Estimates and determinants of valid self-reports of musculoskeletal disease in the elderly

Association between sleep duration and musculoskeletal pain: The Korea National Health and Nutrition Examination Survey 2010-2015

Both extremely long and short sleep durations have been associated with increased risk of numerous health problems. This study examined the association between self-reported sleep duration and reporting of musculoskeletal pain in the adult Korean population.This study included data from 17,108 adults aged ≥50 years, obtained from the Korea National Health and Nutrition Examination Survey 2010-2012 and 2013-2015. Self-reported daily hours slept and the presence of musculoskeletal pain in knee joint, hip joint, or low back were examined. Patients were stratified into 5 groups by their sleep duration: ≤5, 6, 7, 8, or ≥9 h. Multivariate logistic regression analysis was performed, adjusting for covariates including age, sex, marital status, smoking, alcohol use, family income level, education, physical exercise, body mass index (BMI), and stress level.A U-shaped relationship was observed between the length of sleep duration and the presence of musculoskeletal pain. After adjusting for covariates, sleep duration of ≤5 h or ≥9 h was significantly associated with musculoskeletal pain experienced for more than 30 days over a 3-month period. We also found that the presence of multi-site musculoskeletal pain was significantly higher among those who slept for ≤5 h or ≥9 h than in those who slept for 7 h.These findings suggest that either short or long sleep duration is associated with musculoskeletal pain among Korean adults.

Validity of patient-reported comorbidities before total knee and hip arthroplasty in patients older than 65 years

Obtaining preoperative medical histories in elderly patients can be challenging, and tools have been developed to aid in history gathering. The purpose of this study is to determine the agreement between patient- and physician-reported histories before total knee or hip arthroplasty. Three hundred eighty-two patients older than 65 years completed a preoperative morbidity assessment form preoperatively. Sensitivity, specificity, κ, and agreement were calculated for each dichotomous response. Diabetes (κ = 0.77) and lung disease (κ = 0.68) had substantial agreement. Fourteen comorbidities ranged from slight to moderate agreement. Osteoarthritis and peripheral vascular disease had no agreement. These results highlight the incongruence between patient- and physician-reported comorbidities and emphasizes the need for detailed histories by health care professionals for medically complicated elderly patients preoperatively.

Underutilization of prescribed drugs use among first generation elderly immigrants in the Netherlands

BACKGROUND

In developed countries, health care utilization among immigrant groups differs where the dominant interpretation is unjustified overutilization due to lack of acculturation. We investigated utilization of prescribed drugs in native Dutch and various groups of immigrant elderly.

METHODS

Cross-sectional study using data from the survey "Social Position, Health and Well-being of Elderly Immigrants" (the Netherlands, 2003). Ethnicity-matched interviewers conducted the survey among first generation immigrants aged 55 years and older. Outcome measure is self-reported use of prescribed drugs. Utilization is explained by need, and by enabling and predisposing factors, in particular acculturation; analysis is conducted by multiple logistic regression.

RESULTS

The study population consisted of immigrants from Turkey (n = 307), Morocco (n = 284), Surinam (n = 308) and the Netherlands Antilles (n = 300), and a native Dutch reference group (n = 304). Prevalence of diabetes mellitus (DM), COPD and musculoskeletal disorders was relatively high among immigrant elderly. Drug utilization in especially Turkish and Moroccan elderly with DM and COPD was relatively low. Drugs use for non-mental chronic diseases was explained by more chronic conditions (OR 2.64), higher age (OR 1.03), and modern attitudes on male-female roles (OR 0.74) and religiosity (OR 0.89). Ethnicity specific effects remained only among Turkish elderly (OR 0.42). Drugs use for mental health problems was explained by more chronic conditions (OR 1.43), better mental health (OR 0.95) and modern attitudes on family values (OR 0.59). Ethnicity specific effects remained only among Moroccan (OR 0.19) and Antillean elderly (OR 0.31). Explanation of underutilization of drugs among diseased with diabetes and musculoskeletal disorders are found in number of chronic diseases (OR 0.74 and OR 0.78) and regarding diabetes also in language proficiency (OR 0.66) and modern attitudes on male-female roles (OR 1.69).

