Linking Persistent Pain and Frailty in Older Adults

Modifiable factors associated with frailty in older Australians in retirement living: A partial proportional odds model

OBJECTIVE

Frailty in older adults is a vulnerable state, often leading to a reduction in function and quality of life. This study sought to identify modifiable factors associated with frailty in Australian retirement village residents.

METHODS

A cross-sectional survey was undertaken with individuals 65 years or older living in 25 retirement villages to collect demographic, health and lifestyle information and screen for frailty (modified Reported Edmonton Frail Scale) and loneliness (UCLA 3-item Loneliness Scale). Partial proportional odds modelling was utilised to determine modifiable resident characteristics associated with frailty, accounting for age and gender.

RESULTS

Of 2240 residents, 1230 completed the survey (55% response rate) with 1081 eligible for analysis. Respondent frailty levels were as follows: Not Frail = 67% (n = 720), Prefrail = 14% (n = 157), Mildly Frail = 11% (n = 123), Moderately-Severely Frail = 7% (n = 81). For individuals 85-89 years old, age was significantly associated with increased odds of frailty (OR = 3.40; 95% CI: 1.62-7.09; p = .001). After adjusting for age and gender, the odds of higher frailty were greater for individuals experiencing (a) pain, which interfered with usual activities (interferes sometimes OR = 3.17; 95% CI: 2.42-4.15; p ≤ .001; interferes all of the time OR = 10.18; 95% CI: 5.42-19.14; p ≤ .001), or (b) feelings of loneliness (OR = 2.55; 95% CI: 1.80-3.62; p ≤ .001). For Not Frail or Prefrail persons, a recent fall incident was associated with enhanced odds of frailty (OR = 2.60; 95% CI: 1.69-3.98; p ≤ .001).

CONCLUSIONS

This cohort of older adults living in Australian retirement villages had greater odds of frailty if experiencing pain, loneliness or falls. Addressing these risk factors could reduce or delay progression to frailty and optimise positive ageing in this population.

Effectiveness of comprehensive geriatric assessment in frail older inpatients

BACKGROUND

Evidence regarding the effects of comprehensive geriatric assessment (CGA) on frail older inpatients is inconclusive. Moreover, various prior studies lacked proper patient selection using frailty assessment tools. Our review aimed to assess whether objectively identifying frail patients in clinical settings using a frailty tool and intervening with CGA provides clinical benefits in frail older inpatients.

METHODS

A systematic review and meta-analysis were conducted by searching PubMed, Embase, and Web of Science (January 1998-October 2022). Keywords included frailty, hospitalization, and CGA. Eligible studies were randomized controlled trials involving patients aged ≥65 years, with frailty defined by specific tools. The primary outcome was mortality; secondary outcomes included activities of daily living, quality of life, pain, patient satisfaction, polypharmacy, antidepressant use, post-discharge disposition, rehospitalization, and cost-effectiveness.

RESULTS

Of 2587 articles, 18 met inclusion criteria (2724 participants). Meta-analysis of five studies showed no significant differences in overall mortality for frail inpatients receiving CGA. However, CGA reduced mortality during follow-ups of ≤6 months. CGA also improved health-related quality of life, patient satisfaction, and activities of daily living, while reducing polypharmacy and modifying antidepressant use.

CONCLUSIONS

CGA did not significantly reduce overall mortality in frail older inpatients compared to usual care but lowered mortality rates at the 6-month follow-up. CGA also improved quality of life, daily functioning, and medication management, underscoring its value for managing frail older inpatients.

Temporal association between chronic pain and frailty occurrence, and the modifiable role of a healthy lifestyle in Chinese middle-aged and older population: a community based, prospective cohort study

BACKGROUND

While western studies suggest a temporal association between chronic pain and frailty, as well as the impacts of healthy lifestyle interventions, these relationships remain underexplored in the Chinese population.

METHODS

We conducted a longitudinal study with 13,601 participants from the China Health and Retirement Longitudinal Study, covering 2011-2018. Pain was assessed via self-report, and frailty was evaluated using a 29-item deficit-accumulation frailty index. Five lifestyle factors, such as physical activity, alcohol consumption, smoking, body mass index, and sleep duration, were assessed, and the participants were categorized into favorable, intermediate, and unfavorable lifestyle groups.

RESULTS

During the 7-year follow-up, 3,356 cases of frailty were discerned. Participants who reported pain at baseline assessment had a higher risk of developing frailty compared to those without pain (hazard ratio [HR] = 1.10; 95%confidence interval [CI], 1.03-1.19). This association was particularly evident in middle-aged individuals (HR = 1.13; 95% CI, 1.01-1.26). Participants with severe pain at baseline assessment had a 1.16-fold higher risk of frailty (95%CI, 1.05-1.28, Ptrend= 0.0067). Among the participants with mild or moderate pain at baseline assessment, the risk of developing frailty was significantly reduced by a favorable lifestyle (HR = 0.62; 95% CI, 0.51-0.76) or intermediate lifestyle (HR = 0.83; 95% CI, 0.70-0.98). Additionally, a favorable lifestyle was significantly associated with a decreased risk of developing frailty in the participants with severe pain at baseline assessment (HR = 0.75; 95%CI, 0.59-0.96). Mediation analysis indicated that a healthy lifestyle could mitigate 2.97% of frailty risk associated with chronic pain.

