Pain, functional limitations, and aging

Medicare Part D Implementation and Associated Health Impact Among Older Adults in the United States

This study examined the effect of Medicare (Part D) implementation on health outcomes among U.S. older adults. Study participants were initially extracted from the 2004–2008 Health and Retirement Study (HRS). Data from respondents who further participated in the HRS 2005–2007 Prescription Drug Study were analyzed (N = 746). This was a retrospective pre-post design with a treatment and a control group. The difference-in-differences approach with panel ordered logistic regressions was used to examine the Part D effect on three patient health outcomes before and after the implementation, controlling for patient sociodemographic characteristics. People with continuous Part D enrollment from 2006–2008 were less likely to have a worse self-rated health than those who were not enrolled in Part D (odds ratio [OR] = 0.48; p < .05). A higher Charlson Comorbidity Index score was associated with a higher likelihood of having worse self-rated overall health, worse mental health, and worse activities of daily living impairment (ORs = 1.12, 1.17, and 1.36, respectively; all ps < .001). The Part D implementation appears to have a positive effect on older adults’ overall health outcomes. A decrease in out-of-pocket cost for health care may encourage older adults to utilize more needed medications, which in turn helped maintain better health.

Incorporating Persistent Pain in Phenotypic Frailty Measurement and Prediction of Adverse Health Outcomes

BACKGROUND

Frailty, a syndrome of physiological deficits, is prevalent among older adults and predicts elevated risk of adverse health outcomes. Although persistent pain predicts similar risk, it is seldom considered in frailty measurement. This article evaluated the construct and predictive validity of including persistent pain in phenotypic frailty measurement.

METHODS

Frailty and persistent pain were operationalized using data from the Health and Retirement Study (2006-2012 waves). Among a subset of adults aged 65 and older (n = 3,652), we used latent class analysis to categorize frailty status and to evaluate construct validity. Using Cox proportional hazards models, we compared time to incident adverse outcomes (death, fall, hospitalization, institutionalization, and functional disability) between frailty classes determined by either including or excluding persistent pain as a frailty component.

RESULTS

In latent class models, persistent pain occurred with other frailty components in patterns consistent with a medical syndrome. Frail and intermediately frail classes determined by including persistent pain were more strongly associated with all adverse outcomes compared with frail and intermediately frail classes determined excluding persistent pain. Frail respondents had significantly greater risk of death compared with nonfrail respondents when frailty models included rather than excluded persistent pain (respectively, hazard ratio [HR] = 3.87, 95% confidence interval [CI] = 2.99-5.00 (including pain); HR = 2.10, 95% CI = 1.71-2.59 (excluding pain).

CONCLUSIONS

Findings support consideration of persistent pain as a component of the frailty phenotype. Persistent pain assessment may provide an expedient method to enhance frailty measurement and improve prediction of adverse outcomes.

A synthesis of qualitative research exploring the barriers to staying in work with chronic musculoskeletal pain

PURPOSE

Qualitative research can help to advance our understanding, management and prevention of work disability. Our aim was to integrate qualitative research findings in order to increase our understanding of barriers to stay in work with chronic pain.

METHODS

We searched five electronic bibliographic databases until September 2012, supplemented by citation tracking and hand-searching. We used meta-ethnography to synthesis our findings. Central to meta-ethnography is identifying “concepts” and developing a conceptual model. Concepts were compared and organised into categories.

RESULTS

The following categories can have an impact on the decision to remain in work: struggling to affirm myself as a good worker; balancing life and work in the face of unpredictable symptoms; my work colleagues don't believe me; the system does not facilitate return to work; the battle for legitimacy.

CONCLUSIONS

Our innovation is to present an internationally relevant model based on a conceptual synthesis. This model highlights the adversarial work experience of people with chronic. The papers span 15 years of qualitative research. A significant finding is that these themes continue to pervade the current work environment for those in pain, and this has clear implications for education, social care and policy.

IMPLICATIONS FOR REHABILITATION

People with chronic pain face an adversarial struggle to maintain their credibility at work. Strategies to maintain personal credibility can have an adverse effect on working lives. Changes at a systems level are needed to facilitate continuance and return to work. Cultural changes in the way that we view people with pain would help to keep people in work.

Age-specific risk factors for incident disability in activities of daily living among middle-aged and elderly community-dwelling Japanese women during an 8-9-year follow up: The Hizen-Oshima study

AIM

The purposes of the present study were to investigate risk factors for incident disability in activities of daily living (ADL) among middle-aged and older women, and to determine whether there are differences in risk factors according to age groups.

METHODS

The participants were 264 Japanese women aged 40 years and older. A self-administered questionnaire was used to survey participants about difficulty in carrying out selected basic and instrumental ADL at baseline and at follow up. ADL disability was defined as difficulty carrying out three or more ADL. Information on knee joint or back pain and comorbidities (heart disease, lung disease, stroke or diabetes mellitus) was obtained using a self-administered questionnaire at baseline. Physical performance measurements (grip strength, chair stand time, rapid walking speed and functional reach) were also carried out at baseline.

RESULTS

The prevalence of incident ADL disability was 44 (27.5%) in women aged 40-64 years, and 57 (54.8%) in women aged ≥65 years (P < 0.001). Multiple logistic regression analysis showed that decreased grip strength and having pain were significantly associated with a higher risk for incident ADL disability among women aged 40-64 years. For women aged ≥65 years, decreased rapid walking speed, having a comorbidity and having pain were associated with incident ADL disability.

CONCLUSIONS

The present study showed that a different set of risk factors was associated with incident ADL disability among women aged 40-64 years and women aged ≥65 years. Age-specific screening and intervention strategies are necessary for effective prevention of incident ADL disability. Geriatr Gerontol Int 2017; 17: 1096-1101.

Associations among pain, depression, and functional limitation in low-income, home-dwelling older adults: An analysis of baseline data from CAPABLE

A complex relationship exists between pain, depression, and functional limitation. These conditions, which substantially impact health care spending and quality of life, remain under-addressed in the current system of health care delivery, particularly among low-income and minority populations. This analysis uses baseline assessment data from CAPABLE, an ongoing randomized controlled trial (RCT), to examine associations between pain, depression, and functional limitation among a sample of low-income, community-dwelling elders with functional limitations. Linear regression revealed close associations between depression, pain, and activity of daily living (ADL) limitation. Mediation analyses indicated that depression fully mediated the relationship between pain intensity and functional limitation and partially mediated the relationship between pain interference and depression. Past research has shown that these conditions may be easily identified using validated assessment tools and effectively addressed through the introduction of interdisciplinary interventions. Several recommendations are presented for clinicians and health care organizations.

Factors associated with ADL/IADL disability in community dwelling older adults in the Irish longitudinal study on ageing (TILDA)

PURPOSE

To identify the factors associated with disability across many domains using a large powered sample in the activities of daily living (ADL) and instrumental activities of daily living (IADL).