CONCLUSIONS

Need and predisposing factors (acculturation) are the strongest determinants for drugs utilization among elderly immigrants. Significant drugs underutilization exists among migrants with diabetes and musculoskeletal disorders.

Sex differences in mortality among older frail Mexican Americans

OBJECTIVE

To examine the association between frailty and 10-year mortality among older men and women of Mexican American origin.

METHODS

Data were collected from 1995-1996 through 2004-2005 among community-dwelling Mexican Americans aged >or=65 years as part of the Hispanic Established Population for the Epidemiologic Study of the Elderly (HEPESE). A standardized frailty measure based on weight loss, exhaustion, grip strength, walking speed, and physical activity was computed. Data were collected on sociodemographics and health characteristics, comorbidities, and performance-based functional measure.

RESULTS

The sample was 59% female, and mean baseline age was 74.5 years of (SD 6.06) at baseline. Hazard ratios (HR) indicated an increased mortality risk in frail men (HR = 3.04, 95% CI 2.16-4.28) compared with frail women (HR = 1.92, 95% CI 1.39-2.65).

CONCLUSIONS

Frailty is an independent predictor of mortality among older men and women of Mexican American origin. This association was found to be stronger among men after adjusting for age, marital status, education, body mass index (BMI), health behaviors, and medical conditions.

Psychological features and coping styles in patients with chronic pain

AIMS

It is said that psychological factors play a crucial role in the development, continuation or amplification of chronic pain. The purpose of the present study was to examine psychological features and coping styles related to chronic pain.

METHODS

Sixty-three patients with persistent pain over 3 months (average age of 59.3 years; 22 men and 41 women) were recruited as subjects from December 2005 to March 2007. As for chronic pain, the duration of pain and the intensity of pain, applied using the Visual Analogue Scale, were evaluated in each patient. In addition, their psychological features were examined with the Profile of Mood States (POMS) and their coping styles were examined using the Coping Inventory for Stressful Situations (CISS).

RESULTS

The duration of pain was not significantly correlated with values of the POMS or CISS. The intensity of pain according to the Visual Analogue Scale was significantly correlated with the tension-anxiety, anger-hostility and fatigue scales of the POMS. Also, the intensity of pain showed negative correlations with the avoidance-oriented coping scale of the CISS.

CONCLUSIONS

Understanding psychological features and coping styles are critical when we determine the proper treatment for chronic pain.

Frailty in older Mexican Americans

OBJECTIVES

To identify sociodemographic characteristics and health performance variables associated with frailty in older Mexican Americans.

DESIGN

A prospective population-based survey.

SETTING

Homes of older adults living in the southwest.

PARTICIPANTS

Six hundred twenty-one noninstitutionalized Mexican-American men and women aged 70 and older included in the Hispanic Established Populations for Epidemiologic Study of the Elderly participated in a home-based interview.

MEASUREMENTS

Interviews included information on sociodemographics, self-reports of medical conditions (arthritis, diabetes mellitus, heart attack, hip fracture, cancer, and stroke) and functional status. Weight and measures of lower and upper extremity muscle strength were obtained along with information on activities of daily living and instrumental activities of daily living. A summary measure of frailty was created based on weight loss, exhaustion, grip strength, and walking speed. Multivariable linear regression identified variables associated with frailty at baseline. Logistic regression examined variables predicting frailty at 1-year follow-up.

RESULTS

Sex was associated with frailty at baseline (F=4.28, P=.03). Predictors of frailty in men included upper extremity strength, disability (activities of daily living), comorbidities, and mental status scores (Nagelkerke coefficient of determination (R(2))=0.37). Predictors for women included lower extremity strength, disability (activities of daily living), and body mass index (Nagelkerke R(2)=0.29). At 1-year follow-up, 83% of men and 79% of women were correctly classified as frail.