CONCLUSIONS

Chronic pain is strongly associated with an increased risk of developing frailty in Chinese older population, but the implementation of healthy lifestyles can significantly reduce this risk.

Longitudinal association between frailty and pain in three prospective cohorts of older population

BACKGROUND AND OBJECTIVES

As the global population ages, frailty and pain have become two significant health issues that impact the quality of life in older adults. Previous studies have not thoroughly explored the relationship between them. This study aims to investigate the longitudinal association between frailty and pain using data from prospective cohorts in China (CHARLS), the United Kingdom (ELSA), and the United States (HRS).

METHODS

This study utilized data from three prospective cohort studies: the China Health and Retirement Longitudinal Study (CHARLS), the English Longitudinal Study of Ageing (ELSA), and the Health and Retirement Study (HRS). Frailty status was assessed using the Rockwood frailty index and categorized into robust, pre-frail, and frail. Pain was evaluated by self-reports. Pain degrees were categorized into mild, moderate and severe. Pain areas were grouped into four main areas: head and neck, trunk, limbs, oral. Generalized linear mixed-effects models were employed to analyze the longitudinal relationship between frailty and pain while adjusting for covariates, including gender, age, marital status, education level, sleep quality, smoking, drinking, hypertension, and diabetes.

RESULTS

According to the inclusion and exclusion criteria, 10,624 participants from CHARLS (47% female, mean age: 60.76 years), 4945 participants from ELSA (52.2% female, mean age: 70.05 years), and 11,439 participants from HRS (55.8% female, mean age: 69.28 years) were included in the subsequent analysis. Compared to robust individuals, those in pre-frail and frail states showed a significantly increased risk of experiencing pain. In all three cohorts, pre-frail individuals had a 3.82-fold increased likelihood of pain compared to robust individuals (OR = 3.82, 95%CI = 3.51-4.15, p-value < 0.001, CHARLS), 4.29-fold (OR = 4.29, 95%CI = 3.74-4.93, p-value < 0.001, ELSA), and 4.17-fold (OR = 4.17, 95%CI = 3.81-4.57 p-value < 0.001, HRS). Frail individuals had a 10.44-fold increased likelihood of pain (OR = 10.44, 95%CI = 9.05-12.04, p-value < 0.001, CHARLS), 10.14-fold (OR = 10.14, 95%CI = 8.05-12.76, p-value < 0.001, ELSA), and 13.27-fold (OR = 13.27, 95%CI = 11.71-15.03, p-value < 0.001, HRS).

CONCLUSION

This study demonstrates that frailty significantly impacts the risk of pain, the degree of pain, and the areas of pain. And this association is consistently observed across older populations in different countries. Future pain management strategies should incorporate frailty assessments to mitigate the adverse effects of pain on the health of older adults.

Knowledge, attitude and practice regarding anterior cruciate ligament injuries among the youth

OBJECTIVES

This study aimed to explore the knowledge, attitude, and practice (KAP) concerning anterior cruciate ligament (ACL) injuries among the youth.

METHODS

This cross-sectional study was conducted at Hospital of Chengdu University of TCM between January 2024 and March 2024, and included the youth aged from 18 to 39 years old. Demographic characteristics and KAP scores were collected via self-administered questionnaires.

RESULTS

A total of 561 valid questionnaires were analyzed. Of these, 292 respondents (52.05 %) were female, and 317 (56.51 %) had experienced ACL injuries or other related sports injuries. The mean scores for knowledge, attitudes, and practices were 19.99 ± 9.28 (possible range: 0-24), 30.34 ± 7.83 (possible range: 9-45), and 25.48 ± 7.40 (possible range: 7-35), respectively. Correlation analyses revealed significant positive correlations between knowledge and attitude (r = 0.506, P < 0.001), knowledge and practice (r = 0.612, P < 0.001), and attitude and practice (r = 0.546, P < 0.001). Structural equation modeling (SEM) indicated direct effects of knowledge on both attitude (β = 1.235, P < 0.001) and practice (β = 0.817, P < 0.001), as well as of attitude on practice (β = 0.490, P < 0.001).

CONCLUSION

The youth demonstrated adequate knowledge but moderate attitudes and practices regarding ACL injuries. Educational interventions targeting psychological factors, attitudes, and the translation of knowledge into consistent preventive behaviors are essential to mitigate injury risks and improve management outcomes among the youth.

