevalence of frailty.

CONCLUSIONS

In summary, higher levels of BPA, MBP, MBzP, and MiBP are significantly associated with higher odds of frailty. Our study provides preliminary evidence that phenol and phthalate biomarker mixture is positively associated with frailty, with MBzP contributing most to the positive association.

How frail is frail in oncology studies? A scoping review

AIMS

The frailty index (FI) is one way in which frailty can be quantified. While it is measured as a continuous variable, various cut-off points have been used to categorise older adults as frail or non-frail, and these have largely been validated in the acute care or community settings for older adults without cancer. This review aimed to explore which FI categories have been applied to older adults with cancer and to determine why these categories were selected by study authors.

METHODS

This scoping review searched Medline, EMBASE, Cochrane, CINAHL, and Web of Science databases for studies which measured and categorised an FI in adults with cancer. Of the 1994 screened, 41 were eligible for inclusion. Data including oncological setting, FI categories, and the references or rationale for categorisation were extracted and analysed.

RESULTS

The FI score used to categorise participants as frail ranged from 0.06 to 0.35, with 0.35 being the most frequently used, followed by 0.25 and 0.20. The rationale for FI categories was provided in most studies but was not always relevant. Three of the included studies using an FI > 0.35 to define frailty were frequently referenced as the rationale for subsequent studies, however, the original rationale for this categorisation was unclear. Few studies sought to determine or validate optimum FI categorises in this population.

CONCLUSION

There is significant variability in how studies have categorised the FI in older adults with cancer. An FI ≥ 0.35 to categorise frailty was used most frequently, however an FI in this range has often represented at least moderate to severe frailty in other highly-cited studies. These findings contrast with a scoping review of highly-cited studies categorising FI in older adults without cancer, where an FI ≥ 0.25 was most common. Maintaining the FI as a continuous variable is likely to be beneficial until further validation studies determine optimum FI categories in this population. Differences in how the FI has been categorised, and indeed how older adults have been labelled as 'frail', limits our ability to synthesise results and to understand the impact of frailty in cancer care.

Polygenic Contributions to Chronic Overlapping Pain Conditions in a Large Electronic Health Record Sample

Chronic overlapping pain conditions (COPCs) are believed to share common etiological mechanisms involving central sensitization. Genetic and environmental factors putatively combine to influence susceptibility to central sensitization and COPCs. This study employed a genome-wide polygenic risk score approach to evaluate genetic influences on 8 common COPCs. COPCs were identified by International Classification of Disease codes in Vanderbilt's deidentified clinical biorepository (BioVU), with each COPC condition empirically weighted for the level of central sensitization based on prior work. A centralized pain score (CPS) was calculated for 55,340 individuals by summing the weighted number of COPCs. Overall, 12,502 individuals (22.6%) were diagnosed with at least 1 COPC, with females exhibiting nearly twice the mean CPS as males. To assess the genetic influence on centralized pain in COPCs, 6 pain polygenic risk scores (PRSs) were developed using UK Biobank data to predict 6 pain criteria (no pain, neck/shoulder, abdomen, hip, knee, low back pain). These PRSs were then deployed in the BioVU cohort to test for association with CPS. In regression models adjusted for age, sex, and BMI, all pain PRSs except hip pain were significantly associated with CPS. Our findings support a shared polygenic influence across COPCs potentially involving central sensitization mechanisms. PERSPECTIVE: This study used a polygenic risk score approach to investigate genetic influences on chronic overlapping pain conditions. Significant findings in this study provide evidence supporting previous hypotheses that a shared polygenic influence involving central sensitization may underly chronic overlapping pain conditions and can guide future biomarker and risk assessment research.

Physical activity and body mass index were interactively related to health-related quality of life among older adults

PURPOSE

The purpose of this study was to examine how meeting physical activity (PA) guidelines (i.e., moderate-to-vigorous aerobic activity, muscle strengthening activity) and weight status were interactively related to health-related quality of life (HRQoL) among older adults.

METHODS

A cross-sectional analysis was conducted using data from 87,495 older adults aged 65+ years who participated in the U.S. 2019 Behavioral Risk Factor Surveillance System. PA, weight status, and HRQoL were assessed by validated questionnaires via phone interviews. Binomial logistic regression models were used to examine the interactive effects of meeting PA guidelines and weight status on the odds of having poor HRQoL after controlling for key confounders.

