Pain characteristics associated with the onset of disability in older adults: the maintenance of balance, independent living, intellect, and zest in the Elderly Boston Study.
OBJECTIVE
To determine the effects of chronic pain on the development of disability and decline in physical performance over time in older adults.


METHODS
Longitudinal cohort study with 18 months of follow-up.


METHODS
Urban and suburban communities.


METHODS
Community-dwelling older adults aged 65 and older (N = 634).


METHODS
Chronic pain assessment consisted of musculoskeletal pain locations and pain severity and pain interference according to the subscales of the Brief Pain Inventory. Disability was self-reported as any difficulty in mobility and basic and instrumental activities of daily living (ADLs, IADLs). Mobility performance was measured using the Short Physical Performance Battery (SPPB). Relationships between baseline pain and incident disability in 18 months were determined using risk ratios (RRs) from multivariable Poisson regression models.


RESULTS
Almost 65% of participants reported chronic musculoskeletal pain at baseline. New onset of mobility difficulty at 18 months was strongly associated with baseline pain distribution: 7% (no sites), 18% (1 site), 24% (multisite), and 39% (widespread pain, P-value for trend < .001). Similar graded effects were found for other disability measures. Elderly adults with multisite or widespread pain had at a risk of onset of mobility difficulty at least three times as great as that of their peers without pain after adjusting for disability risk factors (multisite pain: risk ratio (RR) = 2.95, 95% confidence interval (CI) 1.58-5.50; widespread pain: RR = 3.57, 95% CI = 1.71-7.48). Widespread pain contributed to decline in mobility performance (1-point decline in SPPB, RR = 1.47, 95% CI = 1.08-2.01). Similar associations were found for baseline pain interference predicting subsequent mobility decline and ADL and IADL disability. Weaker and less-consistent associations were observed with pain severity.


CONCLUSIONS
Older community-dwelling adults living with chronic pain in multiple musculoskeletal locations have a substantially greater risk for developing disability over time and for clinically meaningful decline in mobility performance than those without pain.
Department of Clinical Neuropsychology, VU University, Amsterdam, the Netherlands.
Laura H P
LH
Eggermont
Suzanne G
SG
Leveille
Ling
L
Shi
Dan K
DK
Kiely
Robert H
RH
Shmerling
Rich N
RN
Jones
Jack M
JM
Guralnik
Jonathan F
JF
Bean
D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000150:complications* / Q000503:physiopathology*; D003071:Cognition; D015331:Cohort Studies; D004185:Disability Evaluation; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D057187:Independent Living; D008297:Male; D008875:Middle Aged; D004856:Postural Balance; D011788:Quality of Life
activities of daily living; mobility limitation; older adults; widespread chronic pain