METHODS

Those aged ≥65 years from the Irish longitudinal study on ageing (TILDA) were included in this cross sectional analysis. Three logistic regression models were used to examine the relationships between 25 health, psychological and sociodemographic variables and difficulties in ADL, IADL and ADL/IADL combined.

RESULTS

The proportion of those reporting combined ADL/IADL difficulties was 18%. More individuals reported difficulty with ADLs (13%) than IADLS (11%). The main model showed that after age, the top three factors associated with difficulty in ADL/IADL combined were pain, taking five or more medications and depression. After age, the factors with the highest impact on ADL disability were pain, taking five or more medications and body mass index (BMI); the factors with the highest impact on IADL were being separated or divorced, living with others (non-spouse) and self-rated memory.

CONCLUSIONS

Awareness of sociodemographics and early interventions for pain and cognitive deficits could reduce ADL/IADL disability and promote successful ageing. Identification of variables that influence ADL/IADLs can be used to inform policy and practice. Implications for rehabilitation After age, pain and taking five or more medications were the strongest factors associated with difficulty in ADL/IADL combined and ADL alone. Practice therefore needs to be cognizant that it is not the disease label but the symptoms of a disease that affect ADL and IADL activities. Given the strong influence of pain on difficulties with ADL and IADL, there is a need for early interventions from a multidisciplinary perspective for pain reduction, control, and self-management. These interventions should include development of pain-coping strategies and exercises to maintain mobility. After age, being separated/divorced or living with non-spouse others are the strongest factors associated with IADL difficulties. Awareness of these social factors can be used to inform support mechanisms, such as development of community services and suitable housing for those with these changing sociodemographics. Unsurprisingly, cognitive impairments were strongly associated with IADL difficulties. Simple cognitive screening assessments could be used for early detection of cognitive changes. In order to maintain optimal cognitive functioning, rehabilitation professionals should facilitate older adults' engagement in activities that are cognitively demanding and socially interactive.

Prevalence and treatment of pain in non-institutionalized very old population: transversal study at national level

BACKGROUND

In Europe, there is no conclusive data at national level about pain prevalence in non-institutionalized very old population. In USA, it has recently been reported a high prevalence (56 %); however, this data can not be extrapolated to other regions because the known influence of geographical and ethnic differences. Furthermore there are few data on use of treatments for pain in this population.

AIMS

To explore prevalence and considered pharmacological treatments for pain in this population.

METHODS

Transversal study on 551 participants aged 80 or more living in Spain (non-institutionalized). Probabilistic multistage sampling was carried out, stratified by sex and place of residence. All Spanish regions were considered for recruitment process. Pain (last 4 weeks), intensity (Face Pain Scale), localization and pharmacological treatments were evaluated by in-person interviews.

RESULTS

Pain's prevalence was 52.5 % (CI 95 % 48.28-56.80) and 38.5 % experienced pain of at least moderate intensity. The most frequently involved body regions were lower limbs (26.6 %) and dorso-lumbar region (21.9 %). Only 40 % of participants with pain and 43.2 % with moderate or severe pain used analgesics, and paracetamol was less frequently used than non-steroidal anti-inflammatory drugs at any pain intensity. Age was not associated with higher prevalence [odds ratios 0.97 (CI 95 % 0.93-1.02) in females and 0.99 (CI 95 % 0.92-1.06) in males].

CONCLUSIONS

The prevalence of pain in non-institutionalized very old people is high. Pain is probably being undertreated, even moderate or severe pain. Guideline's recommendations are probably not being considered to select the analgesic therapy.

A geriatric assessment in general practice: prevalence, location, impact and doctor-patient perceptions of pain

BACKGROUND

To investigate what a geriatric assessment in general practice adds towards previous findings of prevalence, location, impact and the dyadic doctor-patient perception of pain in this age group.

METHODS

Cross-sectional study. Consecutive patients aged 70 and over underwent a comprehensive geriatric assessment in general practice that included a basic pain assessment (severity, sites and impact). Patients with pain and their doctors then independently rated its importance. Pain was correlated with further findings from the assessment, such as overall health, physical impairments, everyday function, falls, mood, health related lifestyle, social circumstances, using bivariate and multivariate statistics. Patient-doctor agreement on the importance of pain was calculated using kappa statistics.

RESULTS

219 out of 297 patients (73.7 %) reported pain at any location. Pain was generally located at multiple sites. It was most often present at the knee (33.9%), the lumbar spine (33.5%) as well as the hip (13.8%) and correlated with specific impairments such as restrictions of daily living (knee) or sleep problems (spine). Patients with pain and their physicians poorly agreed on the importance of the pain problem.

CONCLUSIONS

A basic pain assessment can identify older patients with pain in general practice. It has resulted in a high prevalence exceeding that determined by encounters in consultations. It has been shown that a geriatric assessment provides an opportunity to address pain in a way that is adapted to older patients' needs - addressing all sites, its specific impact on life, and the patients' perceived importance of pain. Since there is little doctor-patient agreement, this seems a valuable strategy to optimize concrete treatment decisions and patient centered care.

TRIAL REGISTRATION

This study is registered in the German Clinical Trial Register ( DRKS00000792 ).

Outcome measures in randomized-controlled trials of neuropathic pain conditions: a systematic review of systematic reviews and recommendations for practice

OBJECTIVES

Neuropathic pain (NeP) is a prevalent, disabling, multidimensional condition with significant morbidity; however, there appears to be a variable approach in the use of outcome measures in NeP trials. A search of systematic reviews of interventional randomized-controlled trials for NeP was undertaken to investigate the range and types of outcome measures used to determine treatment effects.

METHODS

Keywords and MESH searches were conducted in 5 electronic databases from inception to January 31, 2012. Full-text English-language reviews based on various acute and chronic NeP conditions were included. Two independent reviewers screened papers for inclusion, extracted data, and assessed the quality of reviews. Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to critically appraise the reviews.

RESULTS

A total of 46 studies were identified: the majority of reviews (n=28/46, 61%) scored well on the PRISMA (PRISMA scores of 20-27/27). Change in levels or intensity of pain were used by the majority of studies as the primary outcome measure in intervention studies (n=40/46 studies, 87%). Few studies used a functional outcome measure as either a primary or secondary outcome measure (n=7/46, 15% of studies).

DISCUSSION

These results demonstrate that measures of pain are predominantly used in trials of NeP conditions and highlight the scant usage of functional outcome measures. The lack of standardization for the diagnostic criteria in NeP trials is also an issue that needs to be considered for future research and guideline development.

Synergistic effect of pain and deficits in ADL towards general practitioner visits

BACKGROUND

Pain and activities of daily living (ADLs) deficits are common problems among elderly people who visit general practitioners (GPs).