RESULTS

Compared to participants meeting both PA guidelines and with normal weight, both underweight and obese older adults had significantly higher odds of having poor general health (OR= 1.55-6.16) regardless of meeting PA guideline status, and those meeting muscle strengthening activities only or meeting neither PA guideline reported higher odds of poor physical health (OR= 1.83-6.22) regardless of weight status. Similarly, those meeting neither PA guideline had significantly higher odds of having poor mental health (OR= 1.69-2.78) regardless of weight status, and those meeting muscle strengthening activities only or meeting neither PA guideline reported higher odds of having frequent activity limitation days (OR= 2.18-7.05).

CONCLUSIONS

The positive associations between moderate-to-vigorous aerobic PA and HRQoL indicate the need to promote aerobic PA in older adults. Both sex and weight status should be considered when designing PA interventions to improve HRQoL among older adults.

The Importance of Nutrition as a Lifestyle Factor in Chronic Pain Management: A Narrative Review

In everyday clinical practice, healthcare professionals often meet chronic pain patients with a poor nutritional status. A poor nutritional status such as malnutrition, unhealthy dietary behaviors, and a suboptimal dietary intake can play a significant role in the occurrence, development, and prognosis of chronic pain. The relationship between nutrition and chronic pain is complex and may involve many underlying mechanisms such as oxidative stress, inflammation, and glucose metabolism. As such, pain management requires a comprehensive and interdisciplinary approach that includes nutrition. Nutrition is the top modifiable lifestyle factor for chronic non-communicable diseases including chronic pain. Optimizing one’s dietary intake and behavior needs to be considered in pain management. Thus, this narrative review reports and summarizes the existing evidence regarding (1) the nutrition-related health of people experiencing pain (2) the underlying potential mechanisms that explain the interaction between nutrition and chronic pain, and (3) the role of nutrition screening, assessment and evaluation for people experiencing pain and the scope of nutrition practice in pain management. Future directions in the nutrition and chronic pain field are also discussed.

Bidirectional associations between body mass and bodily pain among middle-aged and older adults

ABSTRACT

Higher body mass and obesity are associated with bodily pain, and rates of chronic pain increase among older adults. Most past studies are cross-sectional, precluding determination of the temporal relationship between body mass and pain. A longitudinal study of body mass and pain among middle-aged adults found that higher body mass index (BMI) led to greater lower back pain. No longitudinal study of BMI and pain has been conducted among adults older than 70 years. This study used dual change score models to determine the directional relationship between BMI and bodily pain in a sample of middle-aged and older adults. Participants (n = 1889) from the Swedish Twin Registry (baseline age range 40-93 years) completed at least 1 nurse assessment of BMI and self-report ratings of pain interference and joint pain. Pain interference was not associated with BMI, but joint pain was analyzed in univariate and bivariate models, with dual change score models modeling the relationship of BMI and joint pain across age, both independently and as part of bivariate relationships. The results indicated a reciprocal relationship between BMI and joint pain, but joint pain generally led to changes in BMI. In addition, the relationship changed with age, until approximately age 80 years, increasing joint pain contributed to higher BMI, but after that time increasing joint pain contributed to lower BMI. In addition, sex differences in the relationship between BMI and pain appeared after age 70 years. Thus, joint pain contributes to changes in BMI among middle-aged and older adults, but the relationship may change by age and sex.

Frailty and risk of mortality in older cancer survivors and adults without a cancer history: Evidence from the National Health and Nutrition Examination Survey, 1999-2014

BACKGROUND

Epidemiologic evidence reporting the role of frailty in survival among older adults with a prior cancer diagnosis is limited.

METHODS

A total of 2050 older adults (≥60 years old) surviving for at least 1 year after a cancer diagnosis and 9474 older adults without a cancer history from the National Health and Nutrition Examination Survey (1999-2014) were included for analysis. The exposure variable, a 45-item frailty index (FI), was categorized on the basis of validated cutoffs (FI ≤ 0.10 [fit], 0.10 < FI ≤ 0.21 [prefrail], and FI > 0.21 [frail]). All-cause mortality was ascertained via the National Death Index. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence interval (CIs) for the FI, and this was followed by restricted cubic splines depicting dose-response curves.

