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LaRowe LR, Miaskowski C, Miller A, Mayfield A, Keefe FJ, Smith AK, Cooper BA, Wei LJ, Ritchie CS. Chronic Pain and Pain Management in Older Adults: Protocol and Pilot Results. Nurs Res 2024; 73:81-88. [PMID: 37582291 PMCID: PMC10829063 DOI: 10.1097/nnr.0000000000000683] [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] [Indexed: 08/17/2023]
Abstract
BACKGROUND Chronic pain occurs in 30% of older adults. This prevalence rate is expected to increase, given the growth in the older adult population and the associated growth of chronic conditions contributing to pain. No population-based studies have provided detailed, longitudinal information on the experience of chronic pain in older adults; the pharmacological and nonpharmacological strategies that older adults use to manage their chronic pain; and the effect of chronic pain on patient-reported outcomes. OBJECTIVES This article aims to describe the protocol for a population-based, longitudinal study focused on understanding the experience of chronic pain in older adults. The objectives are to determine the prevalence and characteristics of chronic pain; identify the pharmacological and nonpharmacological pain treatments used; evaluate for longitudinal differences in biopsychosocial factors; and examine how pain types and pain trajectories affect important patient-reported outcomes. Also included are the results of a pilot study. METHODS A population-based sample of approximately 1,888 older adults will be recruited from the National Opinion Research Center at the University of Chicago's AmeriSpeak Panel to complete surveys at three waves: enrollment (Wave 1), 6 months (Wave 2), and 12 months (Wave 3). To determine the feasibility, a pilot test of the enrollment survey was conducted among 123 older adults. RESULTS In the pilot study, older adults with chronic pain reported a range of pain conditions, with osteoarthritis being the most common. Participants reported an array of pharmacological and nonpharmacological pain strategies. Compared to participants without chronic pain, those with chronic pain reported lower physical and cognitive function and poorer quality of life. Data collection for the primary, longitudinal study is ongoing. DISCUSSION This project will be the first longitudinal population-based study to examine the experience and overall effect of chronic pain in older adults. Pilot study results provide evidence of the feasibility of study methods. Ultimately, this work will inform the development of tailored interventions for older patients targeted to decrease pain and improve function and quality of life.
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Affiliation(s)
- Lisa R. LaRowe
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Angela Miller
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Francis J. Keefe
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Alexander K. Smith
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA
- San Francisco VA Medical Center, San Francisco, CA
| | - Bruce A. Cooper
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA
| | - Lee-Jen Wei
- Harvard T.H. Chan School of Public Health, Boston, MA
| | - Christine S. Ritchie
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA
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Simone de Souza Vasconcelos K, de Carvalho Bastone A, Alvarenga Vieira R, Cristina de Souza Andrade A, Correa Dias R, Domingues Dias JM, Rodrigues Perracini M, Oliveira Guerra R, de Souza Moreira B. Examining the factors associated with functional capacity of community-dwelling older adults using the ICF framework: a cross-sectional study from the Frailty in Brazilian Older Adults Study (FIBRA). Physiother Theory Pract 2023; 39:2454-2469. [PMID: 35659442 DOI: 10.1080/09593985.2022.2079574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND There are many factors associated with functioning and disability in older adults and these relationships are not clear. OBJECTIVE To explore the factors associated with functional capacity of older adults using the framework of the International Classification of Functioning, Disability, and Health (ICF). METHODS This is a cross-sectional study with a dataset from a survey of 1 377 community-dwelling older adults (≥ 65 years) in a middle-income country. Three functional outcomes were selected to represent the functioning domains: 1) muscle strength for body function; 2) walking speed for activity; and 3) advanced activities of daily living (ADL) for participation. Demographic, clinical, and social information was selected to represent the domains of health conditions and contextual factors (i.e. personal and environmental factors). Multivariate models tested the impact of these factors on each outcome. RESULTS Depressive symptoms, age, and physical activity were associated with the three outcomes. Muscle strength was also associated with urinary incontinence, visual deficits, female sex, and employment. Walking speed was also associated with urinary incontinence, obesity, fractures due to falls, female sex, health professionals' visits, and walking aid devices. Advanced ADL were also associated with stroke, visual deficits, education, employment, health perception, social support, and walking aid devices. CONCLUSION Functional capacity of older adults is associated with some non-modifiable factors, such as age and sex. The modifiable factors must be addressed by health professionals and policymakers in the geriatric area, especially depression, obesity, physical inactivity, and social support.