OBJECTIVE

To examine whether the probability of visiting a GP is related to deficits in ADLs and pain, and whether these factors act synergistically towards GP visits.

METHODS

A total of 3097 subjects aged ≥65 years from the Austrian Health Interview Survey formed the cohort. Visiting the GP in the last 4 weeks, chronic pain (CP; pain for at least 3 months) and deficits in ADLs across 11 dimensions were reported. Binary logistic regression models were applied and were stepwise controlled for possible confounders. Based on odds ratios (OR), the synergy index (SI), population attributable fraction (PAF) and relative excess risk due to interaction (RERI) were calculated.

RESULTS

Overall, 61.0% visited their GP; 51.2% were affected by ADL deficits and 42.2% by CP. In subjects with ADL deficits, the OR for GP consultation was 1.32 (95% confidence interval [CI] 1.11-1.56) and in subjects with CP, 1.93 (95% CI 1.63-2.27) in the fully adjusted model. The OR for those affected by both was 2.56 (95% CI 2.08-3.15); SI was 1.82 (95% CI 1.04-3.18), PAF was 0.27 (95% CI 0.08-0.47) and RERI was 0.70 (95% CI 0.13-1.27).

CONCLUSION

There is a strong synergistic effect of CP and deficits in ADL in patients ≥65 years on visiting the GP. Prevention, screening, treatment and rehabilitation in this population should focus on both CP and ADL deficits.

Pain in Community-Dwelling Older Adults with Dementia: Results from the National Health and Aging Trends Study

OBJECTIVES

To report prevalence, correlates, and medication management of pain in community-dwelling older adults with dementia.

DESIGN

Cross-sectional.

SETTING

In-person interviews with self- or proxy respondents living in private residences or non-nursing home residential care settings.

PARTICIPANTS

Nationally representative sample of community-dwelling Medicare beneficiaries aged 65 and older enrolled in the National Health and Aging Trends Study 2011 wave.

MEASUREMENTS

Dementia status was determined using a modified previously validated algorithm. Participants were asked whether they had had bothersome and activity-limiting pain over the past month. A multivariable Poisson regression model was used to determine the relationship between bothersome pain and sociodemographic and clinical characteristics.

RESULTS

Of the 7,609 participants with complete data on cognitive function, 802 had dementia (67.2% aged ≥80, 65.0% female, 67.9% white, 49.7% proxy response, 32.0% lived alone, 18.8% lived in residential care); 670 (63.5%) participants with dementia experienced bothersome pain, and 347 (43.3%) had pain that limited activities. These rates were significantly higher than in a propensity score-matched cohort without dementia (54.5% bothersome pain, P < .001, 27.2% pain that limited activity, P < .001). Proxies reported slightly higher rates of pain than self-respondents, but differences were statistically significant only for activity-limiting pain (46.6% proxy vs 40.1% self, P = .03). Correlates of bothersome pain included arthritis, heart and lung disease, less than high school education, activity of daily living disability, depressive and anxiety symptoms, and low energy. Of those reporting pain, 30.3% stated that they rarely or never took any medications for pain.

CONCLUSION

Community-living older adults with dementia are at high risk of having pain. Creative interventions and programs are needed to manage pain adequately in this vulnerable population.

Lower Extremity Proximal Muscle Function and Dyspnea in Older Persons

OBJECTIVES

To evaluate the association between performance on a single chair stand and moderate to severe exertional dyspnea.

DESIGN

Cross-sectional.

SETTING

Cardiovascular Health Study.

PARTICIPANTS

Community-dwelling individuals aged 65 and older (N = 4,413; mean age 72.6; female, n = 2,518 (57.1%); nonwhite, n = 199 (4.5%); obese, n = 788 (17.9%); history of smoking, n = 2,410 (54.6%)).

MEASUREMENTS

Performance on single chair stand (poor (unable to rise without arm use) vs normal (able to rise without arm use)), moderate to severe exertional dyspnea (American Thoracic Society grade ≥2), age, sex, ethnicity, obesity, smoking, frailty status (Fried-defined nonfrail, prefrail, frail), high cardiopulmonary risk (composite of cardiopulmonary diseases and diabetes mellitus), spirometric impairment, arthritis, depression, stroke, and kidney disease.

RESULTS

Poor performance on the single chair stand was established in 369 (8.4%) and moderate to severe exertional dyspnea in 773 (17.5%). Prefrail status was established in 2,210 (50.1%), frail status in 360 (8.2%), arthritis in 2,241 (51.4%), high cardiopulmonary risk in 2,469 (55.9%), spirometric impairment in 1,076 (24.4%), kidney disease in 111 (2.5%), depression in 107 (2.4%), and stroke in 93 (2.1%). In multivariable regression models, poor performance on the single chair stand was associated with moderate to severe exertional dyspnea (unadjusted odds ratio (OR) = 3.48, 95% confidence interval (CI) = 2.78-4.36; adjusted OR = 1.85, 95% CI = 1.41-2.41).

CONCLUSION

Poor performance on a single chair stand was associated with an adjusted 85% greater likelihood of moderate to severe exertional dyspnea than normal performance. These results suggest that reduced proximal muscle function of the lower extremities is associated with moderate to severe exertional dyspnea, even after adjusting for multiple confounders.

The understanding of pain by older adults who consider themselves to have aged successfully

OBJECTIVES

Despite an ageing population and an increased prevalence of chronic pain, the relationship between chronic pain and the concept of successful ageing is unclear. The aim of the present research was to explore older people's views on past and present experiences of pain, and its management, and how these experiences relate to their perceptions of successful ageing.

METHODS

Semi-structured interviews with six participants, aged 75 years or older, who considered themselves to have aged successfully, explored what this concept meant to them and their experiences of pain. Data analysis used methods drawn from grounded theory. The themes reported in this article are 'understanding of pain' and 'perceptions of ageing'.

RESULTS

None of the participants recalled painful experiences that were not attributable to physical trauma. They believed that pain is part of life and a natural consequence of the ageing process. While some accepted this with little resistance, others felt frustration at what they considered a dismissive attitude towards older people experiencing pain from healthcare practitioners. The concept of successful ageing was previously unfamiliar to participants, and their conceptualization of ageing derived from comparing themselves with their peers.

CONCLUSIONS

The findings of the present study suggest that predictable experiences of pain as one ages may contribute to an acceptance of pain as a biomedical certainty, a belief reinforced both by health professionals and society. However, one may have chronic pain and yet consider oneself to have aged successfully, and it should therefore be recognized that there is a distinction between having pain and having a problem with pain.

Prevalence of pain with advancing age brief report

BACKGROUND

The epidemiology of chronic pain with advancing age remains poorly established. Although most studies have examined somatic (musculoskeletal and joint) pain, visceral pain (such as headache and abdominal pain) has warranted less attention. We present longitudinal data from age 70 to 90 years concerning chronic musculoskeletal/joint pain, abdominal pain, and headache.