RESULTS

For older cancer survivors, the mean age at the baseline was 72.6 years (SD, 7.1 years); 5.9% were fit, 38.2% were prefrail, and 55.9% were frail. Older adults without a cancer history were slightly younger (mean age, 70.0 years) and less frail (47.9% were frail). At each level of the FI, cancer survivors (1.9 per 100 person-years for FI ≤ 0.10, 3.4 per 100 person-years for 0.10 < FI ≤ 0.21, and 7.5 per 100 person-years for FI > 0.21) had higher mortality than their cancer-free counterparts (1.4 per 100 person-years for FI ≤ 0.10, 2.4 per 100 person-years for 0.10 < FI ≤ 0.21, and 5.4 per 100 person-years for FI > 0.21). The multivariable model suggested a positive association between the FI and all-cause mortality for survivors (aHR for FI > 0.21 vs FI ≤ 0.10, 2.80; 95% CI, 1.73-4.53) and participants without a cancer history (aHR for FI > 0.21 vs FI ≤ 0.10, 2.75; 95% CI, 2.29-3.32). Restricted cubic splines indicated that all-cause mortality risk increased with the FI in a monotonic pattern.

CONCLUSIONS

Frailty is associated with a higher risk of death in older cancer survivors and the elderly without a cancer history.

Path Model Factors Associated with Depressive Symptoms among Older Thais Living in Rural Areas

Depressive symptoms are complex and are often more severe in older people. However, there is limited research exploring the causal relationships between depression and its associated factors in the geriatric population, particularly in Thailand. We aimed to evaluate the direction of these complex relationships in the Thai population. A cross-sectional design was conducted on 312 Thai community-dwelling older adults aged 60 years or above who registered for primary care services. The participants were recruited from July 2019 to January 2020, and they responded to standard assessments. The relationships between pain, the number of medications, frailty, locomotive syndrome, and depressive symptoms were investigated using path analysis. The results showed that most participants were women and had multiple diseases, mild pain, frailty, and grade I−II locomotive syndrome. The prevalence of depressive symptoms was 16%. The model showed significant positive direct and indirect paths from locomotive syndrome to depressive symptoms (β = 0.296, p < 0.01; β = 0.099, p < 0.01, respectively). There was a significant positive direct path from frailty to depressive symptoms (β = 0.219, p < 0.01) and a significant positive indirect path from pain to depressive symptoms (β = 0.096, p < 0.01).

Abuse of Non-opioid Analgesics in Germany: Prevalence and Associations Among Self-Medicated Users

BACKGROUND

Abuse of non-opioid analgesics (NOA) is associated with serious health consequences. However, due to inconsistent definitions of NOA abuse, prevalence estimates for the German population are unclear.

OBJECTIVES

This study aimed to estimate the 12-month prevalence of NOA abuse among self-medicated users of these drugs in the general German population and to identify risk factors.

METHODS

Data are from the 2015 Epidemiological Survey of Substance Abuse, a nationally representative sample with 9,204 individuals aged 18-64 years. Classification of NOA abuse was based on self-reported information according to the definition of the ICD-10-GM diagnosis F55.2 abuse of non-dependence producing substances. Multiple logistic regression was performed to examine associations between NOA abuse and sociodemographic, behavioral, and health-related variables.

RESULTS

The weighted 12-month prevalence of NOA abuse was 14.6% (95%-CI [13.2- 16.0]) among self-medicated users of these drugs. Extrapolation of the proportion of individuals abusing NOA to the German population aged 18 to 64 is 3,243,396 individuals or 6.4% (95%-CI [5.7- 7.1]). Inexplicable physical pain, being underweight, depression, hazardous alcohol use, daily smoking, illegal drug use, and frequent use of NOA (one or more times per week and daily use) were associated with an increased probability of NOA abuse. The use of cannabis was associated with a lower probability of NOA abuse.

CONCLUSION

Abuse of NOA is highly prevalent in the German population. Against the background of increasing self-medication of NOA, healthcare providers need to be aware of potential risk factors of abuse to better identify and prevent this problem.

Magnitude and factors associated with postoperative depression among adult orthopedics patients during COVID-19 pandemics: A multi-center cross-sectional study

BACKGROUND

Postoperative depression is one of the devastating problems and important health concerns in adult orthopedics surgical patients. It is often under-diagnosed and appropriate perioperative management of patients is recommended. This study aimed to determine the magnitude and factors associated with postoperative depression among orthopedics patients in Ethiopia.