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Affiliation(s)
- Karina Simone de Souza Vasconcelos
- Postgraduate Program in Rehabilitation Science, School of Physical Education, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Alessandra de Carvalho Bastone
- Postgraduate Program in Rehabilitation and Functional Performance, Department of Physical Therapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Renata Alvarenga Vieira
- Department of Physical Therapy, School of Physical Therapy, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, Brazil
| | | | - Rosângela Correa Dias
- Postgraduate Program in Rehabilitation Science, School of Physical Education, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - João Marcos Domingues Dias
- Postgraduate Program in Rehabilitation Science, School of Physical Education, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Mônica Rodrigues Perracini
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil
| | - Ricardo Oliveira Guerra
- Department of Physical Therapy, Universidade Federal do Rio Grande do Norte (UFRN), Natal, Brazil
| | - Bruno de Souza Moreira
- Center for Studies in Public Health and Aging, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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Pinheiro-Araujo CF, Rocha MR, Carvalho GF, Moraes R, Silva DC, Dach F, Bevilaqua-Grossi D. One-year changes in clinical and balance parameters in individuals of different subtypes of migraine. Musculoskelet Sci Pract 2023; 66:102806. [PMID: 37400347 DOI: 10.1016/j.msksp.2023.102806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Migraine has been associated with balance dysfunction, more pronounced in patients with aura and chronic migraine. Also, it has been suggested that balance deficits are progressive through the migraineurs lifetime. OBJECTIVE To analyze the one-year progression of balance parameters and clinical parameters associated with balance in female patients with and without migraine. DESIGN Prospective cohort study. METHODS The participants were distributed in four groups: control (CG; n = 27) migraine with aura (MA; n = 25), migraine without aura (MwA; n = 26), and chronic migraine (CM; n = 27). They performed the Sensory Organization Test, Motor Control Test and Adaptation Test protocols of dynamic posturography tests. Questionnaires about fear of falls, dizziness disability, and kinesiophobia were administered. These assessments were performed twice: baseline and after 1-year (follow-up). No intervention was performed for balance improvement, and the participants maintained their usual migraine treatment prescribed. RESULTS None of the groups differed in balance tests between baseline and follow-up. We observed a reduction in migraine frequency in MA (-2.2 days, p = 0.01) and CM (-10.8 days, p < 0.001) groups, and in the migraine intensity (-2.3 points, p = 0.001) in CM group. Significant decreases in the scores of fear of falling, dizziness disability, and kinesiophobia were observed in the migraine groups (p < 0.05), but the differences did not exceed the minimal detectable change of the questionaries scores. CONCLUSION Women with different migraine subtypes did not present balance changes in a one-year interval. The improvements in migraine's clinical features were not accompanied by improvements in balance parameters.
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Affiliation(s)
- Carina F Pinheiro-Araujo
- Health Sciences Department, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, Monte Alegre, Ribeirão Preto, SP, Brazil.
| | - Michely R Rocha
- Health Sciences Department, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, Monte Alegre, Ribeirão Preto, SP, Brazil.
| | - Gabriela F Carvalho
- Institute of Health Sciences, Academic Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), University of Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany.
| | - Renato Moraes
- Biomechanics and Motor Control Lab, School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Bandeirantes Avenue, 3900, Monte Alegre, Ribeirão Preto, SP, Brazil.
| | - Daiane C Silva
- Health Sciences Department, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, Monte Alegre, Ribeirão Preto, SP, Brazil.
| | - Fabiola Dach
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, Monte Alegre, Ribeirão Preto, SP, Brazil.
| | - Debora Bevilaqua-Grossi
- Health Sciences Department, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, Monte Alegre, Ribeirão Preto, SP, Brazil.
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Chen B, Li M, Zhao H, Liao R, Lu J, Tu J, Zou Y, Teng X, Huang Y, Liu J, Huang P, Wu J. Effect of Multicomponent Intervention on Functional Decline in Chinese Older Adults: A Multicenter Randomized Clinical Trial. J Nutr Health Aging 2023; 27:1063-1075. [PMID: 37997729 DOI: 10.1007/s12603-023-2031-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/04/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVES To confirm whether multicomponent exercise following vivifrail recommendations was an effective method for improving physical ability, cognitive function, gait, balance, and muscle strength in Chinese older adults. METHODS This was a multicenter and randomized clinical trial conducted in Jiangsu, China, from April 2021 to April 2022. Intervention lasted for 12 weeks and 104 older adults with functional declines were enrolled. All participants were randomly assigned to a control (usual care plus health education) or exercise group (usual care plus health education plus exercise). Primary outcomes were the change score of Short Physical Performance Battery (SPPB) and activities of daily living (ADL). The secondary outcomes included instrumental activities of daily living, Tinetti scores, Frailty score, short-form Mini Nutritional Assessment, Mini-Mental State Examination, Geriatric Depression Scale-15, the 12-item Short Form Survey, 4-meter gait speed test, 6-min walking distance, grip strength, and body composition analysis. RESULTS Among the participants, the average age was 85 (82, 88) years. After 12 weeks of follow-up, the exercise group showed a significant improvement in SPPB, with a change of 2 points (95% confidence interval [0, 3.5], P<0.001) compared to control. In contrast, SPPB remained stable in the control group. Compared to the control group, ADL improved in the exercise group, as did instrumental activities of daily living, Tinetti, Frailty, Short Form Survey, 4-meter gait speed test, and 6-min walking distance. Although there was no significant difference between groups in body composition analysis after post-intervention, the exercise group still improved in soft lean mass (P=0.002), fat-free mass (P=0.002), skeletal muscle mass index (P<0.001), fat-free mass index (P=0.004), appendicular skeletal muscle mass (P<0.001), and leg muscle mass (P<0.001), while the control group had no significant increase. No difference was observed in adverse events during trial period. CONCLUSIONS The multicomponent exercise intervention following vivifrail recommendations is an effective method for older adults with functional decline and can reverse the functional decline and improve gait, balance, and muscle strength. Additionally, the 12-week multicomponent exercise method provides guidance for Chinese medical professionals working in the field of geriatrics and is a promising method to improve physical function in the general population.