METHODS

Data was collected by the Jerusalem Longitudinal Study, which is a prospective study of a representative sample from the 1920-1921 birth-cohort living in West Jerusalem. Participants underwent comprehensive assessment at home in 1990, 1998, 2005, and 2010, at ages 70 (n = 460), 78 (n = 763), 85 (n = 1149), and 90 years (n = 394), respectively, and were directly questioned concerning the presence and location of pain.

RESULTS

The overall prevalence of pain of any kind at ages 70, 78, 85, and 90 years was 73% (n = 336/460), 81.1% (n = 619/763), 56.3% (n = 647/1149), and 31.2% (n = 123/394), respectively. Pain at younger ages only was associated with female gender, lower educational status, functional dependence, physical inactivity, increased body mass index, loneliness, depression, and poor self-rated health. At ages 70, 78, 85, and 90 years, chronic neck/back pain was present among 41.5%, 58.9%, 30.1%, and 14.6% of participants, respectively; chronic joint pain was present among 43.0%, 60.6%, 45.2%, and 25.2%, respectively. In contrast abdominal pain was less common and disappeared among the oldest old: 14.7%, 13.9%, 1.7%, and 1.5%, respectively, with a similar pattern for headache: 43.3%, 33.5%, 2.1%, and 1.3%. While pain was reported at ≥2 sites by 42.3% and 54.6% at ages 70 and 78 years, respectively, by ages 85 and 90 years, pain was most frequently reported at only 1 site.

CONCLUSIONS

Visceral pain (headache and abdominal pain) completely disappeared among the oldest old, in contrast to a far smaller decline in somatic (musculoskeletal and joint) pain.

Physical activity attitudes, beliefs, and practices among adults 50 and older: baseline community assessment

This study aligned with the National Blueprint, a coalition of national organizations to identify the principal barriers to physical activity participation in older adults and to outline strategies for increasing physical activity levels. A community coalition took the initiative to conduct a baseline assessment of health attitudes, perceptions, and behaviors among community adults in order to understand the immediate needs of the adult community. Adults 50 and older (N = 309) completed surveys of health and physical activity (PA) behaviors. Individuals reported below average physical activity levels. Motives and barriers to PA differed by gender and race/ethnicity. Age and health perceptions significantly predicted PA levels. Findings support previous research with this age group, thus discussion of the utility of multi-level approaches (e.g., social ecological model) to health betterment in communities is forwarded. Providing multi-level resources (personal, social, environmental, policy) can increase opportunities for adoption and maintenance of health behaviors.

High prevalence of falls, fear of falling, and impaired balance in older adults with pain in the United States: findings from the 2011 National Health and Aging Trends Study

OBJECTIVES

To determine the prevalence of clinically relevant falls-related outcomes according to pain status in older adults in the United States.

DESIGN

Cross-sectional analysis of the 2011 National Health and Aging Trends Study, a sample of Medicare enrollees aged 65 and older (response rate 71.0%).

SETTING

In-person assessments were conducted in the home or residential care facility of the sampled study participant.

PARTICIPANTS

Individuals aged 65 and older (n = 7,601, representing 35.3 million Medicare beneficiaries).

MEASUREMENTS

Participants were asked whether they had been "bothered by pain" and the location of pain, as well as questions about balance and coordination, fear of falling, and falls.

RESULTS

Fifty-three percent of the participants reported bothersome pain. The prevalence of recurrent falls in the past year (≥ 2 falls) was 19.5% in participants with pain and 7.4% in those without (age- and sex-adjusted prevalence ratio (PR) = 2.63, 95% confidence interval (CI) = 2.28-3.05). The prevalence of fear of falling that limits activity was 18.0% in those with pain and 4.4% in those without (adjusted PR = 3.98, 95% CI = 3.24-4.87). Prevalence of balance and falls outcomes increased with number of pain sites. For example, prevalence of problems with balance and coordination that limited activity was 6.6% in participants with no pain, 11.6% in those with one site of pain, 17.7% in those with two sites, 25.0% in those with three sites, and 41.4% in those with four or more sites (P < .001 for trend). Associations were robust to adjustment for several potential confounders, including cognitive and physical performance.

CONCLUSION

Falls-related outcomes were substantially more common in older adults with pain than in those without. Accordingly, pain management strategies should be developed and evaluated for falls prevention.

Direct and indirect relationships between physical activity and happiness levels among older adults: a cross-sectional study

OBJECTIVES

The purposes of this study were to examine if physical activity (PA) is associated to happiness and to investigate if social functioning and health status mediate this association.

METHOD

Participants of this cross-sectional study were 323 men and women, age 60 or over, who were covered by the medical insurance of the French National Education System, France. They received by mail a self-report questionnaire that asked for information about general health, PA, and happiness.

RESULTS

In multinomial logistic regressions, the total volume of PA was associated to higher levels of happiness, but this association disappeared in the presence of social functioning. A structural equation modelling (SEM) showed an indirect association between PA and happiness, which was mediated by participants' health status and social functioning; in this SEM model, social functioning was the only variable directly associated to happiness.

CONCLUSION

Complex associations among PA, health status, and social functioning appear to determine happiness levels in older adults.

Prevalence and impact of pain among older adults in the United States: findings from the 2011 National Health and Aging Trends Study

This study sought to determine the prevalence and impact of pain in a nationally representative sample of older adults in the United States. Data from the 2011 National Health and Aging Trends Study were analyzed. In-person interviews were conducted in 7601 adults ages ≥65 years. The response rate was 71.0% and all analyses were weighted to account for the sampling design. The overall prevalence of bothersome pain in the last month was 52.9%, afflicting 18.7 million older adults in the United States. Pain did not vary across age groups (P = 0.21), and this pattern remained unchanged when accounting for cognitive performance, dementia, proxy responses, and residential care living status. Pain prevalence was higher in women and in older adults with obesity, musculoskeletal conditions, and depressive symptoms (P < 0.001). The majority (74.9%) of older adults with pain endorsed multiple sites of pain. Several measures of physical capacity, including grip strength and lower-extremity physical performance, were associated with pain and multisite pain. For example, self-reported inability to walk 3 blocks was 72% higher in participants with than without pain (adjusted prevalence ratio 1.72 [95% confidence interval 1.56-1.90]). Participants with 1, 2, 3, and ≥4 sites of pain had gait speeds that were 0.01, 0.03, 0.05, and 0.08 meters per second slower, respectively, than older adults without pain, adjusting for disease burden and other potential confounders (P < 0.001). In summary, bothersome pain in the last month was reported by half of the older adult population of the United States in 2011 and was strongly associated with decreased physical function.

Functional limitations and depressive symptoms: a longitudinal analysis of older Mexican American couples

OBJECTIVES

This study extends previous work on longitudinal patterns of spousal associations between functional impairments and psychological well-being in older couples in 3 important ways: By examining Mexican Americans, by considering a broader range of functional limitations, and by assessing the role of health status, social integration, and socioeconomic resources in these associations.