MATERIALS AND METHODS

This multi-center cross-sectional study was conducted on 443 adult post-orthopedics surgical patients. All the data were entered and analyzed with SPSS version 25. Bivariable and multivariable logistic regression was used to identify the associated factors with the outcome variable. P-values <0.05 were taken as statistically significant with 95% CI. Data were collected after distributing 9-item standard patient health questionnaires and the Oslo-3 item social support scale tool.

RESULT

Based on our study result, the magnitude of postoperative depression among adult orthopedics surgical patients was 61.8% (95% CI: 56.8-65.7). Using multivariable logistic regression analysis, factors which had an association with postoperative depression were female in gender, Farmer in occupation, having a history of previous substance use, history of anxiety, Patients who had moderate to poor social support, BMI <18.5 kg/m², and patients who had an open fracture.

CONCLUSION

The magnitude of postoperative depression was high. Due emphasis needs to be given to screening and treatment of postoperative depression, especially among patients of the female gender, farmer occupation, moderate to poor social support, history of substance use and anxiety, low BMI, and open fracture.

Prevalence and associated factors of frailty in patients attending rural and urban geriatric clinics

OBJECTIVES

To investigate the prevalence and factors associated with frailty in rural and urban older outpatients in Vietnam.

METHODS

This cross-sectional study included 1084 outpatients (aged ≥60 years; mean age 71.7 ± 7.4 years; female 65%) from rural (n = 600) and urban (n = 484) geriatric clinics from December 2019 to July 2020. Frailty was assessed using Fried frailty phenotype. Factors associated with frailty were assessed using logistic regression.

RESULTS

Overall, frailty prevalence was 28% (rural, 26%; urban, 30%; p = 0.220). Factors associated with frailty were older age (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.13-1.20, p < 0.001), being underweight (OR 1.88, 95% CI 1.10-3.27, p = 0.025) and limitations in activities of daily living (ADLs) (OR 6.04, 95% CI 1.63-22.41, p = 0.007) and instrumental ADLs (OR 5.83, 95% CI 3.74-9.08, p < 0.001). Higher education (OR 0.47, 95% CI 0.29-0.76, p = 0.002) and productive work (OR 0.39, 95% CI 0.21-0.71, p = 0.002) were protective factors against frailty.

CONCLUSIONS

In Vietnam, the prevalence of frailty in older outpatients was 28%, though not significantly different between urban and rural areas. Older age, being underweight and limitations in functional status can increase the odds of frailty, but higher education and productive work can reduce the odds of frailty.

Obesity Hurts: The Why and How of Integrating Weight Reduction With Chronic Pain Management

Amongst adults with chronic pain, overweight and obesity are highly prevalent. The association between chronic pain and overweight is driven by several explanations, including increased biomechanical load, changes in the gut microbiome, and low-grade (neuro)inflammation. Moreover, the link between overweight, obesity and chronic pain can best be considered from a lifestyle perspective. Since conservative treatment for chronic pain is often limited to short-term and small effects, addressing important comorbidities within a lifestyle approach could be the next step towards precision medicine for these patients. Indeed, evidence shows that combining weight reduction with conservative pain management is more effective to reduce pain and disability, compared to either intervention alone. This perspective article aims to update the reader with the current understanding of the possible explanatory mechanisms behind the interaction between overweight/obesity and chronic pain in an adult population. Second, this paper applies this knowledge to clinical practice, including assessment and conservative treatment of overweight/obesity in adults with chronic pain. Henceforth, clinical recommendations and guidelines are provided based on available scientific evidence and the authors' clinical expertise.

IMPACT

This paper will guide clinicians in the implementation of weight reduction programs within pain management.