CONCLUSION

Different variables were identified as statistically significant predictors of frailty in Mexican-American men and women aged 70 and older. The prevention, development, and treatment of frailty in older Mexican Americans may require consideration of the unique characteristics of this population.

Pain, lower-extremity muscle strength, and physical function among older Mexican Americans

OBJECTIVE

To examine the relation between pain on weight bearing, lower-extremity muscle strength, and physical function among older Mexican Americans.

DESIGN

Cross-sectional study.

SETTING

Five Southwestern states: Texas, New Mexico, Colorado, Arizona, and California.

PARTICIPANTS

A population-based sample of 544 noninstitutionalized Mexican-American men and women age 71 years and older.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Pain on weight bearing, lower-extremity muscle strength, and physical function.

RESULTS

Of the 544 subjects, 244 (44.9%) reported pain on weight bearing. Mean muscle strength in men ranged from 9.3 kg for knee extension, 12.8 kg for hip flexion, to 13.0 kg for hip abduction. In women, mean strength ranged from 6.6 kg for knee extension, 9.5 kg for hip flexion, to 8.6 kg for hip abduction. Mean of physical function score was 70.7 for men and 60.6 for women. Pain on weight bearing was negatively associated with summary lower-extremity muscle strength only in women (-.05, P < .001) after controlling for all covariates. Pain on weight bearing was negatively associated with physical function in both men (-15.33, P < .001) and women (-11.03, P < .001), and lower-extremity muscle strength was positively associated with physical function in both men (37.77, P < .001) and women (73.50, P < .001), after controlling for all covariates.

CONCLUSIONS

Among older Mexican Americans, the presence of pain was associated with decreased muscle strength in women and decreased physical function in both men and women. High muscle strength was associated with high physical function in both men and women.

Diseases and Impairments as Risk Factors for Onset of Disability in the Older Population in England and Wales: Findings From the Medical Research Council Cognitive Function and Ageing Study

BACKGROUND

This paper reports the association between self-reported diseases and impairments and 2-year onset of disability in a prospective study of people aged 65 years or older in five urban and rural centers in England and Wales (Medical Research Council Cognitive Function and Ageing Study; MRC-CFAS).

METHODS

We initially reviewed risk factors for onset of disability in 35 prospective studies of functional decline in older people published in 1998-2001. In the present study, disability was defined as requiring help from another person at least several times a week and was assessed by dependency in activities of daily living. Polytomous and bivariate logistic regression models were fitted for onset of disability and mortality among those nondisabled at baseline (n=7913), adjusting for age, sex, and sociodemography.

RESULTS

Among prevalent conditions, arthritis (population-attributable risk 11.4%) and cognitive impairment indicated by a Mini-Mental State Examination score of <or=21 (population-attributable risk 6.8%) were powerful predictors of incident disability. Baseline cognitive impairment, stroke, treated diabetes, chronic airways obstruction, coronary heart disease, and treated hypertension were significantly associated with both incident disability and mortality, whereas Parkinson's disease, eyesight problems, and arthritis were statistically significant disabling conditions not associated with mortality. Stroke, heart attack, cognitive impairment, eyesight problems, and hearing problems were newly occurring conditions significantly associated with onset of disability.

CONCLUSIONS

Cognitive impairment, arthritis, followed by stroke, and problems with vision have major impact on population disability at older ages. Both prevalent and incident conditions must be considered as risk factors to accurately assess potential benefits from prevention.

