Mobility Limitations and Fall-Related Factors Contribute to the Reduced Health-Related Quality of Life in Older Adults With Chronic Musculoskeletal Pain.

PURPOSE: To investigate (1) the prevalence of chronic musculoskeletal pain (CMP) among a sample of community-dwelling older adults and (2) health-related quality of life (HRQOL) in people with CMP, particularly the association with mobility limitations and falls-related factors. METHOD: Overall, 295 (response rate 73.5%) community-dwelling older adults were recruited across 10 sites. CMP was assessed using recognized criteria. In the sample of people with CMP, a hierarchical multiple regression analysis was conducted with HRQOL as the dependent variable and a number of independent variables were then inserted into the model. After controlling for demographic and medical variables, mobility (timed up and go (TUG), walking aid use, sedentary behavior) and fall-related factors (falls history, balance confidence, concerns about consequences of falling) were inserted into the model at the second step and changes in adjusted R(2) noted. RESULTS: Within our sample of older adults, 52% had CMP (154/295). Compared to the group without CMP of similar age (n = 141), those with CMP had reduced HRQOL and profound mobility limitations and more falls risk factors (P < 0.001). The mobility and falls explanatory variables increased the variance explained within HRQOL from 14% to 36% (adjusted R(2) change 20%) in those with CMP. Sedentary behavior, pain interference, concerns about the consequences of falling, falls history, TUG scores, and balance confidence all remained significant predictors of HRQOL in the fully adjusted model in the CMP sample. CONCLUSION: Older adults with CMP have pronounced mobility limitations and increased falls risk factors, and these are associated with a marked reduction in HRQOL. Future prospective research is required to build on this cross-sectional study.

Musculoskeletal pain characteristics associated with lower balance confidence in community-dwelling older adults.

OBJECTIVE: To determine whether musculoskeletal pain (pain severity and number of chronic pain sites; single or multisite) is associated with balance confidence over and above previously established risk factors. DESIGN: Cross-sectional study. SETTING: Ten community sites (five day centres, two sheltered housing schemes and three community 'clubs') in the UK. PARTICIPANTS: Two hundred and eighty-nine community-dwelling older adults [response rate 72%, mean age 78 (standard deviation 8) years, 67% female] completed the study assessment. Eligibility criteria were as follows: living in the community; aged ≥60 years; able to walk ≥10m; able to communicate in English; and no cognitive (e.g. dementia), neurological or mental health conditions. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Balance confidence as measured by the 16-item Activities Balance Confidence (ABC) scale (lower scores indicate less confidence). RESULTS: One hundred and fifty participants had at least one site of chronic musculoskeletal pain (52%), and the remaining 139 (48%) participants did not report chronic musculoskeletal pain. Older people with chronic musculoskeletal pain had significantly lower scores on the ABC scale compared with those without chronic musculoskeletal pain (mean 48.3 vs 71.3, P<0.001). After adjustment for established risk factors, two separate hierarchical regression models demonstrated that both pain severity (ß=-0.106, P=0.029) and number of chronic musculoskeletal pain sites (ß=-0.98, P=0.023) were significantly associated with lower balance confidence. CONCLUSION: Both pain severity and number of chronic pain sites (particularly multisite pain) are associated with lower balance confidence in community-dwelling older adults. Further research is needed to target pain symptoms and balance confidence in relation to fall risk in older adults with chronic musculoskeletal pain.

Older adults with chronic musculoskeletal pain are at increased risk of recurrent falls and the brief pain inventory could help identify those most at risk.

AIM: Chronic musculoskeletal pain (CMP) and falls are common among community-dwelling older adults. The study aims were: (i) to investigate the relationship between CMP and any falls (≥1), single falls and recurrent falls (≥2) in community-dwelling older adults; and (ii) to determine the discriminative validity of the Brief Pain Inventory (BPI) to differentiate between non-fallers and (a) any and (b) recurrent fallers. METHODS: A cross-sectional study involving 295 community-dwelling participants (mean age 77.5 ± 8.1 years, 66.4% female) was carried out. CMP was assessed and classified as none (comparison group), single and multisite (≥2). The BPI severity and interference subscales were used, and falls were recorded over 12 months. Data were analyzed with logistic regression and receiver operating characteristic curves (ROC). RESULTS: Over half of the participants (154/295, 52.2%) had CMP (41.6% single and 58.4% multisite pain). Participants with CMP were at increased risk of recurrent falls (OR 2.25, 95% CI 1.03-4.88), and this risk was highest in those with multisite CMP (OR 3.43, CI 1.34-8.65). The BPI severity subscale showed good discriminative ability to differentiate between recurrent and non-fallers with an area under the curve (AUC) of 0.731 (95% CI 0.635-0.826); a mean score of 5.1 had a sensitivity of 93.3% and specificity of 56.7%. The AUC for the BPI interference subscale was 0.724 (95% CI 0.630-0.818), and a cut-off score of 4.6 had a sensitivity of 84.4% and specificity of 57.8% CONCLUSION: Older adults with multisite CMP are at greatest risk of recurrent falls. In clinical settings, the BPI could prove useful to discriminate between recurrent and non-fallers.