Frailty in Pancreas Transplantation

There are a variety of definitions and criteria used in clinical practice to define frailty. In the absence of a gold-standard definition, frailty has been operationally defined as meeting 3 out of 5 phenotypic criteria indicating compromised function: low grip strength, low energy, slowed walking speed, low physical activity, and unintentional weight loss. Frailty is a common problem in solid organ transplant candidates who are in the process of being listed for a transplant, as well as after transplantation. Patients with diabetes or chronic kidney disease (CKD) are known to be at increased risk of being frail. As pancreas transplantation is exclusively performed among patients with diabetes and the majority of them also have CKD, pancreas transplant candidates and recipients are at high risk of being frail. Sarcopenia, fatigue, low walking speed, low physical activity, and unintentional weight loss, which are some of the phenotypes of frailty, are very prevalent in this population. In various solid organs, frail patients are less likely to be listed or transplanted and have high waitlist mortality. Even after a transplant, they have increased risk of prolonged hospitalization, readmission, and delayed graft function. Given the negative impact of frailty on solid organ transplants, we believe that frailty would have a similar or even worse impact on pancreas transplantation. Due to the paucity of data specifically among pancreas transplant recipients, here we include frailty data from patients with CKD, diabetes, and various solid organ transplant recipients.

Abdominal obesity, body mass index and the risk of frailty in community-dwelling older adults: a systematic review and meta-analysis

Obese older people are more likely to be frail than those with a normal body mass index (BMI), but the results of individual studies have been inconsistent. We conducted a systematic review and meta-analysis to clarify the association between obesity and the risk of frailty, and whether there was a relationship between BMI and frailty, in community-dwelling older adults aged ≥60 years. Eight databases (PubMed/MEDLINE, EMBASE, EBSCO, CINAHL, Scopus, Cochrane Library and Web of Science) were systematically searched from inception to August 2020. Relative risks for incident frailty were pooled using a random-effects model. We found a positive association between abdominal obesity and frailty [relative risk (RR) = 1.57, 95% confidence interval (CI) 1.29-1.91, I2 = 48.1%, P = 0.086, six observational studies, 18,764 subjects]. People in the higher category of waist circumference had a pooled 57% higher risk of frailty than those with a normal waist circumference. In addition, a total of 12 observational studies comprising 37,985 older people were included in the meta-analysis on the relationship between BMI and the risk for frailty. Taking the normal BMI as the reference group, the pooled RR of frailty risk ranged from 1.45 (95% CI 1.10-1.90, I2 = 83.3%; P < 0.01) for the underweight group, to 0.93 (95% CI 0.85-1.02, I2 = 34.6%; P = 0.114) for the overweight group and to 1.40 (95% CI 1.17-1.67, I2 = 86.1%; P < 0.01) for the obese group. We have shown that obesity or underweight is associated with an increased risk of frailty in community-dwelling older adults.

Association of Diabetes With Lower Back Pain: A Narrative Review

Diabetes mellitus with its increasing prevalence is one of the four major non-communicable diseases. It is characterized by hyperglycemia, which may progress to chronic complications such as peripheral vascular disease and neuropathy. This paper highlights the pathophysiology associated with diabetes, which is restricted to not only hyperglycemia but also other comorbidities including chronic lower back pain. Diabetes is a metabolic disorder associated with hypercholesteremia, hypertriglyceridemia, and hypertension. This chain of events leads to free plasma fatty acids and a pro-inflammatory state, therefore promoting calcification of blood vessels, which may block the blood supply to vertebral discs and thereby increase vulnerability in the patients with ongoing inflammatory disease such as osteoarthritis and also causing costochondritis. Functional limitation due to increased load on the weight-bearing joints is a common mechanical complication of diabetes. Obesity in diabetes is more prevalent due to a disturbed metabolism, which is aggravated with a persistent inflammatory state. Moreover, the aim of this review is to encourage further conduction of clinical studies to explore the definite cause and potential therapy for chronic lower back pain in diabetes, thereby investigating the association of lipid metabolism and skeletal muscle atrophy leading to chronic back pain, the role of diabetic medications, and vulnerability in the female gender. Diminished physical activity and depression in diabetic patients disrupt the hypothalamic-pituitary-adrenal axis (HPA), which further contributes to lower back pain. Further clinical investigation and research in this regard will establish substantial data for the linkage between depression in diabetes and back pain. However, despite all the advancements of medical literature, the exact cause of lower back pain in diabetes is arguable. Pain impedes the health status and life quality; therefore, it is essential to maintain the quality of health in patients with diabetes by treating not only hyperglycemia but also other multifactorial causes leading to lower back pain.