Pain and Frailty in Childhood Cancer Survivors: A Narrative Review

A significant proportion of childhood cancer survivors experience persistent health problems related to cancer or cancer treatment exposures, including accelerated or early onset of aging. Survivors are more likely than non-cancer peers to present a frail phenotype suggestive of reduced physiologic reserve and have symptoms that interfere with function in daily life, including pain. Studies in the general population, mostly among older adults, suggest that pain is a significant contributor to development and progression of frail health. This association has not been explored among childhood cancer survivors. In this narrative review, we highlight this gap by summarizing the epidemiologic evidence on pain and frailty, including their prevalence, common risk factors, and correlates in childhood cancer survivors. We further discuss associations between pain and frailty in non-cancer populations, likely biological mechanisms in survivors, and potential interventions targeting both domains.

Frailty as a mediator of postoperative delirium in older adults undergoing orthopedic surgery: A causal mediation analysis

Background

Postoperative delirium has a high prevalence in hospitalized older adults. Frail older adults have an increased risk for developing it. Preoperative pain-a common symptom in older adults with orthopedic conditions-shows a connection with frailty through an inflammatory process. However, an association among preoperative pain, frailty, and postoperative delirium remains unexplored among older adults undergoing orthopedic surgery.

Objectives

To examine the magnitude, direction, and mediation effect of frailty on the association between preoperative pain and postoperative delirium among older adults undergoing orthopedic surgery.

Design

A secondary analysis of a prospective cohort study.

Setting and participants

A cohort of 200 older adults (60 years and older) who underwent major orthopedic surgery at a university hospital in Thailand was recruited for the study.

Methods

Participants responded to the Demographic and Health Information Form, the Reported Edmonton Frailty Scale-Thai version, and the Thai version of the 4 A's test. Analyses were conducted using a causal mediation analysis with 95 % confidence intervals.

Results

We found that 12.5 % of participants developed postoperative delirium. For the direct paths associated with postoperative delirium, statistically significant effects were observed for frailty, preoperative pain, and comorbidity. Considering frailty as a mediator of postoperative delirium, a significant positive indirect effect was identified from preoperative pain. Controlling for age and comorbidities, frailty mediated the association between preoperative pain and postoperative delirium in a statistically significant manner; the average direct effect was 0.014 (95 % confidence interval: 0.008-0.020), the average causal mediating effect was 0.002 (95 % confidence interval: 0.000-0.010), the total effects was 0.017 (95 % confidence interval: 0.010-0.020), and the probability mediation accounted for 14 % (95 % confidence interval: 0.031-0.300).

Conclusion

Integrating the concept of age-related decline and frailty assessment may offer opportunities to provide disease-specific care and strengthen precision perioperative care, which ultimately enhance quality of life in older adults undergoing orthopedic surgery.

Associations among frailty conditions and pain indicators: Data from 22 356 European older adults

AIM

Recent studies supported the presence of a relationship between pain and frailty, but more research is needed to highlight the pain-frailty association. The study aimed to investigate the prevalence and the influence of different pain indicators on frailty while controlling for age, sex and country.

METHODS

This observational study used data from the sixth wave of the SHARE survey. A sample of 22 356 community-dwelling individuals aged >60 years from six European countries (Spain, Estonia, France, Greece, Czech Republic and Sweden) was analyzed. The pain was measured through assessment of medication used for joint pain or other types of pain, pain location, polypharmacy and pain level. Frailty was assessed with the modified Fried Frailty phenotype.

RESULTS

Pain indicators, especially widespread pain and pain severity, were significantly associated with prefrailty (odds ratio 3.30, 95% CI 2.40, 4.55; and odds ratio 0.61, 95% CI 0.51, 0.72) and frailty status (odds ratio 4.69, 95% CI 3.31, 6.67; and odds ratio 0.37, 95% CI 0.30, 0.44). Advancing age and female sex consistently correlated with increased prefrailty (odds ratio 1.06, 95% CI 1.05, 1.07; and odds ratio 1.36, 95% CI 1.22, 1.53) and frailty risk (odds ratio 1.11, 95% CI 1.10, 1.12; and odds ratio 1.71, 95% CI 1.48, 1.96). Country-specific differences emerged, with Spaniards showing higher odds ratios of prefrailty and frailty compared with Swedish, French and Czech individuals, whereas Greeks showed elevated odds ratios compared with Spaniards. The factors associated jointly explained 27.5% of the variance in frailty categories.

CONCLUSION

Significant associations were identified, particularly with widespread pain and pain severity, highlighting their impact on frailty. Country-specific variations in frailty prevalence were observed, alongside consistent associations with advancing age and female sex. These findings provide valuable insights into the intricate interplay between pain and frailty, offering the potential for targeted interventions in older adults' care through tailored pain management strategies. Geriatr Gerontol Int 2024; 24: 1362-1369.

Multimorbidity and COVID-19 Outcomes in the Emergency Department: Is the Association Mediated by the Severity of the Condition at Admission?

