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Alrawaili SM, Alkhathami KM, Elsehrawy MG, Obaidat SM, Alhwoaimel NA, Alenazi AM. Multisite Pain and Intensity were Associated with History Fall among Older Adults: A Cross-Sectional Study. J Multidiscip Healthc 2024; 17:1241-1250. [PMID: 38524864 PMCID: PMC10960544 DOI: 10.2147/jmdh.s449531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/11/2024] [Indexed: 03/26/2024] Open
Abstract
Purpose This study examined the independent associations among multisite pain, pain intensity, and the risk of falls, including a history of falls in the previous 12 months and frequent falls (≥ two falls vs one or two falls) among community-dwelling older adults. Methods A cross-sectional design from Wave 2 of the National Social Life, Health, and Aging Project was used. Data on pain intensity and location (45 sites) over the past 4 weeks were collected. Multisite pain was categorized into four groups: none, one, two, and three or more sites. The main outcomes of falls were a history of falls and frequent falls. The covariates included age, sex, race, body mass index, education, medications, and comorbidities. Results Among 3,196 participants in Wave 2, 2,697 were included because of missing key variables related to pain and fall history. The prevalence of falls and frequent falls were 30.3% (n = 817) and 12.6% (n = 339), respectively. Multisite pain at ≥ three sites (odds ratio (OR) 2.04, confidence interval (CI) [1.62, 2.57]; p < 0.001) and two sites (OR 1.72, 95% CI [1.30, 2.27]; p < 0.001) was significantly associated with an increased risk of falls. An increase in pain intensity was significantly associated with an increased risk of fall (OR 1.28, 95% CI [1.15, 1.44], p < 0.001), independent of multisite pain. Multisite pain at ≥3 sites (OR 2.19, 95% CI [1.56, 3.07], p < 0.001) and 2 sites (OR 1.54, 95% CI [1.01, 2.34], p = 0.045) was associated with an increased risk of frequent falls. An increase in pain intensity was associated with risk of frequent falls (OR 1.64, 95% CI [1.40, 1.91], p < 0.001), independent of multisite pain. Conclusion Multisite pain and pain intensity were associated with a history of falls and frequent falls among older adults, emphasizing the need for routine pain evaluation to develop fall prevention strategies in this population.
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Affiliation(s)
- Saud M Alrawaili
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Khalid M Alkhathami
- Department of Health Rehabilitation, Shaqra University, Shaqra, Saudi Arabia
| | - Mohamed G Elsehrawy
- Department of Nursing, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Sakher M Obaidat
- Department of Physical Therapy and Occupational Therapy, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa, Jordan
| | - Norah A Alhwoaimel
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Aqeel M Alenazi
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
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Atee M. Pain is underestimated in older adults with risk of falls. Aging Med (Milton) 2024; 7:136-137. [PMID: 38571674 PMCID: PMC10985766 DOI: 10.1002/agm2.12283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/25/2023] [Accepted: 01/04/2024] [Indexed: 04/05/2024] Open
Affiliation(s)
- Mustafa Atee
- The Dementia CentreHammondCareOsborne ParkWestern AustraliaAustralia
- Curtin Medical School, Faculty of Health SciencesCurtin UniversityBentleyWestern AustraliaAustralia
- Sydney Pharmacy School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Centre for Research in Aged Care, School of Nursing and MidwiferyEdith Cowan UniversityJoondalupWestern AustraliaAustralia