A Mobile Health Behavior Intervention to Reduce Pain and Improve Health in Older Adults With Obesity and Chronic Pain: The MORPH Pilot Trial

Chronic, multisite pain is a common phenomenon in aging and is associated with a host of negative health outcomes. It is a complex and multifaceted condition that may be exacerbated by weight gain and long periods of inactivity. Unfortunately, older adults suffering from chronic pain have unique barriers limiting access to center-based behavior change interventions. The MORPH study first adapted and iteratively refined an evidence-based group-mediated intervention for delivery in the home via mHealth tools (a smartphone app, teleconferencing software, wearable activity monitor, smart weight scale). This was followed by a pilot randomized controlled trial (RCT) meant to assess feasibility of the MORPH intervention, and to examine initial effects on physical function, pain, weight, and sedentary behavior. We recruited low-active and obese older adults with multisite pain to partake in a series of N-of-1 refinement studies (N = 5 total) or a 12-week pilot RCT delivered largely in the home (N = 28 assigned to active intervention or wait-list control). The refinement phase identified several key technological (e.g., selection of a new smart weight scale) and user interface (e.g., clarification of in-app phrasing) modifications that were made before initiating the RCT phase. Analyses of covariance, controlling for baseline values, sex, and age indicated effects favoring the intervention across all domains of interest: there was a substantially clinically meaningful difference in short physical performance battery scores (0.63 points, η² = 0.08), a moderate-to-large difference in PROMIS pain intensity scores (5.52 points, η² = 0.12), a large difference in body weight (2.90 kg, η² = 0.207), and a moderate effect on adjusted ActivPAL-assessed sedentary time (64.90 min, η² = 0.07) with a small effect on steps (297.7 steps, η² = 0.01). These results suggest a largely-home delivered movement and weight loss program for older adults with pain is feasible and recommendations are provided for future programs of this nature.

Clinical Trial Registration:ClinicalTrials.gov, Identifier: NCT03377634.

The association between obesity and chronic pain among community-dwelling older adults: a systematic review and meta-analysis

OBJECTIVES

To systematically review studies and explore the association between obesity and chronic pain among community-dwelling older adults.

METHODS

A comprehensive literature search was conducted in 9 databases and the Pubmed search engine from their inception to March 19, 2020. Studies that investigated the associations between overweight/obesity and chronic pain among older people were obtained. Comprehensive Meta-analysis was used to meta-analyze the eligible studies.

RESULTS

Totally 14 studies with 40,999 participants were included in this review, and 8 of these studies were meta-analyzed. The meta-analyses showed that both overweight (pooled OR = 1.166, 95% CI: 1.104-1.232, p < 0.01) and obesity (pooled OR = 1.786, 95% CI: 1.530-2.085, p < 0.01) had significant associations with chronic pain among older adults.

CONCLUSIONS

Overweight and obesity are both associated with chronic pain among older adults. It is suggested that body weight control strategies might be incorporated into the pain management program for older adults with obesity.

Association between ambulatory blood pressure variability and frailty among older hypertensive patients

Frailty and hypertension often coexist and are increasingly prevalent with advancing age. Although hypertension is independently associated with frailty, whether high blood pressure variability affecting frailty is unclear. In this retrospective study, we consecutively enrolled elderly patients with essential hypertension undergoing 24-hour ABPM. The frailty was assessed by a 38-item frailty index. The parameters of blood pressure variability of ABPM, including ARV, coefficient of CV, SD, and weighed SD were calculated. Ordinal logistic regression was used to investigate the association between blood pressure variability and frailty. A total of 242 hypertensive patients were recruited and divided into the frail group, pre-frail group, and non-frail group. The overall magnitudes of BP variability, assessed by ARV, CV, SD, and weighed SD, were significantly greater in patients with frailty than those with pre-frailty and non-frailty. With adjustment for covariates, ARV of 24-hour, diurnal, and nocturnal SBP were independently associated with frailty (24 hours, OR: 2.48, 95% CI: 2.01-3.07; daytime, OR: 1.83, 95% CI: 1.60-2.10; nighttime, OR: 1.19, 95% CI: 1.12-1.27). The CV of 24-hour, diurnal, and nocturnal SBP was independently associated with frailty in the study (24 hours, OR: 1.2, 95% CI: 1.05-3.07; daytime, OR: 1.19, 95% CI: 1.05-1.34; nighttime, OR: 1.13, 95% CI: 1.03-1.24). For SD and weighed SD, only 24-hour systolic SD was independent risk factor associated with frailty (OR: 1.12, 95% CI: 1.01-1.23). The greater blood pressure variability of SBP, particular ARV and CV, were independent risk factors associated with higher-order frailty status. Longitudinal studies are needed to investigate the causality associations between hypertension and frailty.