Background/Objectives: Charlson Comorbidity Index (CCI) is one of the most reliable indicators to assess the impact of multimorbidity on COVID-19-related outcomes. Moreover, the patient's clinical conditions are associated with SARS-CoV-2 outcomes. This study aimed to analyze the association between multimorbidity and COVID-19-related outcomes, evaluating whether the National Early Warning Score 2 (NEWS2) mediated these associations. Methods: Data were obtained through the platform "EPICLIN". We analyzed all patients who tested positive for COVID-19 after accessing the emergency department (ED) of San Luigi Gonzaga (Orbassano) and Molinette (Turin) hospitals from 1 March to 30 June 2020. Different outcomes were assessed: non-discharge from the ED, 30-day mortality, ICU admission/death among hospitalized patients, and length of hospitalization among surviving patients. Two subgroups of patients (<65 and 65+ years old) were analyzed using logistic regressions, Cox models, and mediation analyses. Results: There was a greater risk of not being discharged or dying among those who were younger and with CCI ≥ 2. Moreover, the higher the CCI, the longer the length of hospitalization. Considering older subjects, a greater CCI was associated with a higher risk of death. Regarding the mediation analyses, multimorbidity significantly impacted the hospitalization length and not being discharged in the younger population. Instead, in the older population, the NEWS2 played a mediation role. Conclusions: This research showed that multimorbidity is a risk factor for a worse prognosis of COVID-19. Moreover, there was a strong direct effect of CCI on not being discharged, and the NEWS2 was found to act as mediator in the association between multimorbidity and COVID-19-related outcomes.

The relationship between pain duration characteristics and pain intensity in herpes zoster-related pain: a single-center retrospective study

Background

The varicella-zoster virus (VZV) can cause herpes zoster (HZ), which may progress to postherpetic neuralgia (PHN), leading to severe inflammatory responses and pain.

Objective

This study investigates the relationship between pain duration characteristics and pain intensity in patients with herpes zoster-related pain, hypothesizing that persistent pain correlates with higher pain intensity compared to intermittent pain.

Methods

A retrospective study was conducted at the Second Affiliated Hospital of Guangxi Medical University, China. Data from patients treated for herpes zoster-related pain between January 2019 and February 2024 were analyzed. Pain intensity was measured using the Numerical Rating Scale (NRS-11), and pain duration was categorized as intermittent or persistent. Multivariate regression models were used to assess the association between pain duration and intensity, adjusting for potential confounders.

Results

A total of 840 patients were included. Persistent pain was significantly associated with higher NRS-11 scores compared to intermittent pain (β = 0.71, 95% CI 0.50-0.91, p < 0.001). Subgroup analyses showed that persistent pain was associated with higher pain intensity in both acute HZ and PHN patients (HZ: β = 0.71, 95% CI 0.45-0.96, p < 0.001; PHN: β = 0.76, 95% CI 0.40-1.13, p < 0.001). Inflammatory markers, such as C-reactive protein (CRP) and white blood cell count, were positively correlated with pain intensity.

Conclusion

Pain duration significantly impacts pain intensity in HZ patients. Considering pain duration is crucial for effective pain management. Further research should explore the mechanisms underlying persistent pain to develop better treatment strategies.

The vicious cycle of frailty and pain: a two-sided causal relationship revealed

Background

The decline in physiological functions in the older people is frequently accompanied with pain and frailty, yet the causal connection between frailty and pain remains uncertain. In this study, we utilized a two-sample Mendelian randomization (MR) approach to investigate the potential causal association between frailty and pain.

Methods

Two-sample bidirectional MR was conducted using summary data from genome-wide association studies to examine the potential causal relationship between frailty (defined by the frailty index and frailty phenotype) and pain. Summary genome wide association statistics were extracted from populations of European ancestry. We also investigated the causal relationship between frailty and site-specific pain, including joint pain, limb pain, thoracic spine pain and low back pain. Causal effects were estimated using the inverse variance weighting method. Sensitivity analyses were performed to validate the robustness of the results.

Results

Genetic predisposition to frailty was associated with an increased risk of pain (frailty phenotype odds ratio [OR]: 1.73; P = 3.54 × 10-6, frailty index OR: 1.36; P = 2.43 × 10-4). Meanwhile, individuals with a genetic inclination toward pain had a higher risk of developing frailty. Regarding site-specific pain, genetic prediction of the frailty phenotype increased the occurrence risk of joint pain, limb pain and low back pain. Reverse MR analysis further showed that limb pain and low back pain were associated with an increased risk of frailty occurrence.

Conclusion

This study presented evidence supporting a bidirectional causal relationship between frailty and pain. We highlighted the significance of addressing pain to prevent frailty and recommend the inclusion of pain assessment in the evaluation system for frailty.

More Movement, Less Bodily Pain? Findings From a Large, Representative Multi-District Aging Study in Ghana

OBJECTIVE

The association of physical activity (PA) with pain has been characterized. Although the literature largely comes from high-income countries, the mechanistic pathways underlying this association remain unknown, particularly in low- and middle-income countries (LMICs). We aim to examine the association between meeting the World Health Organization (WHO) PA guidelines and pain among aging adults and identify the factors that may mediate this association.

DESIGN

We used a quantitative cross-sectional study design.

SETTING AND PARTICIPANTS

Representative data from adults aged ≥50 years who participated in the Aging, Health, Psychological Well-being, and Health-seeking Behavior Study were used.