Older Adults with Osteoarthritis: Psychological Status and Physical Function

The purpose of this study was to identify how sociodemographic characteristics such as age, race, and socioeconomic status; psychosocial factors of hardiness, health promotion practices, and social support; health status; and pain are related to the ability of older, community-residing individuals with osteoarthritis (OA) to maintain psychological equilibrium and physical function. A total of 81 older adults with OA completed a survey that included a sociodemographic data form, a hardiness scale, a measure of health promoting practices, and five subscales from the Arthritis Impact Measure Scale 2 on social support, general health status, pain, and psychological status and physical function. Analyses using multiple regression showed that hardiness, pain, and social support were significant contributors to psychological status and physical function and, respectively, accounted for 53% and 54% of the variance. By knowing about OA and being aware of factors that contribute to maintaining independence in individuals with OA, nurses can provide expert help to aging individuals.

Incidence of functional limitation in older adults: the impact of gender, race, and chronic conditions

OBJECTIVES

To evaluate the relation of chronic conditions, gender, and race to the incidence of activities of daily living (ADLs) limitation in older adults.

DESIGN

The 2-year cumulative incidence of functional limitation was estimated from survival analysis methods by using elders without baseline functional limitations.

SETTING

Longitudinal Study of Aging (LSOA). Initial interviews: 1984; reinterviews: 1986, 1988, and 1990.

PARTICIPANTS

A total of 4205 elderly subjects from the LSOA.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

DEPENDENT VARIABLES

self-reported moderate (1-2 ADLs) and severe (> or =3 ADLs) functional limitation.

INDEPENDENT VARIABLES

sociodemographics, self-reported chronic conditions, and prior levels of functional limitation.

RESULTS

Gender and race predicted moderate functional limitation onset, after controlling for age and education. Arthritis, diabetes, prior cerebrovascular disease (CVD), incontinence, and impaired vision were significant predictors of moderate functional limitation onset after controlling for demographics. Differences in the prevalence of chronic conditions appear to explain why moderate functional limitation incidence rates are higher in older women and blacks. Gender, but not race, predicted onset of severe functional limitation, after controlling for age and education. Prior moderate functional limitation, CVD, and vision impairment predicted onset of severe functional limitation after controlling for demographics.

CONCLUSION

Prevention of functional decline should target chronic conditions and moderate functional limitation in older adults.

Chronic rheumatologic symptoms in a tri-ethnic sample of men and women aged 75 and older

BACKGROUND

The high prevalence of musculoskeletal symptoms in elderly persons tends to obscure the recognition of specific medical conditions. The purpose of this study is to describe the prevalence of chronic rheumatologic symptoms and the associated measures of health status in an older population.

METHODS

This is a cross-sectional study of 507 noninstitutionalized tri-ethnic men and women aged 75 and older living in Galveston County, Texas. A home interview collected data on demographics, chronic medical conditions, cognition, depression, and functional status. Site, severity, and duration of rheumatologic symptoms such as morning stiffness, body tenderness, and body aching in the past month were also collected.

RESULTS

There was a high prevalence of nonspecific rheumatologic symptoms such as morning stiffness (32% in the shoulder girdle, 31% in the hip girdle), tenderness to touch (9%), and generalized body aching (11%) in the study population. Twenty-one percent of the subjects reported either bilateral shoulder or hip girdle stiffness or tenderness lasting more than 30 minutes almost every day or every day or generalized body aching most of the time during the past month. Age-, gender-, and ethnicity-adjusted multivariate analyses showed that more than three self-reported chronic medical conditions, poor or fair self-reported health, impairment in instrumental activities of daily living (IADL), and the presence of depressive or anxiety symptoms were associated with the presence of these chronic rheumatologic symptoms.

CONCLUSION

Chronic rheumatologic symptoms are common in people aged 75 and older. Such symptoms are markers for underlying poor health and for anxiety and depression among older subjects.

Impact of pain on disability among older Mexican Americans

BACKGROUND

Joint pain is a very common complaint among elderly persons and may lead to functional disability. The purpose of this study is to estimate the prevalence of self-reported pain on weight bearing and its impact on the 2-year incidence of limitation in lower-body activities of daily living (ADL) in initially nondisabled Mexican American elderly subjects.