Assessing Global Frailty Scores: Development of a Global Burden of Disease-Frailty Index (GBD-FI)

Frailty is an independent age-associated predictor of morbidity and mortality. Despite this, many countries lack population estimates with large heterogeneity between studies. No population-based standardised metric for frailty is available. We applied the deficit accumulation model of frailty to create a frailty index (FI) using population-level estimates from the Global Burden of Disease (GBD) 2017 study across 195 countries to create a novel GBD frailty index (GBD-FI). Standard FI criteria were applied to all GBD categories to select GBD-FI items. Content validity was assessed by comparing the GBD-FI with a selection of established FIs. Properties including the rate of deficit accumulation with age were examined to assess construct validity. Linear regression models were created to assess if mean GBD-FI scores predicted one-year incident mortality. From all 554 GBD items, 36 were selected for the GBD-FI. Face validity against established FIs was variable. Characteristic properties of a FI—higher mean score for females and a deficit accumulation rate of approximately 0.03 per year, were observed. GBD-FI items were responsible for 19% of total Disability-Adjusted Life Years for those aged ≥70 years in 2017. Country-specific mean GBD-FI scores ranged from 0.14 (China) to 0.19 (Hungary) and were a better predictor of mortality from non-communicable diseases than age, gender, Healthcare Access and Quality Index or Socio-Demographic Index scores. The GBD-FI is a valid measure of frailty at population-level but further external validation is required.

Being Underweight Is Associated with Worse Surgical Outcomes of Total Knee Arthroplasty Compared to Normal Body Mass Index in Elderly Patients

Purpose

Being underweight has never been studied in relation to the radiologic and clinical outcomes of total knee arthroplasty (TKA) in elderly patients. The aim of this study was to determine the effect of being underweight on TKA radiological and clinical outcomes and to investigate whether being underweight influences postoperative complications compared to normal body mass index (BMI) in elderly patients.

Patients and Methods

A total of 118 female patients aged 65 years or older with BMI < 25 kg/m² who underwent primary TKA were divided into two groups based on BMI: group A: 18.5 kg/m² < BMI < 25 kg/m²; group B: BMI < 18.5 kg/m². The radiologic and clinical outcomes were evaluated at follow-up of 6, 12, and 24 months after surgery such as the hip-knee-ankle angle, the American Knee Society (AKS) score, Western Ontario and McMaster University score (WOMAC), and patellofemoral (PF) scale. Moreover, postoperative complications during follow-up were investigated.

Results

Preoperative clinical scores did not differ significantly between the two groups. Postoperative WOMAC pain (1.8 ± 1.9 versus 3.4 ± 2.6, p = 0.02), WOMAC function (12.4 ± 8.1 versus 16.5 ± 8.5, p = 0.012) and PF scales (26.1 ± 3.6 versus 23.7 ± 4.1, p = 0.002) were worse in the underweight group at 12 and 24 months after surgery. The frequency of postoperative complications did not differ significantly between groups. In multivariate linear regression analysis, underweight patient group was significantly associated with worse postoperative WOMAC and PF scores (p = 0.002, 0.005).

Conclusion

Although postoperative complications of TKA did not differ between groups, underweight patients had worse clinical outcomes of TKA compared to patients with normal BMI in elderly patients. Therefore, care should be taken when performing TKA in elderly underweight patients.

A Biopsychosocial Model of Chronic Pain for Older Adults

Population

Comprehensive evaluation of chronic pain in older adults is multifaceted.

Objective and Methods

Research on chronic pain in older adults needs to be guided by sound conceptual models. The purpose of this paper is to describe an adaptation of the Biopsychosocial Model (BPS) of Chronic Pain for older adults. The extant literature was reviewed, and selected research findings that provide the empiric foundation for this adaptation of the BPS model of chronic pain are summarized. The paper concludes with a discussion of specific recommendations for how this adapted model can be used to guide future research.

Conclusions

This adaptation of the BPS model of chronic pain for older adults provides a comprehensive framework to guide future research in this vulnerable population.