Pain Lowers Subjective Survival Probabilities Among Middle-Aged and Older Adults.

OBJECTIVES: Pain is a leading cause of disability and a limiting factor in individuals' assessments of their own subjective health; however, its association with subjective longevity has yet to be explored. Subjective survival probabilities (SSPs), or one's own perceived chances of living to a given age, can influence individuals' behavior as they plan for their futures. This study assesses whether pain correlates to lower SSPs. METHODS: We use a repeated cross-section of the 2000-2018 waves of the Health and Retirement Study, a longitudinal and nationally representative survey of Americans aged 51 and older (N = 31,773). RESULTS: Fractional logit regressions indicate that, across all age groups, respondents with severe and/or interfering pain reported significantly lower SSPs than those with no pain (Marginal Effect [ME] = -0.03 to -0.06, p < .05). Controlling for all covariates, mild or moderate noninterfering pain was only associated with a significant reduction in SSPs among the youngest group reporting their chances of living to age 75 (ME = -0.02, p < .001). Descriptively and in the model results, respondents with mild or moderate noninterfering pain appeared to more closely resemble pain-free respondents than those with severe or interfering pain. DISCUSSION: These findings highlight the importance of pain on SSPs, and contribute to the growing evidence that pain interference is uniquely important in predicting meaningful health outcomes.

Pain, Physical Demands at Work, and Future Work Expectations Among Older Adults in the United States.

Background and Objectives: In the United States, pain is becoming increasingly prevalent among older adults at the same time as policies are incentivizing work longer. Given that pain and physically demanding jobs are both linked to early retirement and they often go hand-in-hand, it is important to assess how the unique effects of pain and physical work demands may interact in predicting future work expectations. Research Design and Methods: Using Health and Retirement Study data (1998, 2004, 2010, and 2016 waves), we assess how pain and physical job demands influence future work expectations of 10,358 adults at midlife (ages 51-56), after accounting for sociodemographic, job, health, and financial characteristics. Results: Compared to men with no pain, activity-interfering pain was associated with low expectations of full-time work past 62 regardless of job demands, while noninterfering pain was associated with 62% higher odds (odds ratio [OR] = 1.62, 95% confidence interval [CI]: 1.35-1.93) of expecting not to work full-time past age 62 only among those with physically demanding jobs. Having both interfering pain and a physically demanding job was associated with increased odds of expecting not to work full-time past age 65 for men (OR = 1.25, 95% CI: 1.06-1.47) and past age 62 for women (OR = 1.18, 95% CI: 1.00-1.39). Discussion and Implications: The co-occurrence of physically demanding work with pain-particularly activity-interfering pain-is associated with low expectations of full-time work past ages 62 and 65 for adults at midlife. Working longer may be feasible for older adults whose pain does not interfere with work, but unrealistic for individuals facing both pain and physically demanding work.

Predictors of Multiwave Opioid Use Among Older American Adults.

Background and Objectives: Despite limited analgesic benefits, long-term opioid therapy (L-TOT) is common among older adults with chronic pain. Extended opioid use poses a threat to older adults as aging metabolisms retain opioids for longer, increasing the risk of injury, overdose, and other negative health outcomes. In contrast to predictors of general opioid use, predictors of L-TOT in older adults are not well documented. We aimed to identify such predictors using all available data on self-reported opioid use in the Health and Retirement Study. Research Design and Methods: Using 5 waves of data, respondents (N = 10,713) aged 51 and older were identified as reporting no opioid use (n = 8,621), a single wave of use (n = 1,410), or multiple waves of use (n = 682). We conducted a multinomial logistic regression to predict both single- and multiwave opioid use relative to no use. Demographic, socioeconomic, geographic, health, and health care-related factors were included in our model. Results: Multivariable findings show that, relative to nonusers, both single- and multiwave users were significantly more likely to be younger (relative risk ratio [RRR] = 1.33; RRR = 2.88); report lower household wealth (RRR = 1.47; RRR = 2.88); live in the U.S. Midwest (RRR = 1.29; RRR = 1.56), South (RRR = 1.34; RRR = 1.58), or West (RRR = 1.46; RRR = 2.34); experience interfering pain (RRR = 1.59; RRR = 3.39), back pain (RRR = 1.35; RRR = 1.53), or arthritic pain (RRR = 1.46; RRR = 2.32); and see the doctor frequently (RRR = 1.50; RRR = 2.02). Multiwave users were less likely to be Black (RRR = 0.69) or Hispanic (RRR = 0.45), and less likely to be never married (RRR = 0.52). Discussion and Implications: We identified demographic, socioeconomic, geographic, and health care-related predictors of chronic multiyear opioid use. Our focus on individuals taking opioids for this extended duration is novel. Differences in opioid use by geographic region and frequency of doctor visits particularly warrant attention from policy-makers and researchers. We make additional recommendations based on a sensitivity analysis limited to 2016-2020 data.