METHODS

We studied a probability sample of 2167 noninstitutionalized Mexican American men and women aged 65 or older residing in five Southwestern states. Subjects were asked about pain on weight bearing, ADL, depressive symptomatology, and the presence of chronic diseases. The body mass index was computed using measured height and weight. Finally, a three-task (tandem balance, 8-foot walk, and repeated chair stands), performance-based, lower-body function test was performed.

RESULTS

The overall prevalence of pain on weight bearing in the sample was 31.9%, with 37.7% for women versus 24.0% for men (p <.001). The most prevalent sites of pain were knees (14.7%), followed by ankle/feet (12.1%). In a logistic regression analysis, pain was a significant independent predictor of subsequent disability and of the inability to perform tandem balance, 8-foot walk, and repeated chair stands.

CONCLUSIONS

Pain on weight bearing is prevalent among older Mexican Americans and is a major independent risk factor for subsequent disability.

Arthritis prevalence and activity limitations in older adults

OBJECTIVE

To evaluate the prevalence of arthritis and activity limitations among older Americans by assessing their demographic, ethnic, and economic characteristics.

METHODS

Data from the Asset and Health Dynamic Survey Among the Oldest Old (AHEAD), a national probability sample of community-dwelling adults born before 1924, were analyzed cross-sectionally. Arthritis that resulted in a physician's visit or a joint replacement not associated with a hip fracture was ascertained by self-report.

RESULTS

The prevalence of arthritis in older adults ranged from 25% in non-Hispanic whites to 40% in non-Hispanic blacks to 44% in Hispanics. A higher prevalence of arthritis was associated with less education as well as lower income and less wealth. The prevalence of limitations in activities of daily living (ADL) among non-Hispanic white, non-Hispanic black, and Hispanic adults who reported arthritis only was 29%, 30%, and 37%, respectively, and increased to 48%, 57%, and 56%, respectively, among those reporting arthritis plus other chronic conditions, after adjustment for age and sex.

CONCLUSION

Non-Hispanic black and Hispanic older adults reported having arthritis at a substantially higher frequency than did non-Hispanic whites. In addition, Hispanics reported higher rates of ADL limitations than did non-Hispanic whites with comparable disease burden. Further study is needed to confirm and elucidate the reasons for these racial and economic disparities in older populations.

The reliability of a self-reported measure of disease, impairment, and function in persons with spinal cord dysfunction

OBJECTIVE

To develop a self-report instrument that would provide information about the different levels of the disablement process, and that (1) was suitable for persons with spinal cord disease (SCD), (2) could be completed quickly, (3) could be mailed, (4) had acceptable reliability, and (5) would be clinically useful.

STUDY DESIGN

Test-retest using a convenience sample.

METHODS

Review of the literature and an expert panel were used to develop the instrument. It was mailed to 49,458 individuals in June 1995 and a second mailing was done in August 1995. A subset of 725 individuals who responded to both mailings was used to examine the instrument's test-retest reliability.

RESULTS

The instrument has a 4th grade reading level and has questions on causal disease, disease severity, impairment, activities of daily living (including a self-reported version of the Functional Independence Measure, the SRFM), and resource utilization. Individual item test-retest reliability was high for a mailed questionnaire; all kappa coefficients were near or above .60 and most were over .70. Intraclass correlation coefficient for the SRFM was .90 and internal consistency (Chronbach's alpha) was .96.

CONCLUSION

This instrument provides a new, rapid way to obtain information relative to the differing levels of the disablement process.

Self-reports and general practitioner information on the presence of chronic diseases in community dwelling elderly. A study on the accuracy of patients' self-reports and on determinants of inaccuracy

OBJECT

The object of the study is to investigate the (in)accuracy of patients' self-reports, as compared with general practitioners' information, regarding the presence of specific chronic diseases, and the influence of patient characteristics.