METHODS

PA was defined using the International Physical Activity Questionnaire (IPAQ). Self-reported pain experience using a cross-culturally validated item over the past month assessed pain severity. Adjusted multivariable ordinal logistic regression and mediation models quantified the hypothesized associations.

RESULTS

The analysis included 1201 adults (mean 66.1 ± 11.9 years; 63.3% female). After adjusting for confounders, adhering to the WHO-recommended PA guidelines was associated with 42% lower odds for severe/extreme pain [odds ratio (OR) 0.58, 95% CI 0.44-0.77]. The association was much stronger among men (OR 0.52, 95% CI 0.31-0.85) than women (OR 0.60, 95% CI 0.42-0.87). The PA-pain association was explained by functional limitations (84.7%), self-rated health (76.6%), sleep problems (20.4%), and injury (6.6%).

CONCLUSIONS AND IMPLICATIONS

Moving more was associated with less pain in older adults from LMICs. Interventions for pain management in old age may focus on enhancing compliance with PA doses, particularly in LMICs. However, longitudinal data will need to confirm these findings.

Psychosocial Characteristics by Pain Presence and Limitations Among Older Adults

PURPOSE

To compare psychosocial outcomes of older adults according to pain experience.

METHOD

Using cross-sectional 2021 data from the National Health and Aging Trends Study, we examined psychosocial characteristics in older adults (N = 3,376) divided into three groups: no pain, pain without activity limitations, and activity-limiting pain.

RESULTS

In multiple regression models, older adults with activity-limiting pain compared to those without pain had significantly higher depression, anxiety, and fear of falling, as well as reduced positive affect, self-realization, self-efficacy, resilience, and social participation. Older adults with non-activity-limiting pain had significantly higher social participation than those without pain, but no differences in self-realization, self-efficacy, or resilience.

CONCLUSION

Pain is strongly associated with all psychosocial outcomes, especially in older adults with activity-limiting pain. Future research should examine the impact of self-realization, self-efficacy, resilience, and social participation on activity limitations. [Journal of Gerontological Nursing, 50(7), 27-34.].

What Predicts a Longer Period of Pain in Patients Referred to an Interdisciplinary Center for Pain Care?

Chronic musculoskeletal pain (CMP) is a global health condition that affects thousands of people. CMP can substantially affect the functional capacity and quality of life of the people impacted, resulting in high costs for health care and social security systems. Sociodemographic factors may play a significant role in pain chronification prevention and control programs. Thus, current risk factors for CMP must be seriously considered as part of an interdisciplinary management strategy. The purpose of the study was to identify the primary sociodemographic characteristics of CMP patients at a multidisciplinary and specialized center for chronic pain. This is a retrospective investigation based on a review of medical records. Age, gender, income, and the time of onset of pain symptoms were among the variables included in the analyzed data. To analyze variables related to the duration of discomfort, a multiple regression model was utilized. Sociodemographic factors explained 37.94% of experiencing prolonged pain, according to the study's findings. Being female and having a family income above the minimum wage were variables that were directly proportional to discomfort duration. Age was not associated with a prolonged duration of pain perception.

[Interdisciplinary pain therapy in the elderly]

Chronic pain in the elderly is becoming increasingly important and is associated with serious health impacts. Therefore, international guidelines demand that pain therapy for the elderly preferably be a multimodal therapy based on a bio-psycho-social pain model. Specific psychometric tests and interview guidelines are available for the interdisciplinary pain assessment. Evidence for the effectiveness of multimodal pain therapy in the elderly remains limited. However, controlled clinical trials have shown that these patients benefit-especially if the intervention is adapted to their specific needs. The focus of movement therapy is not only muscle strengthening but also coordination exercises. In individual physical therapy and occupational therapy, everyday solutions can be developed for individual physical limitations that are more frequent in old age. In psychological training, pain acceptance, balancing rest and activity, social integration and dealing with aging are particularly important topics. Relaxation and mindfulness techniques can also favorably affect pain and function. Thus, these are popular with patients and are often adopted in everyday pain management. Pain education is considered useful as an adjunctive measure and can also be increasingly supported by digital media in the elderly. Complementary therapy components include confrontational treatment of fear-avoidance beliefs (the German AMIKA scale, Ältere Menschen in körperlicher Aktion, "older people in physical action") and naturopathic applications as an active self-help strategy. Since it is unclear how long the achieved therapeutic effects last, follow-up care is of particular importance in therapy for older patients.