The avoidance of activities due to fear of falling contributes to sedentary behavior among community-dwelling older adults with chronic musculoskeletal pain: a multisite observational study.

OBJECTIVE: Physical inactivity and sedentary behavior (SB) are leading causes of mortality. We investigated if older adults with chronic musculoskeletal pain (CMP) are more sedentary than a group of similar age and sex without CMP and possible contributory factors to this. METHOD: In this multisite observational study, 285 community-dwelling older adults (response rate 71%) took part. One hundred forty-four had CMP (78.4 years, 65.9% female), and 141 formed the comparison group without CMP. Details regarding falls were collected, and all participants completed the brief pain inventory (BPI), modified version of the survey of activities and fear of falling in elderly scale (mSAFFE), and the International Physical Activity Questionnaire (IPAQ) to measure SB. Data were analyzed with hierarchical regression analysis. RESULTS: Older adults with CMP spent approximately 3 1/2 hours a day more being sedentary than the comparison group (11.5 hours vs 7.9, P<0.001). The addition of BPI interference and mSAFFE scores in the regression analysis resulted in an R(2) change of 10.4% in IPAQ scores, over and above the variance explained by the background demographic, medical, and mobility factors. Excessive concerns about the consequences of falling did not increase the variance in SB. Within the final model, mSAFFE scores were the largest independent predictor of SB (ß=0.461, P<0.001). CONCLUSIONS: Older adults with CMP are significantly more sedentary than those of a similar sex and age without CMP. It appears that the avoidance of activities due to fear of falling is a significant contributory factor to SB in older adults with CMP.

Pain interference is associated with psychological concerns related to falls in community-dwelling older adults: multisite observational study.

BACKGROUND: Pain interference and psychological concerns related to falls (PCRF) are pervasive phenomena among community-dwelling older adults, yet their association remains elusive. OBJECTIVE: The purpose of this study was to establish whether pain interference is associated with PCRF in community-dwelling older adults. DESIGN: This was a multisite cross-sectional study. METHOD: Two hundred ninety-five community-dwelling older adults (mean age=77.5 years, SD=8.1; 66.4% female) participated in the study. All participants completed the Brief Pain Inventory (BPI) interference subscale, Short Falls Efficacy Scale-International (FES-I), Activities-specific Balance Confidence Scale (ABC), modified version of the Survey of Activities and Fear of Falling in Elderly Scale (mSAFFE), and Consequences of Falling Scale (CoF). Hierarchical multiple regression analysis were conducted. In the first step of the study, sociodemographic and known risk factors for psychological concerns related to falls were inserted into the model, followed by the BPI interference subscale score in the second step. RESULTS: One hundred sixty-nine participants (57.3%) reported some pain interference. The BPI interference subscale was highly correlated with all PCRF (r>.5, P<.0001). After the adjustment for established risk factors, the BPI interference subscale significantly increased the variance in the Short FES-I (R2 change=13.2%), ABC (R2 change=4.7%), mSAFFE (R2 change=5.0%), and CoF (R2 change=10.0%). Pain interference was a significant and independent predictor in the final model for the Short FES-1 (ß=0.455, P<.001), ABC (ß=-0.265, P<.001), mSAFFE (ß=0.276, P<.001), and CoF (ß=0.390, P<.001). LIMITATIONS: The study was cross-sectional. CONCLUSIONS: Pain interference is an important contributing factor in each of the psychological concerns related to falls. Pain interference had the strongest impact on reducing falls efficacy and increasing older adults' concerns about the consequences of falling.

Pain is associated with recurrent falls in community-dwelling older adults: evidence from a systematic review and meta-analysis.