METHODS

Questionnaire data of 2380 community-dwelling elderly patients, aged 55-85 years, on the presence of chronic non-specific lung disease, cardiac disease, peripheral atherosclerosis, stroke, diabetes, malignancies, and osteoarthritis/rheumatoid arthritis were compared with data from the general practitioners, using the kappa-statistic. Associations between the accuracy of self-reports and patient characteristics were studied by multiple logistic regression analyses.

RESULTS

Kappa's ranged from 0.30 to 0.40 for osteoarthritis/rheumatoid arthritis and atherosclerosis, to 0.85 for diabetes mellitus. In the multivariate analyses, educational level, level of urbanization, deviations in cognitive function, and depressive symptomatology had no influence on the level of accuracy. An influence of gender, age, mobility limitations, and recent contact with the general practitioner was shown for specific diseases. For chronic non-specific lung disease, both "underreporting" and "overreporting" are more prevalent in males, compared to females. Furthermore, males tend to overreport stroke and underreport malignancies and arthritis, whereas females tend to overreport malignancies and arthritis. Both overreporting and underreporting of cardiac disease are more prevalent as people are older. Also, older age is associated with overreporting of stroke, and with underreporting of arthritis. The self-reported presence of mobility limitations is associated with overreporting of all specific diseases studied, except for diabetes mellitus, and its absence is associated with underreporting, except for diabetes mellitus and atherosclerosis. Recent contact with the general practitioner is associated with overreporting of cardiac disease, atherosclerosis, malignancies and arthritis, and with less frequent underreporting of diabetes and arthritis.

CONCLUSIONS

Results suggest that patients' self-reports on selected chronic diseases are fairly accurate, with the exceptions of atherosclerosis and arthritis. The associations found with certain patient characteristics may be explained by the tendency of patients to label symptoms, denial by the patient, or inaccuracy of medical records.

The prevalence and impact of arthritis in older persons

OBJECTIVE

To review that what is known about the prevalence and impact of arthritis on disability and health care expenditures incurred by older persons.

METHODS

The current prevalence estimates of osteoarthritis and osteoporosis in the US are examined, and what is known about the relationship of arthritis, broadly defined to disability, and the impact of arthritis-specific disability on home care and nursing home use by older persons are reviewed.

RESULTS

Arthritis is a major contributor to disability among older people and is especially disabling for older women, who have higher prevalence rates and greater disability than their male counterparts. Studies of the relationship of arthritis to long-term care use indicate that arthritis can be a risk factor insofar as it can cause disability that results in homeboundedness, which, in turn is a risk factor for nursing home use. It is possible that previous analyses that included arthritis and disability as competing risk factors for nursing home use underestimate the contribution of arthritis because arthritis is a risk factor for disability; thus, the two variables may be strongly correlated.

CONCLUSIONS

More study is needed to understand the contribution of sex to prevalence of arthritis and severity of arthritis-specific disability. The route through which arthritis affects long-term care use also needs careful longitudinal study. If arthritis is confirmed to be a major risk factor for disability that leads to long-term care use, the development and testing of interventions to prevent/minimize arthritis-specific disability should be a major research priority.

The relationships among anxiety, depression, and pain in a geriatric institutionalized sample

This study sought to determine if depression and/or anxiety is uniquely related to pain after controlling for the strong association between anxiety and depression. Both depression and anxiety were assessed in an elderly institutionalized sample using: (1) research-based diagnoses based on Diagnostic and Statistical Manual-revised 3rd edition (DSM-IIIR) criteria, and (2) evaluations of one's recent affective states using the Profile of Moods States (POMS). Pain was assessed by pain intensity and number of pain complaints. A series of path models indicated that: (1) both research-based anxiety and depression share unique variance with pain, and (2) only POMS anxiety is uniquely related to pain. A path model using both measures of anxiety and depression indicated that only the anxiety measures are significantly related to pain. However, POMS anxiety sustained a significantly greater relationship with pain than did research-based anxiety.