METHOD

Drawing on data from 6 waves of the Hispanic Established Population for the Epidemiologic Study of the Elderly (1993-2007), we employed growth curve models to investigate the implications of the spouse's functional limitations for the respondent's age trajectories of depressive symptoms in older Mexican American couples. Models were run separately for husbands and wives.

RESULTS

The spouse's functional limitations were associated with higher levels of depressive symptoms in the respondent. Personal resources can both ameliorate and intensify the adverse implications of the spouse's functional limitations for the respondent's depressive symptomatology. The interplay among these factors can vary by gender and the type of the spouse's functional impairment.

DISCUSSION

Future studies would benefit by examining caregiving patterns in older couples, by distinguishing between different dimensions of social support available to them, and by considering changes in couples' marital quality and social ties over time.

Functional impairment in obesity: a focus on knee and back pain

SUMMARY Cross-sectional and longitudinal evidence strongly indicate that obesity is related to physical impairment and joint pain, particularly in the lumbar spine, sacroiliac and knee joints. What is most disturbing is that obese children under 15 years are now reporting joint pain and cannot perform functional tasks as well as their nonobese counterparts. As the prevalence of obesity rises, so do the rates of musculoskeletal disease and physical dysfunction. Functional tasks that involve supporting or transferring body weight are typically painful and difficult to perform. Of most concern is that some of these tasks are simply impossible depending on the severity of obesity. As a consequence, the individual's quality of life suffers. A BMI of 35 kg/m(2) is emerging as the threshold at which functional impairment rates rise dramatically. To restore functional independence and optimize functional gains over the long term, a combination of treatments for the obese patient with joint pain may be effective. The initial use of physical therapy, pain medications or joint viscosupplementation, coupled with diet, exercise, or bariatric surgery are options for weight loss and reduction of pain symptoms. Irrespective of age, weight loss can reduce or eliminate joint pain. As body weight is reduced, so should the reliance on medication with a concomitant improvement in functional mobility.

[Chronic pain among elderly residents in São Paulo, Brazil: prevalence, characteristics, and association with functional capacity and mobility (SABE Study)]

The objective was to identify the prevalence and characteristics of chronic pain and the association with functional capacity. This was a cross-sectional study with a population sample of community-dwelling elderly residents in the city of São Paulo, Brazil, using home interviews. Statistical analysis used the RaoScott test of association with p < 0.05. Prevalence of chronic pain was 29.7% (95%CI: 25.4-33.9), most frequent in the lower back (25.4%) and lower limbs (21.9%), and moderate in 45.8% and intense in 46% of the sample. Chronic pain was associated with increased dependence and decreased mobility (p < 0.001).

Patients' experiences of chronic non-malignant musculoskeletal pain: a qualitative systematic review

BACKGROUND

Musculoskeletal (MSK) pain is one of the most predominant types of pain and accounts for a large portion of the primary care workload.

AIM

To systematically review and integrate the findings of qualitative research to increase understanding of patients' experiences of chronic non-malignant MSK pain.

DESIGN AND SETTING

Synthesis of qualitative research using meta-ethnography using six electronic databases up until February 2012 (Medline, Embase, Cinahl, Psychinfo, Amed and HMIC).

METHOD

Databases were searched from their inception until February 2012, supplemented by hand-searching contents lists of specific journals for 2001-2011 and citation tracking. Full published reports of qualitative studies exploring adults' own experience of chronic non-malignant MSK pain were eligible for inclusion.

RESULTS

Out of 24 992 titles, 676 abstracts, and 321 full texts were screened, 77 papers reporting 60 individual studies were included. A new concept of pain as an adversarial struggle emerged. This adversarial struggle was to: 1) affirm self; 2) reconstruct self in time; 3) construct an explanation for suffering; 4) negotiate the healthcare system; and 5) prove legitimacy. However, despite this struggle there is also a sense for some patients of 6) moving forward alongside pain.

CONCLUSIONS

This review provides a theoretical underpinning for improving patient experience and facilitating a therapeutic collaborative partnership. A conceptual model is presented, which offers opportunities for improvement by involving patients, showing them their pain is understood, and forming the basis to help patients move forward alongside their pain.

A meta-ethnography of patients’ experience of chronic non-malignant musculoskeletal pain

Background

The alleviation of pain is a key aim of health care yet pain can often remain a puzzle as it is not always explained by a specific pathology. Musculoskeletal (MSK) pain is one of the most predominant kinds of chronic pain and its prevalence is increasing. One of the aims of qualitative research in health care is to understand the experience of illness, and make sense of the complex processes involved. However, the proliferation of qualitative studies can make it difficult to use this knowledge. There has been no attempt to systematically review and integrate the findings of qualitative research in order to increase our understanding of chronic MSK pain. A synthesis of qualitative research would help us to understand what it is like to have chronic MSK pain. Specifically, it would help us understand peoples' experience of health care with the aim of improving it.

Aim

The aim of this study was to increase our understanding of patients’ experience of chronic non-malignant MSK pain; utilise existing research knowledge to improve understanding and, thus, best practice in patient care; and contribute to the development of methods for qualitative research synthesis.

Methods

We used the methods of meta-ethnography, which aim to develop concepts that help us to understand a particular experience, by synthesising research findings. We searched six electronic bibliographic databases (including MEDLINE, EMBASE and PsycINFO) and included studies up until the final search in February 2012. We also hand-searched particular journals known to report qualitative studies and searched reference lists of all relevant qualitative studies for further potential studies. We appraised each study to decide whether or not to include it. The full texts of 321 potentially relevant studies were screened, of which 77 qualitative studies that explored adults’ experience of chronic non-malignant MSK pain were included. Twenty-eight of these studies explored the experience of fibromyalgia.

Results

Our findings revealed the new concept of an adversarial struggle that explains the experience of people with chronic MSK pain. This included the struggle to affirm self and construct self over time; find an explanation for pain; negotiate the health-care system while feeling compelled to stay in it; be valued and believed; and find the right balance between sick/well and hiding/showing pain. In spite of this struggle, our model showed that some people were able to move forward alongside their pain by listening to their body rather than fighting it; letting go of the old self and finding a new self; becoming part of a community and not feeling like the only one; telling others about pain and redefining relationships; realising that pain is here to stay rather than focusing on diagnosis and cure; and becoming the expert and making choices. We offer unique methodological innovations for meta-ethnography, which allowed us to develop a conceptual model that is grounded in 77 original studies. In particular, we describe a collaborative approach to interpreting the primary studies.