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Seth M, Horne JR, Pohlig RT, Sions JM. Pain, Balance-Confidence, Functional Mobility, and Reach Are Associated With Risk of Recurrent Falls Among Adults With Lower-Limb Amputation. Arch Rehabil Res Clin Transl 2023; 5:100309. [PMID: 38163037 PMCID: PMC10757173 DOI: 10.1016/j.arrct.2023.100309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Objective The study evaluated whether pain intensity and extent, balance-confidence, functional mobility, and balance (eg, functional reach) are potential risk factors for recurrent falls among adults with a lower-limb amputation. Design Cross-sectional study. Setting Research laboratory. Participants Eighty-three adults with unilateral lower-limb amputation that occurred >1 year prior (26 transfemoral- and 57 transtibial-level amputation; 44.6% women; 51.8% traumatic cause of amputation; N=83). Intervention Not applicable. Main Outcome Measures Participants reported on the number of falls in the past year, as well as pain intensity in the low back, residual, and sound limbs. Balance-confidence (per the Activities-Specific Balance-Confidence Scale [ABC]), functional mobility (per the Prosthetic Limb Users Survey of Mobility ([PLUS-M]), and balance (per the Functional Reach and modified Four Square Step Tests) were obtained. Results After considering non-modifiable covariates, greater extent of pain, less balance-confidence, worse self-reported mobility, and reduced prosthetic-side reach were factors associated with recurrent fall risk. Adults reporting pain in the low back and both lower-limbs had 6.5 times the odds of reporting recurrent falls as compared with peers without pain. A 1-point increase in ABC score or PLUS-M T score, or 1-cm increase in prosthetic-side reaching distance, was associated with a 7.3%, 9.4%, and 7.1% decrease in odds of reporting recurrent falls in the past year, respectively. Conclusions Of the 83 adults, 36% reported recurrent falls in the past year. Presence of pain in the low back and both lower-limbs, less balance-confidence, worse PLUS-M score, and less prosthetic-side reaching distance were identified as modifiable factors associated with an increased odd of recurrent falls.
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Affiliation(s)
- Mayank Seth
- Department of Physical Therapy, Delaware Limb Loss Studies, University of Delaware, Newark, DE
- Children's Specialized Hospital, Research Department, Union, NJ
| | | | - Ryan Todd Pohlig
- Biostatistics Core, University of Delaware, Newark, DE
- Epidemiology Program, University of Delaware, Newark, DE
| | - Jaclyn Megan Sions
- Department of Physical Therapy, Delaware Limb Loss Studies, University of Delaware, Newark, DE
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Loughran KJ, Tough D, Ryan CG, Wellburn S, Martin D, Dixon J, Harrison SL. The Association of Pain with Incident Falls in People with Chronic Obstructive Pulmonary Disease: Evidence from the English Longitudinal Study of Ageing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6236. [PMID: 37444084 PMCID: PMC10341239 DOI: 10.3390/ijerph20136236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/28/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023]
Abstract
People with chronic obstructive pulmonary disease (COPD) have a higher prevalence of pain and a greater risk of falls than their healthy peers. As pain has been associated with an increased risk of falls in older adults, this study investigated the association between pain and falls in people with COPD compared to healthy controls. Data from the English Longitudinal Study of Ageing were used to establish an association between pain and falls when modelled with a generalised ordinal logistic regression and adjusted for sex, age, wealth, and education (complete case analysis only; n = 806 COPD, n = 3898 healthy controls). The odds were then converted to the predicted probabilities of falling. The predicted probability of falling for people with COPD was greater across all pain categories than for healthy controls; for COPD with (predicted probability % [95%CI]), no pain was 20% [17 to 25], with mild pain was 28% [18 to 38], with moderate pain was 28% [22 to 34] with severe pain was 39% [30 to 47] and for healthy controls with no pain was 17% [16 to 18], mild pain 22% [18 to 27], moderate pain 25% [20 to 29] and severe pain 27% [20 to 35]. The probability of falling increased across pain categories in individuals with COPD, with the most severe pain category at a nearly 40% probability of falling, indicating a potential interaction between COPD and pain.
