title: Pain and the risk for falls in community-dwelling older adults: systematic review and meta-analysis.
abstract: OBJECTIVE
  To conduct a systematic review and meta-analysis to establish the association between pain and falls in community-dwelling older adults.
  
  
  METHODS
  Electronic databases from inception until March 1, 2013, including Cochrane Library, CINAHL, EBSCO, EMBASE, PubMed, and PsycINFO.
  
  
  METHODS
  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.
  
  
  METHODS
  One author extracted all data, and this was independently validated by another author.
  
  
  RESULTS
  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.
authors.affiliation: School of Health and Social Care, University of Greenwich, London, United Kingdom. Electronic address: b.stubbs@greenwich.ac.uk.
authors.forename: Brendon
authors.initials: B
authors.lastname: Stubbs
authors.affiliation: Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands.
authors.forename: Tarik
authors.initials: T
authors.lastname: Binnekade
authors.affiliation: Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands.
authors.forename: Laura
authors.initials: L
authors.lastname: Eggermont
authors.affiliation: College for Interdisciplinary Studies, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Amir A
authors.initials: AA
authors.lastname: Sepehry
authors.affiliation: School of Health and Social Care, University of Greenwich, London, United Kingdom; School of Psychology, University of Greenwich, London, United Kingdom.
authors.forename: Sandhi
authors.initials: S
authors.lastname: Patchay
authors.affiliation: School of Health and Social Care, University of Greenwich, London, United Kingdom.
authors.forename: Pat
authors.initials: P
authors.lastname: Schofield
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D006801:Humans; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology*; D062072:Patient Acuity; D015995:Prevalence; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors
keywords: Accidental falls/prevention & control; Accidental falls/statistics & numerical data; Aged, 80 and over; CI; Meta-Analysis; NOS; Newcastle Ottawa Scale; OR; Postural balance risk factors; RCT; Review; Risk assessment; Risk assessment/methods; World health geriatric assessment; confidence interval; odds ratio; randomized controlled trial