Conclusion

Our model helps us to understand the experience of people with chronic MSK pain as a constant adversarial struggle. This may distinguish it from other types of pain. This study opens up possibilities for therapies that aim to help a person to move forward alongside pain. Our findings call on us to challenge some of the cultural notions about illness, in particular the expectation of achieving a diagnosis and cure. Cultural expectations are deep-rooted and can deeply affect the experience of pain. We therefore should incorporate cultural categories into our understanding of pain. Not feeling believed can have an impact on a person’s participation in everyday life. The qualitative studies in this meta-ethnography revealed that people with chronic MSK pain still do not feel believed. This has clear implications for clinical practice. Our model suggests that central to the relationship between patient and practitioner is the recognition of the patient as a person whose life has been deeply changed by pain. Listening to a person’s narratives can help us to understand the impact of pain. Our model suggests that feeling valued is not simply an adjunct to the therapy, but central to it. Further conceptual syntheses would help us make qualitative research accessible to a wider relevant audience. Further primary qualitative research focusing on reconciling acceptance with moving forward with pain might help us to further understand the experience of pain. Our study highlights the need for research to explore educational strategies aimed at improving patients’ and clinicians’ experience of care.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Musculoskeletal pain and physical functioning in the oldest old

BACKGROUND

Little is known about the impact of pain on physical functioning among the oldest-old subjects. In this study, we first examined the associations between the number of painful sites and measures of physical functioning reflecting different stages of the disablement process (physical impairment, functional limitation and disability) among nonagenarians (more than ninety years old persons). Second, we described the effect of painful sites on disability during a 2-year follow-up period.

METHODS

This study is based on baseline (n = 1177) and 2-year follow-up (n = 709) data of the nationwide Danish 1905 cohort study. Musculoskeletal pain was assessed as reported pain in back, hips or knees when moving or resting. Physical performance measures included maximum grip strength and habitual walking speed. Disability in performing activities of daily living was defined as the need for assistive device or personal help in transferring, dressing, washing, using toilet and/or walking indoors.

RESULTS

At baseline, the number of painful sites was significantly associated with measured grip strength and walking speed as well as self-reported disability in a stepwise manner; the more sites with pain, the poorer the physical functioning. The follow-up analyses showed corresponding but slightly weaker stepwise associations between baseline pain and disability level at follow-up, and indicated that although on the whole, single or multi-site pain did not predict the onset of disability, multi-site pain increased the risk of developing severe disability.

CONCLUSIONS

The findings of this study suggest that musculoskeletal pain in nonagenarians is highly prevalent and is associated with poor physical performance and disability.

Functional pain severity and mobility in overweight older men and women with chronic low-back pain--part I

OBJECTIVE

This study determined whether mobility and functional pain were different among older men and women with chronic low-back pain and varying body mass index levels.

DESIGN

This was a comparative, descriptive study of older adults with obesity with low-back pain (N = 55; 60-85 yrs). The participants were stratified on the basis of body mass index: overweight (25-29.9 kg/m), obese (30-34.9 kg/m), and severely obese (35 kg/m). The participants completed a functional test battery (walking endurance, chair rise, stair climb, 7-day activity monitoring, and gait parameters) and pain ratings with activity ("functional pain").

RESULTS

The functional pain scores during walking and stair climb were highest in the severely obese group compared with the overweight group (P < 0.05), but the functional test scores were not found to be significantly different by body mass index. Gait base of support was 36% greater and single/double support times were 3.1%-6.1% greater in the severely obese group compared with the overweight group (P < 0.05). The women had slower chair rise and stair climb times and had slower walking velocity than did the men. Daily step numbers were lowest in the severely obese group compared with the obese and overweight groups (2971 vs. 3511 and 4421 steps per day; P < 0.05) but were not different by sex. Normalized lumbar extensor, abdominal curl, and leg press strength values were lowest in the severely obese group, and the women had 18%-34% lower strength values than did the men for all three exercises (P < 0.05). Lumbar strength was associated with stair climb, chair rise, and walking endurance times. Body mass index was an independent predictor of walking endurance time but not of steps taken per day.

CONCLUSIONS

In this study, the persons with obesity reported higher functional pain values during walking and stair climb and had lower lumbar strength compared with the overweight participants. Rehabilitation strategies that include lumbar extensor strengthening may help improve functional mobility and walking duration, both of which can help with weight management in older adults with obesity with chronic low-back pain.

Pain among older Hispanics in the United States: is acculturation associated with pain?

BACKGROUND

Previous studies suggest that acculturation may influence the experience of pain.

STUDY DESIGN

We conducted a cross-sectional study to estimate the association between acculturation and the prevalence, intensity, and functional limitations of pain in older Hispanic adults in the United States.

METHODS SUBJECTS

Participants were English- (HE) and Spanish-speaking (HS) Hispanic and non-Hispanic White (NHW) individuals aged 50 years and older who were interviewed for the Health and Retirement Study during 1998-2008.

MEASURES

We measured: 1) acculturation as defined by language used in interviews, and 2) the presence, intensity, and functional limitations of pain.

ANALYSIS

We applied logistic regression using generalized estimating equations, with NHW as the reference category.

RESULTS

Among 18,593 participants (16,733 NHW, 824 HE, and 1,036 HS), HS had the highest prevalence (odds ratio [OR] = 1.3; 95% confidence interval [CI  = 1.1-1.4) and intensity (OR = 1.6; 95% CI = 1.4-1.9) of pain, but these differences were not significant after adjusting for age, sex, years of education, immigration status (U.S.- vs non-U.S-born), and health status (number of health conditions). Even after adjustment, HS reported the lowest levels of functional limitation (OR = 0.7; 95% CI 0.6-0.9).

CONCLUSION

Pain prevalence and intensity were not related to acculturation after adjusting for sociodemographic factors, while functional limitation was significantly lower among HS even after adjusting for known risk factors. Future studies should explore the reasons for this difference.

Effects of a low-volume, vigorous intensity step exercise program on functional mobility in middle-aged adults

Aging-related decline in functional mobility is associated with loss of independence. This decline may be mitigated through programs of physical activity. Despite reports of aging-related mobility impairment in middle-aged adults, this age group has been largely overlooked in terms of exercise programs that target functional mobility and the preservation of independence in older age. A method to quantitatively assess changes in functional mobility could direct rehabilitation in a proactive rather than reactive manner. Thirty-three healthy but sedentary middle-aged adults participated in a four week low-volume, vigorous intensity stepping exercise program. Two baseline testing sessions and one post-training testing session were conducted. Functional mobility was assessed using the timed up and go (TUG) test, with its constituent sit-to-walk and walk-to-sit phases examined using a novel inertial sensor-based method. Additionally, semi-tandem balance and knee extensor muscle isometric torque were assessed. Trunk acceleration during walk-to-sit reduced significantly post-training, suggesting altered movement control due to the exercise program. No significant training-induced changes in sit-to-walk acceleration, TUG time, balance or torque were observed. The novel method of functional mobility assessment presented provides a reliable means to quantify subtle changes in mobility during postural transitions. Over time, this exercise program may improve functional mobility.