[Interdisciplinary pain therapy in the elderly]

Chronic pain in the elderly is becoming increasingly important and is associated with serious health impacts. Therefore, international guidelines demand that pain therapy for the elderly preferably be a multimodal therapy based on a bio-psycho-social pain model. Specific psychometric tests and interview guidelines are available for the interdisciplinary pain assessment. Evidence for the effectiveness of multimodal pain therapy in the elderly remains limited. However, controlled clinical trials have shown that these patients benefit-especially if the intervention is adapted to their specific needs. The focus of movement therapy is not only muscle strengthening but also coordination exercises. In individual physical therapy and occupational therapy, everyday solutions can be developed for individual physical limitations that are more frequent in old age. In psychological training, pain acceptance, balancing rest and activity, social integration and dealing with aging are particularly important topics. Relaxation and mindfulness techniques can also favorably affect pain and function. Thus, these are popular with patients and are often adopted in everyday pain management. Pain education is considered useful as an adjunctive measure and can also be increasingly supported by digital media in the elderly. Complementary therapy components include confrontational treatment of fear-avoidance beliefs (the German AMIKA scale, Ältere Menschen in körperlicher Aktion, "older people in physical action") and naturopathic applications as an active self-help strategy. Since it is unclear how long the achieved therapeutic effects last, follow-up care is of particular importance in therapy for older patients.

The Difficulties of Managing Pain in People Living with Frailty: The Potential for Digital Phenotyping

Pain and frailty are closely linked. Chronic pain is a risk factor for frailty, and frailty is a risk factor for pain. People living with frailty also commonly have cognitive impairment, which can make assessment of pain and monitoring of pain management even more difficult. Pain may be sub-optimally treated in people living with frailty, people living with cognitive impairment and those with both these factors. Reasons for sub-optimal treatment in these groups are pharmacological (increased drug side effects, drug-drug interactions, polypharmacy), non-pharmacological (erroneous beliefs about pain, ageism, bidirectional communication challenges), logistical (difficulty in accessing primary care practitioners and unaffordable cost of drugs), and, particularly in cognitive impairment, related to communication difficulties. Thorough assessment and characterisation of pain, related sensations, and their functional, emotional, and behavioural consequences ("phenotyping") may help to enhance the assessment of pain, particularly in people with frailty and cognitive impairment, as this may help to identify who is most likely to respond to certain types of treatment. This paper discusses the potential role of "digital phenotyping" in the assessment and management of pain in people with frailty. Digital phenotyping is concerned with observable characteristics in digital form, such as those obtained from sensing-capable devices, and may provide novel and more informative data than existing clinical approaches regarding how pain manifests and how treatment strategies affect it. The processing of extensive digital and usual data may require powerful algorithms, but processing these data could lead to a better understanding of who is most likely to benefit from specific and targeted treatments.

Mapping review of pain management programmes and psychological therapies for community-dwelling older people living with pain

PURPOSE

Persistent pain is common in older people and people living with frailty. Pain or the impact of pain on everyday life is potentially modifiable. We sought to map research evidence and information from randomised controlled trials (RCTs) of pain management programmes and psychological therapies targeting community-dwelling older people, and explore appropriate strategies and interventions for managing or reducing the negative impact of pain for older people, particularly those with frailty.

METHOD

A mapping review of pain management programmes and psychological therapies for community-dwelling older people living with chronic pain. We searched for systematic reviews of randomised controlled trials and for individual randomised controlled trials and extracted data from eligible studies.

RESULTS

Searches resulted in 3419 systematic review records and 746 RCT records from which there were 33 eligible interventions identified in 31 eligible RCTs (48 reports). Broad aims of the interventions were to: improve physical, psychological, or social functioning; adjust the effects or sensation of pain psychologically; enhance self-care with self-management skills or knowledge. Common mechanisms of change proposed were self-efficacy enhanced by self-management tasks and skills, using positive psychological skills or refocusing attention to improve responses to pain, and practising physical exercises to improve physiological well-being and reduce restrictions from pain. Content of interventions included: skills training and activity management, education, and physical exercise. Interventions were delivered in person or remotely to individuals or in groups, typically in 1-2 sessions weekly over 5-12 weeks.

CONCLUSION

All the evaluated interventions appeared to show potential to provide some benefits to older people. None of the included studies assessed frailty. However, some of the included interventions appear appropriate for community-dwelling older people living with both frailty and pain.

Managing Non-Cancer Chronic Pain in Frail Older Adults: A Pilot Study Based on a Multidisciplinary Approach

Considering the multidimensionality of chronic pain, it is crucial to develop comprehensive strategies for its effective management. However, establishing well-defined, evidence-based guidelines for such approaches remains challenging. To overcome this, we present the finding from a 4-month intervention to enhance the management of non-cancer chronic pain in older adults with pre-frailty and frailty. The intervention's core elements comprised a multidisciplinary individualized plan, a case manager, and patient education. This pilot study involved 22 participants (≥65 years). It assessed changes in pain frequency and intensity (pain scale), frailty (Fried frailty phenotype criteria), and medication adherence (Brief Adherence Rating Scale) before and after the 4-month intervention. The results were encouraging: pain frequency and intensity and frailty score tended to decrease, and medication adherence showed significant improvement. This preliminary small-scale pilot study provides a foundation for further research and for exploring the potential scalability of this multidisciplinary patient-centred intervention.

Frailty in Kingdom of Saudi Arabia-Prevalence and Management, Where Are We?

