title: Frequency, severity and determinants of functional limitations in older adults with joint pain and comorbidity: results of a cross-sectional study.
abstract: Older adults with joint pain and comorbidity are especially at risk of becoming functionally impaired. Therefore, we studied the frequency and severity of functional limitations and identified potential modifiable determinants that may reduce functional limitations. A prospective cohort study of older adults (≥65 years) with joint pain and comorbidity provided cross-sectional baseline data (n=407). Based on the International Classification of Functioning, Disability and Health (ICF) model, we measured Physical Functioning; PF, (Instrumental) Activities of Daily Living; (I)ADL, and participation. Apart from examining the frequency and severity, we identified determinants of functional limitations with multivariate regression analyses, by adding determinants in two steps: (1) only physical determinants, (2) physical and psychosocial determinants. Limitations in PF, ADL, IADL and participation were present in 66%, 31%, 61% and 47% of the participants, respectively. About 22% reported limitations on all four measures. Of the physical determinants, especially frailty and higher pain intensity were related to functional limitations. Remarkably, adding psychosocial determinants to the model weakened some of these relations. The psychosocial determinants were especially related to poor PF (i.e. anxiety symptoms, activity avoidance and poor general health perception) and participation restrictions (i.e. depressive symptoms, less social support). An inverse relation was present between self-efficacy and both outcomes. In conclusion, our sample reported substantial levels of functional limitations. More depressive symptoms, more activity avoidance and less social support were indicative of more functional limitations, whereas higher perceived self-efficacy was indicative of better functioning. Such psychosocial determinants should receive more attention in research.
authors.affiliation: General Practice and Elderly Care Medicine and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: l.hermsen@vumc.nl.
authors.forename: Lotte A H
authors.initials: LA
authors.lastname: Hermsen
authors.affiliation: General Practice and Elderly Care Medicine and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Public Mental Health, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
authors.forename: Stephanie S
authors.initials: SS
authors.lastname: Leone
authors.affiliation: General Practice and Elderly Care Medicine and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Martin
authors.initials: M
authors.lastname: Smalbrugge
authors.affiliation: Rehabilitation Medicine and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Joost
authors.initials: J
authors.lastname: Dekker
authors.affiliation: General Practice and Elderly Care Medicine and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Henriëtte E
authors.initials: HE
authors.lastname: van der Horst
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000503:physiopathology* / Q000523:psychology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D051346:Mobility Limitation; D010147:Pain Measurement; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: Aging; Comorbidity; Disability; Functioning; Joint pain; Quality of life