The role of pain in understanding racial/ethnic differences in the frequency of physical activity among older adults

OBJECTIVE

To evaluate racial/ethnic differences in physical activity among white, black, and Hispanic adults aged 65 years and older, and to assess the potential role of pain as a mediator.

METHODS

Analyses were based on data from the 2008 Health and Retirement Study. Logistic regression was used to evaluate associations between race/ethnicity and pain and the odds of regular physical activity.

RESULTS

Compared to Whites, the odds of both light physical activity and moderate/vigorous physical activity were lower among Blacks, but not Hispanics. A graded inverse association between levels of pain severity and the odds of physical activity was found, but pain did not mediate racial/ethnic differences in physical activity.

DISCUSSION

When compared to Whites, older Blacks appear to have relatively low rates of physical activity even without comparatively high levels of pain, while older Hispanics experience relatively high rates of pain, but are perhaps more resilient to the effects of pain on physical activity.

Pain as a risk factor for disability or death

OBJECTIVES

To determine whether pain predicts future activity of daily living (ADL) disability or death in individuals aged 60 and older.

DESIGN

Prospective cohort study.

SETTING

The 1998 to 2008 Health and Retirement Study (HRS), a nationally representative study of older community-living individuals.

PARTICIPANTS

Twelve thousand six hundred thirty-one participants in the 1998 HRS aged 60 and older who did not need help in any ADL.

MEASUREMENTS

Participants reporting that they had moderate or severe pain most of the time were defined as having significant pain. The primary outcome was time to development of ADL disability or death over 10 yrs, assessed at five successive 2-year intervals. ADL disability was defined as needing help performing any ADL: bathing, dressing, transferring, toileting, eating, or walking across a room. A discrete hazards survival model was used to examine the relationship between pain and incident disability over each 2-year interval using only participants who started the interval with no ADL disability. Several potential confounders were adjusted for at the start of each interval: demographic factors, seven chronic health conditions, and functional limitations (ADL difficulty and difficulty with five measures of mobility).

RESULTS

At baseline, 2,283 (18%) participants had significant pain. Participants with pain were more likely (all P < .001) to be female (65% vs 54%), have ADL difficulty (e.g., transferring 12% vs 2%, toileting 11% vs 2%), have difficulty walking several blocks (60% vs 21%), and have difficulty climbing one flight of stairs (40% vs 12%). Over 10 years, participants with pain were more likely to develop ADL disability or death (58% vs 43%, unadjusted hazard ratio (HR) = 1.67, 95% confidence interval (CI) = 1.57-1.79), although after adjustment for confounders, participants with pain were not at greater risk for ADL disability or death (HR = 0.98, 95% CI = 0.91-1.07). Adjustment for functional status almost entirely explained the difference between the unadjusted and adjusted results.

CONCLUSION

Although there are strong cross-sectional relationships between pain and functional limitations, individuals with pain are not at higher risk of subsequent disability or death after accounting for functional limitations. Like many geriatric syndromes, pain and disability may represent interrelated phenomena that occur simultaneously and require unified treatment paradigms.

The psycho-social dimension of pain and health-related quality of life in the oldest old

BACKGROUND

Chronic pain has an impact on the physical and social functioning of older people which in turn may worsen their health-related quality of life. Research with focus on prolonged extensive pain in the most elderly and how pain may interfere with their life situation is scarce.

AIMS

  The aims were to describe and investigate pain from a multidimensional point of view (duration, location, psycho-social) and health-related quality of life as well as to compare sex and age groups in people aged 80 years and over.

METHODS

In this cross-sectional study, a total of 225 of 282 people responded to a questionnaire consisting of two instruments and background questions. The psycho-social dimension of pain was measured using the Multidimensional Pain Inventory-Swedish language version (MPI-S) with five scales: Pain Severity, Interference, Life Control, Affective Distress and Social Support. Health-related quality of life was measured using the Short Form Health Survey-12 (SF-12).

RESULTS

Median duration of pain was 9.0 years, and the mean number of pain locations was 2.04. The MPI-S scale Interference with a negative orientation had the highest mean score, while the mean score for Social Support was the highest for the scales with a positive orientation. The duration of pain was significantly greater for women, and those aged 80-85 years had higher pain severity than those aged≥86. Participants with a lower health-related quality of life experienced significantly more severe pain, were more troubled with pain and had less control of their life.

CONCLUSIONS

Older people with prolonged pain suffered from a low health-related quality of life. Pain interfered with their lives and contributed to diminished control in their daily lives. Nurses are essential for the identification and prevention of pain and should be aware of how pain affects older people's physical, mental and social health.

Ageing Challenges the Results of any Outcome Study: How to Address the Effects of Ageing on Activities of Daily Living

OBJECTIVES: Clinical study results might be substantially biased by the effects of ageing, resulting in considerable underestimation of treatment efficacy, especially when assessing activities of daily living (ADL) in elderly people. This study aimed to define age- and comorbidity-related normative values in ADL. METHODS: In cross-sectional sampling, 23 763 German-speaking Swiss individuals were contacted. Valid questionnaires from 16 191 (68%) eligible individuals ≥ 18 years of age were included in the study. Age-related ADL reference values were calculated using questionnaire data. RESULTS: The sample was representative of the German-speaking Swiss population as determined by 2003 census data. Age- and pain-related ADL reference values were plotted and confirmed that disability increased with increasing age. CONCLUSIONS: The use of ADL scales that provide age- and comorbidity-related reference values for outcome studies or studies focusing on the elderly is recommended in order to reduce the effect of bias.

Fixed-dose combinations for emerging treatment of pain

INTRODUCTION

Pain is a large and growing medical need that is not currently being fully met, primarily due to the shortcomings of existing analgesics (insufficient efficacy or limiting side-effects). Better outcomes might be achieved using a combination of analgesics. The ratio of the combinations matters and should therefore be evaluated using rigorous quantitative and well-documented analysis.

AREAS COVERED

Advances have been made in understanding the normal physiology of pain processing, including the pathways and neurotransmitters involved. Insight has also been gained about physiological processes that can lead to different 'types' of pain and the transition from acute to chronic pain conditions. This 'multimechanistic' nature of most pains is better matched using a 'multimechanistic' rather than 'monomechanistic' analgesic approach. Such an approach - and the experimental design and data analysis to assess optimal combinations - is described and discussed.

EXPERT OPINION

There are sound pharmacologic, as well as practical, reasons for using combinations of drugs to treat pain. Compared with single agents, they offer a potential better match to the underlying pain physiology and thus greater efficacy or reduced side effects. The optimal efficacy and side-effect ratio must be determined in a scientifically rigorous manner.