A recent report from the United Nations state that the percentage of elderly individuals in the Kingdom of Saudi Arabia (KSA) will witness a sharp increase in the next three decades (5.6% in 2017 to 23% by 2050). This situation will lead to an increased prevalence of comorbidities and hence, will require close monitoring and constant care of such individuals who are prone to suffer from complications such as arthritis, cardiovascular disorders, diabetes, neurological disorders, etc. Frailty is one such age-related phenomenon which enhances the risk of falling, functional restrictions and greater vulnerability to adverse consequences, which tend to lead to institutionalization. Such factors highlight the importance of the urgent awareness for circumventing the progression of frailty toward a compromised health status. This concise report is an attempt to sum up the relevant research articles published with regard to frailty and concomitant diseases in the last 5 years. It also sums up the research on frailty in the KSA elderly population, till date. This article reflects the opinions of an author on tackling such issues through a well-directed mechanism involving interdisciplinary transitional care and geriatric co-management.

Assessing the Predictive Power of Frailty and Life-Space Mobility on Patient-Reported Outcomes of Disability in Older Adults with Low Back Pain

Background: Frailty and decreased life-space mobility are known as risk factors to develop physical limitations leading to disability in older adults with low back pain (LBP). This cross sectional study aimed to investigate the prevalence and predictive power of frailty and life-space mobility on patient-reported outcomes of disability in older adults with LBP. Methods: The sample comprised 165 older adults with LBP who visited two tertiary care hospitals between December 2021 and February 2022. The participants responded to structured standard questionnaires. Data were analyzed using descriptive statistics and robust logistic regression. Results: More than two-thirds of participants were classified as non-frail (26.67%) or pre-frail (66.67%). Mobility restrictions and minimal to severe disability were identified. Controlling other variables, frailty (OR = 1.74, 95% CI: 1.14–2.64) and restricted life-space mobility (OR = 0.42, 95% CI: 0.26–0.67) were significantly associated with disability. Integrating frailty with life-space mobility evaluations demonstrated the highest predictive power for disability-related LBP (AUC = 0.89, 95% CI: 0.84–0.93). Conclusion: Frailty and restricted life-space mobility significantly predicted disability in older adults with LBP. Healthcare professionals should recognize the critical importance of integrating patient-reported outcomes with screening for frailty and life-space mobility limitation to optimize care or tract symptom progression.

Evaluation of the correlation between frailty and sleep quality among elderly patients with osteoporosis: a cross-sectional study

BACKGROUND

The incidence of osteoporosis increases with age. Frailty is a distinct characteristic seen in older osteoporosis patients. Poor sleep quality is common in elderly individuals. However, there are few studies on the correlation between frailty and sleep quality in elderly patients with osteoporosis in China.

METHODS

This cross-sectional study was conducted from December 8, 2020, to April 30, 2021. A total of 247 patients who met the inclusion and exclusion criteria were recruited in outpatient departments at West China Hospital. A self-designed demographic data questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the Frailty Phenotype scale were used to evaluate the sleep quality and frailty of the participants. Multivariate logistic regression was performed to evaluate the factors affecting frailty and sleep quality in osteoporosis patients.

RESULTS

A total of 231 valid questionnaires were statistically analysed. The mean frailty score was 3.2 ± 1.6 and a total of 152 (65.8%) were frailty. The mean PSQI score was 11.9 ± 4.5 and a total of 183 (79.2%) patients had poor sleep quality (PSQI > 7). Multiple logistic regression showed that female, pain, polypharmacy, activities of daily living status (ADLs), and sleep quality were independent influencing factors for frailty, while comorbidity, ADLs and frailty status were independent influencing factors for sleep quality.

CONCLUSION

We found that frailty and sleep quality were prevalent and that frailty was positively correlated with the PSQI score in elderly patients with osteoporosis in China. The higher the frailty score is, the worse the sleep quality. It means the frailer old patients were, the worse their sleep quality, and poor sleep quality may increase the risk of frailty in elderly patients with osteoporosis. To manage elderly patients with osteoporosis effectively, medical staff should pay attention to frailty, sleep quality and its influencing factors.

Population-Focused Approaches for Proactive Chronic Pain Management in Older Adults

Chronic pain, and the ethical management thereof, is the single most imperative health issue of this decade. Although a growing majority of individuals with chronic pain are middle-aged, the largest proportion of sufferers are older adults. Shifting tides in practice and research have led to population-focused approaches to pain management; however, the practice of many healthcare providers remains reactive and individualistic, limiting the discovery and implementation of long-term solutions for pain management in older adults. Yet, nurses and other health professionals have an opportune position to provide expert pain care by proactively providing evidence-based care for patients systematically. The purpose of this article is to stimulate discussion on three paradigms important to population-focused pain management: (1) prevention; (2) restoration and rehabilitation; and (3) palliation, which are in line with current national policy initiatives for improving patients' care experience, improving overall health and quality of life, and reducing associated health care costs.