BACKGROUND: Pain and recurrent falls are highly problematic in community-dwelling older adults, yet the association remains elusive. OBJECTIVE: The objective of this study was to investigate the association between pain and recurrent falls in community-dwelling older adults. DESIGN: Two independent reviewers conducted searches of major electronic databases, completed methodological assessment, and extracted the data of all included articles. Articles that were included are those that (1) involved community-dwelling older adults; (2) recorded recurrent falls; and (3) assessed pain. Articles that were excluded are those that included participants with dementia, any neurological conditions, or those with orthopedic trauma/surgery in the past 6 months. RESULTS: Out of a potential of 71 articles, 11 met the inclusion criteria and 7 (N = 9,581) were eligible for the meta-analysis. The annual prevalence of recurrent falls in those reporting pain (12.9%) was higher than the pain-free control group (7.2%, P < 0.001). A global meta-analysis established that pain was associated with recurrent falls (odds ratio [OR]: 2.04, confidence interval [CI]: 1.75-2.39; N = 3,950 with pain and N = 5,631 controls), and this was decreased in a subgroup meta-analysis utilizing prospective studies only (OR: 1.79, CI: 1.44-2.21, P < 0.001, I2 = 0%; N = 3, N = 2,646). A subgroup analysis comparing recurrent fallers vs. non-fallers only (OR: 2.18, CI: 1.82-2.60, N = 6,320, I2 = 0%) established the odds were particularly higher than single fallers vs. non-fallers (OR:1.44, CI: 1.26-1.64, N = 6,903, (I2) = 0%). CONCLUSION: Older adults with pain are at particularly increased risk of recurrent falls. Clinicians working with recurrent fallers should routinely assess pain while pain specialists should inquire about older adults' falls history.

Is there a relationship between pain and psychological concerns related to falling in community dwelling older adults? A systematic review.

PURPOSE: To systematically review and synthesise the research evidence linking pain to psychological concerns about falling in community dwelling older adults. METHODS: A systematic review was conducted in accordance with the preferred reporting items of systematic reviews and meta-analysis statement (PRISMA). Major electronic databases were searched from inception until June 2013. Two authors independently conducted the searches, extracted data and completed methodological quality assessments. Articles were included if they measured one of the psychological concerns related to falling in a sample of community dwelling older adults with pain, or explored the association between the two. RESULTS: Of a potential 892 articles, 12 met the eligibility criteria (n=3398). The methodological quality of the included studies was variable and none of the included studies primary aim was to investigate the relationship between pain and psychological concerns related to falls. Two studies found significant differences in psychological concerns related to falls in older adults with pain and a control group. Nine out of 10 studies reported a significant correlation between pain and psychological concerns related to falls in their sample. CONCLUSION: This review provides provisional evidence that pain is associated with fear of falling (FOF), avoidance of activities due to FOF and falls efficacy in community dwelling older adults. Implications for Rehabilitation Pain is a common and pervasive problem in community dwelling older adults and can affect an individual's mobility, levels of physical activity and increase their falls risk. Psychological concerns related to falls, such as fear of falling (FOF), falls efficacy and balance confidence are also common and troublesome issues in older adults, yet the association with pain has not been investigated with a systematic review. This review provides provisional evidence that pain may increase older adult's risk of developing FOF, avoiding activities due to a FOF and impact their falls efficacy. In recognition of the findings of this review, clinicians working with older adults with pain should consider assessing psychological concerns related to falls and if necessary intervene if they identify an individual at risk.

Pain and the risk for falls in community-dwelling older adults: systematic review and meta-analysis.

OBJECTIVE: To conduct a systematic review and meta-analysis to establish the association between pain and falls in community-dwelling older adults. DATA SOURCES: Electronic databases from inception until March 1, 2013, including Cochrane Library, CINAHL, EBSCO, EMBASE, PubMed, and PsycINFO. STUDY SELECTION: Two reviewers independently conducted the searches and completed methodological assessment of all included studies. Studies were included that (1) focused on adults older than 60 years; (2) recorded falls over 6 or more months; and (3) identified a group with and without pain. Studies were excluded that included (1) participants with dementia or a neurologic condition (eg, stroke); (2) participants whose pain was caused by a previous fall; or (3) individuals with surgery/fractures in the past 6 months. DATA EXTRACTION: One author extracted all data, and this was independently validated by another author. DATA SYNTHESIS: A total of 1334 articles were screened, and 21 studies met the eligibility criteria. Over 12 months, 50.5% of older adults with pain reported 1 or more falls compared with 25.7% of controls (P<.001). A global meta-analysis with 14 studies (n=17,926) demonstrated that pain was associated with an increased odds of falling (odds ratio [OR]=1.56; 95% confidence interval [CI], 1.36-1.79; I(2)=53%). A subgroup meta-analysis incorporating studies that monitored falls prospectively established that the odds of falling were significantly higher in those with pain (n=4674; OR=1.71; 95% CI, 1.48-1.98; I(2)=0%). Foot pain was strongly associated with falls (n=691; OR=2.38; 95% CI, 1.62-3.48; I(2)=8%) as was chronic pain (n= 5367; OR=1.80; 95% CI, 1.56-2.09; I(2)=0%). CONCLUSIONS: Community-dwelling older adults with pain were more likely to have fallen in the past 12 months and to fall again in the future. Foot and chronic pain were particularly strong risk factors for falls, and clinicians should routinely inquire about these when completing falls risk assessments.