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Affiliation(s)
- B Chen
- Jianqing Wu, Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, P.R. China, Fax: 011-86-25-83780170, Telephone number: 011-86-25-68305103, Email address:
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Tansuğ M, Kahraman T, Genç A. Differences in Pain Characteristics and Functional Associations between Nursing Home Residents and Community-Dwelling Older Adults: A Cross-Sectional Study. Ann Geriatr Med Res 2021; 25:187-196. [PMID: 34433255 PMCID: PMC8497941 DOI: 10.4235/agmr.21.0066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/20/2021] [Indexed: 11/25/2022] Open
Abstract
Background Pain is one of the most critical issues in older adults, and the place of residence may play an important role in pain characteristics and related factors. However, it is an understudied subject. This study investigated differences in pain characteristics and functional associations between nursing home residents and community-dwelling older adults. Methods Older adult participants were recruited from nursing homes (n=73) and the community (n=73). Pain characteristics, including type, intensity, and number of pain sites, were evaluated. Other outcome measures were functional mobility, walking speed, functional independence, physical activity, anxiety, depression, and health-related quality of life. Results Nursing home residents experienced musculoskeletal pain more frequently and had a greater number of pain sites than community-dwelling older adults (p<0.05). Walking speed and mobility were significantly lower and anxiety and depression were significantly higher in nursing home residents (p<0.05). While higher pain intensity was significantly correlated with low scores on physical measures, low health-related quality of life, and higher depression and anxiety symptoms in both groups (p<0.05), the magnitudes of the correlations were much higher in nursing home residents. The number of pain sites was significantly correlated with low scores on physical measures, low health-related quality of life, and higher depression and anxiety symptoms mainly in nursing home residents (p<0.05). Conclusion Compared to community-dwelling older adults, nursing home residents experienced musculoskeletal pain more frequently and at more sites in the body. Higher pain intensity and number of pain sites were associated with worse clinical variables, mainly in nursing home residents. This study highlights the importance of regular pain assessment, especially in nursing home care settings.
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Affiliation(s)
- Melis Tansuğ
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Near East University, Lefkosa, Turkish Republic of Northern Cyprus
| | - Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Arzu Genç
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
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Garcia Meneguci CA, Meneguci J, Sasaki JE, Tribess S, Júnior JSV. Physical activity, sedentary behavior and functionality in older adults: A cross-sectional path analysis. PLoS One 2021; 16:e0246275. [PMID: 33513196 PMCID: PMC7846014 DOI: 10.1371/journal.pone.0246275] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/17/2021] [Indexed: 12/17/2022] Open
Abstract
Disability is negatively associated with the health of older adults, and it can be mediated by healthy lifestyles and behaviors throughout one's life. In this context, understanding the interrelationships between sedentary behavior, physical activity and functionality may assist in the implementation of effective public health actions. Thus, the aim of the present study was to investigate the relationships between both physical activity and sedentary behavior and functionality in older adults and the possible mediators. The variables analyzed were selected according to the content analysis of International Classification of Functioning, Disability and Health model, and included activity, participation, health conditions, body functions and structures, environmental factors and personal factors. 419 individuals participated in the study. Physical activity was directly associated with disability in instrumental activities of daily living (IADL), and the association was mediated by self-esteem, aerobic endurance, and agility/balance. Sedentary behavior was indirectly associated with IADL disability, and the association was mediated by aerobic resistance, nutritional status, and agility/balance. Regarding the basic activities of daily living (BADL), physical activity showed an indirect association mediated by aerobic resistance and IADL. The association of sedentary behavior with BADL was mediated by aerobic resistance and lower limb flexibility. These results reinforce the idea that functionality is multidimensional, and the mediating factors must be considered when strategies for promoting physical activity and reducing sedentary behavior are designed.
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Affiliation(s)
| | - Joilson Meneguci
- Graduate Program in Health Care, Federal University of Triangulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Jeffer Eidi Sasaki
- Graduate Program in Physical Education, Federal University of Triangulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Sheilla Tribess
- Graduate Program in Physical Education, Federal University of Triangulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Jair Sindra Virtuoso Júnior
- Graduate Program in Health Care, Federal University of Triangulo Mineiro (UFTM), Uberaba, MG, Brazil
- Graduate Program in Physical Education, Federal University of Triangulo Mineiro (UFTM), Uberaba, MG, Brazil
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