Chronic Conditions, Persistent Pain, and Psychological Distress Among the Rural Older Adults: A Path Analysis in Shandong, China

Psychological distress were found to be associated with chronic conditions and persistent pain. However, few studies explored the underlying pathways between them. This study aimed to analyze the path of chronic conditions and persistent pain on psychological distress through sleep quality and self-rated health. A total of 2,748 rural older people in Shandong, China were included in this study. Path analysis was performed by using Mplus 8.3 to examine the associations between chronic conditions, persistent pain, sleep quality, self-rated health, and psychological distress after adjusting for age, gender, education, and household income. The prevalence of psychological distress among the older adults in this study was 47.49%. Chronic conditions and persistent pain were indirectly associated with psychological distress through six mediating pathways: (1) the path from chronic conditions to psychological distress through sleep quality (β = 0.041, 95%CI: 0.015-0.067) and self-rated health (β = 0.064, 95%CI: 0.038-0.091), respectively, and a chain mediation existed (β = 0.007, 95% CI: 0.000-0.014); (2) the path of persistent pain and psychological distress through sleep quality (β = 0.058, 95% CI: 0.014-0.102) and self-rated health (β = 0.048, 95% CI: 0.000-0.096), respectively, also the chain mediation found (β = 0.009, 95% CI: 0.005-0.014). Psychological distress was associated with chronic conditions and persistent pain through decreased sleep quality and self-rated health among Chinese rural older people. Multi-pronged targeted intervention should be taken for older adults with chronic conditions and persistent pain.

Pain Characteristics and Quality of Life in Older People at High Risk of Future Hospitalization

This study deals with how pain characteristics in conjunction with other factors affect quality of life (QoL) in a vulnerable primary care population. We recruited vulnerable older people (75+, n = 825) living in south-eastern Sweden. A postal questionnaire included pain aspects, QoL (EQ-5D-3L, RAND-36 physical functioning, attitudes toward own aging, and life satisfaction), functional status, social networks, and basic demographic information. Pain extent and localization was obtained by digitalization of pain drawings reported on standard body charts. Most respondents were experiencing pain longer than 3 months (88.8%). Pain frequency varied mostly between occasionally (33.8%) and every day (34.8%). A minority reported high pain intensity (13.6%). The lower back and lower legs were the most frequently reported pain locations (>25%). Multiple linear regression model revealed three characteristics of pain (intensity, frequency, and extent) remained inversely associated with the EQ-5D-3L index score (R² = 0.57). Individually, each of these pain characteristics showed a negative impact on the other three dimensions of QoL (R² = 0.23–0.59). Different features of pain had impact on different dimensions of QoL in this aging population. A global pain assessment is useful to facilitate individual treatment and rehabilitation strategies in primary care.

Association of Pain and Impact of Dual-Task Exercise on Function, Cognition and Quality of Life

PURPOSE

This study aimed to assess the factors associated with pain and evaluate the impact of dual-task exercise on pain improvement, quality of life (QOL), cognition and function in older adults.

PATIENTS AND METHODS

This study is a secondary data analysis of the HAPPY (Healthy Ageing Promotion Program for You) study. At risk older adults ≥ 60 years old were enrolled in a community dual-task exercise program. Assessments for frailty, sarcopenia, falls, quality of life (QOL) and perceived health, depression, cognition and physical function were performed at baseline and 3 months. Pain intensity was derived from EQ-5D and stratified into no pain, slight pain and moderate to extreme pain.

RESULTS

Out of 296 participants, 37.2% had slight pain and 11.1% had moderate to severe pain. Both slight and moderate to extreme pain compared with no pain group were significantly associated with lower perceived health (68.2,63.6 vs 76.0) and QOL index (0.70,0.59 vs 0.93); moderate to extreme pain was also significantly associated with depression, low mental vitality, frailty, sarcopenia and poorer physical performance. After 3 months of dual-task exercise, pain improved in 70.8% of the moderate to extreme pain group and 50.8% of slight pain group. Significant improvement in perceived health, QOL, physical function and cognition were also observed.

CONCLUSION

Proactive efforts are required to screen for pain and manage frailty, sarcopenia and depression. Dual-task exercise proved safe and possibly effective in reducing pain and improving QOL, physical and cognitive function in older adults. Prospective randomized studies are needed to validate the effectiveness of dual-task vs single-task exercise, including impact of reversal of frailty and sarcopenia in pain management.

A Biopsychosocial Model of Chronic Pain for Older Adults

Population

Comprehensive evaluation of chronic pain in older adults is multifaceted.

Objective and Methods

Research on chronic pain in older adults needs to be guided by sound conceptual models. The purpose of this paper is to describe an adaptation of the Biopsychosocial Model (BPS) of Chronic Pain for older adults. The extant literature was reviewed, and selected research findings that provide the empiric foundation for this adaptation of the BPS model of chronic pain are summarized. The paper concludes with a discussion of specific recommendations for how this adapted model can be used to guide future research.

Conclusions

This adaptation of the BPS model of chronic pain for older adults provides a comprehensive framework to guide future research in this vulnerable population.