Hispanics and Hospice: A Systematic Literature Review.

Background. Hospice has been shown to improve patient and family satisfaction with care, reduce hospitalizations and hospital costs, and reduce pain and symptoms. Despite more than 40 years of hospice care and related research in the U.S., few studies examining hospice experiences have included Hispanics. Thus, little is known about hospice barriers, facilitators, and outcomes among Hispanics.Aim. This systematic literature review aimed to provide a comprehensive overview of studies assessing knowledge of and attitudes toward hospice, barriers and facilitators to hospice use, utilization patterns, and hospice-related outcomes among Hispanics.Design. Between March 2019 and March 2020 we searched Ovid Medline (PubMed), EMBASE, and CINAHL, using search terms for hospice care, end-of-life care, Hispanics, and Latinos. All steps were guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. U.S. studies that examined Hispanics' knowledge and attitudes towards hospice, facilitators or barriers to hospice use, hospice use, and hospice-related outcomes were included. Qualitative studies and non-empirical work were excluded. Study quality was assessed using Hawker's quality criteria.Results. Of the 4,841 abstracts reviewed, 41 peer-reviewed articles met the inclusion criteria. These studies largely report lower hospice knowledge and awareness among Hispanics and mixed results around hospice use and outcomes in comparison to Whites.Conclusion. There has been relatively little research focused specifically on Hispanics' experience with hospice. Future research should focus on testing interventions for overcoming hospice-related disparities among Hispanics and on improving access to quality hospice care among terminally ill Hispanics.

Factors Associated With Advance Care Planning by Race.

OBJECTIVE: This study aims to quantify and interpret Black-White differences in the factors associated with advance care planning (ACP), with specific attention to self-reported presence of chronic conditions and healthcare stereotype threat (HCST) in medical settings. METHOD: Black and White individuals aged 50 and older (N = 499) were recruited from community centers and assisted living facilities in southern California and on Amazon Mechanical Turk. Six sequential logistic regressions assessed the effect of age, presence of chronic conditions, income, and HCST on predicting 3 components of ACP by race. RESULTS: Findings suggest that the awareness of ongoing chronic conditions predicts all 3 aspects of ACP for Whites, but not for Blacks. HCST positively predicts the appointment of a durable power of attorney, but only for Black respondents. DISCUSSION: These findings offer a novel perspective on racial disparities in ACP that may inform health care providers and community practices.

Is Chronic Pain Temporal Pattern Associated with Middle-Aged and Older Adults' Perceptions of their Futures?

A psychological consequence of chronic pain may be an inappropriately limited future time perspective (FTP) for middle-aged and older adults. FTP is defined as one's perception of time as limited or expansive. Potentially meaningful measures, like pain temporal pattern, are often ignored in the chronic pain literature. The present study uses secondary data to assess the association between pain temporal pattern and FTP, and the moderating effect of pain duration. Among 140 individuals with chronic pain, there was no significant association between pain pattern and FTP. However, both pain-related activity interference and pain duration were associated with FTP where greater interference predicted more limited FTP (b = -0.16, p = .03) and longer pain duration contributed to more expansive FTP (b = 0.001, p = .03). The temporal pattern x pain duration interaction terms were non-significant. We discuss implications, limitations, and future directions of these findings.