title: Depression and self-rated health are proximal predictors of episodes of sustained change in pain in independently living, community dwelling elders.
abstract: OBJECTIVE
  To identify, in community dwelling elders, the determinants of sustained pain improvement or worsening.
  
  
  METHODS
  A longitudinal study with two baseline and 11 monthly follow-up interviews was conducted. Pain was assessed monthly using the Parmelee adaptation of the McGill Pain Inventory.
  
  
  METHODS
  Subjects included 109 Caucasian and 132 African American, Philadelphia residing Medicare recipients (65-74 years of age).
  
  
  METHODS
  To identify sustained pain change (> or =2 months), the data for each subject were reconfigured to yield 10 overlapping 3-month data segments. Each segment was classified as improved or worsened pain. Other variables included: the Geriatric Depression Scale (GDS), self-rated health (SRH), physical functioning, and number of improved or worsened medical conditions.
  
  
  RESULTS
  Pain experienced (over 3-month periods) was typically stable. Sustained improved pain was more likely than worsened pain. Odds ratios obtained through Generalized Estimation Equation analyses showed that a 1-point increase in GDS scores increased the odds of worsened pain by 1.18 (1.11-1.30). Fair/poor SRH, being female, and having medical conditions worsen increased the odds of worsened pain by 4.04 (2.12-7.70), 1.63 (1.11-2.38), and 2.12 (1.42-3.16), respectively. Observed, statistically significant associations between these variables, except gender, and improved pain were in the opposite direction.
  
  
  CONCLUSIONS
  With a 1-month time lag between predictor variable assessment and follow-up pain measures, the study supports temporal associations between depressive symptoms and SRH and subsequent pain change. Clinicians providing care to community dwelling elders are advised to evaluate and attend to both the depressive symptoms and SRH of their patients.
authors.affiliation: Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania 19072, USA.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Rosso
authors.forename: Rollin M
authors.initials: RM
authors.lastname: Gallagher
authors.forename: Mark
authors.initials: M
authors.lastname: Luborsky
authors.forename: Jana M
authors.initials: JM
authors.lastname: Mossey
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D003863:Depression / Q000503:physiopathology*; D005260:Female; D015577:Geriatric Assessment; D006304:Health Status; D016852:Housing for the Elderly; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010146:Pain / Q000503:physiopathology / Q000523:psychology; D010147:Pain Measurement