The relationship between prescription medication use and ability to ambulate distances after spinal cord injury

OBJECTIVE

To investigate the relationship between prescription medication use for pain and spasticity and ambulation distances while controlling for pain severity, injury severity, age, sex, and race in participants with spinal cord injury (SCI).

DESIGN

Secondary analysis of survey data.

SETTING

Specialty hospital in the Southeast United States.

PARTICIPANTS

Adults (N=407) with traumatic SCI identified through inpatient and outpatient hospital databases.

INTERVENTION

Not applicable.

MAIN OUTCOMES MEASURES

A questionnaire measured prescription medication use, ambulation distance, and other demographic data. A composite score of four 10-point scales from the Brief Pain Inventory was used to measure pain severity. Multinomial logistic regression was used to calculate the odds ratio (OR) of ambulation distance using 1000 ft or more as the reference group.

RESULTS

Persons with SCI who were heavy prescription medication users (defined as weekly or daily use for pain or spasticity) were more likely to be limited to distances less than 150 (OR, 2.82; 95% confidence interval [CI], 1.57-5.04) and 150 to 999 ft (OR, 2.52; 95% CI, 1.45-4.39).

CONCLUSION

Heavy prescription medication use for pain and spasticity was related inversely to a person's ability to achieve community ambulation distances of 1000 ft or more.

Detecting and categorizing frailty status in older adults using a self-report screening instrument

PURPOSE

The purpose of this study was to design and validate a self-reported assessment tool for the identification of frailty.

MATERIALS AND METHODS

A thousand community-dwelling older adults (≥60 years), users of the medical insurance of the French national education system, received (Year 1) a postal questionnaire requesting information about health and socio-demographic characteristics. Among those who responded to the questionnaire (n=535), 398 individuals were classified as frail, pre-frail, or robust. One year later (Year 2), the same questionnaire was sent to this group and n=309 were returned. Frailty was operationalized using four criteria: low body mass index (BMI), low level of physical activity, and dissatisfaction with both muscle strength and endurance.

RESULTS

Frailty constituted a single entity, different from physical limitation and co-morbidity. Compared with robust individuals, frail persons were older, had more chronic diseases, higher levels of disability and physical function decline. Pre-frail individuals had an intermediate distribution. Those people classified as either frail or pre-frail had higher frequency of hospitalization, and a higher probability of co-morbidity than robust. Frailty was also associated with higher mortality.

CONCLUSIONS

Our screening tool for frailty was able to evidence important characteristics of this syndrome, i.e., it is a single entity with grades of severity which are associated with health problems. Detecting and categorizing frailty may lead to early therapeutic interventions to combat this condition.

Identifying the Relationship Between Chronic Pain, Depression, and Life Satisfaction in Older African Americans

Empirical research on the chronic pain experience of older African Americans is scarce. Here, the authors examined the influence psychosocial indicators have on the pain experience in a sample of older African Americans. Data were collected from African Americans ( N = 247) 50 to 96 years of age (69.4 ± 9.4). All participants provided self-report data on pain indicators, demographic characteristics, social (social support, locus of control, life satisfaction) variables, and depression. Those reporting higher levels of social support and depressive symptoms experienced greater pain intensity. Pain had an indirect effect on depression as mediated through life satisfaction.These findings demonstrate the need to focus more on the means to prevent and treat pain and to ameliorate its impact on social well-being, psychological functioning, and quality of life in older adults in general and older minority adults in particular.

Exploring extensions to working life: job lock and predictors of decreasing work function in older workers

PURPOSE

 Job lock, one form of restricted job mobility that often prevents older workers from retiring, is linked to existing health and work place problems. This study explored (i) the rate of change in work limitation for job locked and non-job locked older workers and (ii) the factors associated with these changes over a 12-month period following a work injury.

METHODS

 Prospective observational cohort study of adults aged  ≥55 years. Data were collected using self-completed questionnaires. Individual growth modelling was used to examine the pre- and post- injury influences on work limitation.

RESULTS

Work limitation was greater in the job locked older workers pre-injury. Both job-locked and non-job locked respondents had initial post-injury decreases in work limitations, suggesting a positive impact of temporary post-injury accommodations. However, both groups had increases in work limitations over time, but the increases were greater in the non-job locked group. In those with job lock, return to work problems were associated with increases in work limitations; in those without job lock, greater increases were associated only with low education.

CONCLUSIONS

These results suggest that job accommodations may be important in moderating increasing work limitation in job-locked older workers. Results support prior findings that job-locked older workers have unique characteristics, perhaps requiring more tailored interventions to maintain them in the workforce.

Predictors of Body Satisfaction: Differences Between Older Men and Women’s Perceptions of Their Body Functioning and Appearance

Objective: This article examines the predictors of body satisfaction among older men and women. Method: A self-reported questionnaire on body satisfaction (focused on body appearance and functioning), health, physical activity, and sociodemographic characteristics was completed by 384 older adults twice, at a year’s interval. Women ( n = 243) were on average 70.3 ± 7.9 years old, and men 70.9 ± 7.5 years old. Results: Body mass index was found to be the strongest predictor of satisfaction with body appearance for both genders, along with body functioning in the case of men. Regarding satisfaction with body functioning, functional limitations were women’s most important predictor of satisfaction, whereas for men body appearance was more important. Discussion: Men seemed to link satisfaction with body appearance more closely to body functioning than did women. Gender differences suggest that interventions to improve body satisfaction must be gender specific, particularly those relating to body functioning.

Treatments for neuropathic pain differentially affect delayed matching accuracy by macaques: effects of amitriptyline and gabapentin

Current clinical treatments for neuropathic pain include amitriptyline, a tricyclic antidepressant with mixed pharmacology that is also clinically reported to impair cognitive performance; and gabapentin, a compound that selectively interacts with alpha2delta-1 calcium channel subunits. Since few assessments of cognitive performance have been made in non-human primates with these marketed treatments, the purpose of this study was to determine their relative abilities to alter working memory as measured in mature macaques in their performance of a delayed matching-to-sample task. Four delay intervals of increasing duration provided increasing impairment in task accuracies during vehicle sessions. Administration of clinically relevant doses of amitriptyline significantly decreased task accuracy at the highest dose tested (3mg/kg). Administration of gabapentin increased mean task accuracy, though the effect was not statistically significant until intra-subject variability was reduced by selecting the individual best dose for each animal (which averaged 12.8mg/kg). Most of the effect was obtained during the presentation of long delay trials (18.2% above vehicle). Task improvement was sustained during sessions run 24h after gabapentin administration. In a series that used a task-relevant distractor to determine gabapentin's effect on attention, drug treatment reversed distractor-impaired accuracy during long delay trials (25.4% above vehicle). The selective improvement in long delay accuracy in both paradigms suggests improvement in encoding or retention components of working memory. It is currently unclear whether the ability of acute administration of gabapentin to modestly improve working memory occurs by a mechanism that could be related to its anti-allodynic mechanism of action.