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Affiliation(s)
- Kirsti J. Loughran
- Centre for Rehabilitation, School of Health & Life Science, Teesside University, Middlesbrough TS1 3BX, UK
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Puto G, Repka I, Muszalik M. Factors Correlating with Functional Capacity in Older People with Chronic Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2748. [PMID: 36768110 PMCID: PMC9915534 DOI: 10.3390/ijerph20032748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/26/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Chronic pain in older people is a global health problem not only in terms of a negative subjective feeling, but also as a social and economic factor. Deterioration of functional capacity is one of the main symptoms of chronic pain; therefore, it should be assessed as a basic parameter in the life of older people. The aim of the study was to analyze the factors which have an impact on the functional capacity of older people with chronic pain. MATERIAL AND METHODS The study was conducted among 181 people over 65 suffering from chronic pain lasting more than 6 months. The study used a questionnaire that included questions about demographic and social characteristics and the following scales: Abbreviated Mental Score (AMTS), Personal Activities of Daily Living (PADL) by Katz, Instrumental Activities of Daily Living (IADL) by Lawton, Geriatric Pain Measure-24 (GPM-24). RESULTS In the study group, a positive correlation was found between: coexisting diseases and withdrawal due to pain, pain intensity, pain resulting from walking or from the effort from other activities, and in terms of the total GPM-24 score. A positive correlation was also found between the Geriatric Depression Scale (GDS) and withdrawal due to pain, pain intensity, pain resulting from walking or from the effort from other activities, and in terms of the total GPM-24 score. A significantly negative correlation was found between: AMTS, ADL, IADL performance and: withdrawal due to pain, pain intensity, pain resulting from walking or from the effort from other activities, and in terms of total GPM-24 score. CONCLUSIONS Chronic pain is more common in people with disabilities in basic and complex activities of daily living, with limited efficiency in cognitive functions and an increased sense of depression. The standard in everyday practice and clinical trials should be taking a history of chronic pain in every older person, monitoring the pain's intensity and accompanying characteristics by using a multidimensional scale for assessing pain in older people.
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Affiliation(s)
- Grażyna Puto
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, Kopernika 25 Street, 31-501 Krakow, Poland
| | - Iwona Repka
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, Kopernika 25 Street, 31-501 Krakow, Poland
| | - Marta Muszalik
- Department of Geriatrics, Faculty of Health Sciences, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland
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Ackerman IN, Barker A, Soh SE. Falls prevention and osteoarthritis: time for awareness and action. Disabil Rehabil 2023; 45:733-738. [PMID: 35191810 DOI: 10.1080/09638288.2022.2040617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Osteoarthritis (OA) and falls both commonly affect older people. While high-level evidence exists to prevent falls in older people, falls prevention is rarely considered within contemporary OA management. OA care and falls prevention have for too long been considered as separate clinical constructs. In the context of ageing populations and growing numbers of people with OA, the time to raise awareness and enact appropriate action is now. This Perspectives on Rehabilitation article draws on the findings from a comprehensive mixed-methods falls and OA research program (which uniquely spanned population, clinician, and consumer perspectives) to better understand existing evidence-practice gaps and identify key opportunities for improvements in clinical care.IMPLICATIONS FOR REHABILITATIONWhile high-level evidence exists to prevent falls in older people, falls prevention is rarely considered within contemporary OA management and this represents a concerning knowledge-to-practice gap.Given ageing populations and growth in the number of people with OA, it is time for falls prevention to be incorporated within routine OA care for older people.To achieve this, we need to re-shape current messaging around falls prevention and develop targeted resources to optimise clinician knowledge and skills in this area.
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Affiliation(s)
- Ilana N Ackerman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Anna Barker
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Silver Chain Group, Melbourne, Australia
| | - Sze-Ee Soh
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,School of Primary and Allied Health Care, Monash University, Melbourne, Australia
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Mediation of pain in the association of sleep problems with falls among older adults in India. Sci Rep 2023; 13:221. [PMID: 36604470 PMCID: PMC9816101 DOI: 10.1038/s41598-022-27010-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 12/23/2022] [Indexed: 01/06/2023] Open
Abstract
Body pain, sleep problems and falls are commonly reported among the elderly population. This study aimed to explore the mediating role of pain in the association of sleep problems with fall-outcomes (falls, fall-injury, and multiple falls) among older adults. Cross-sectional data from the baseline survey of Longitudinal Aging Study in India (LASI), 2017-18 were used. The total sample size for the study was 28,285 older adults aged 60 years and above. Falls and fall-related injuries among older adults in the last two years were self-reported. The Jenkins Sleep Scale (JSS-4) was used to assess sleep problems while pain was assessed using questions on whether respondents reported that they were troubled by pain and they required some form of medication or treatment for the relief of pain. Multivariable logistic regression and mediation analyses were conducted to fulfill the study objectives. While 13% older adults suffered from sleep problems, 38.83% were troubled with pain. Additionally, 12.63%, 5.64% and 5.76% older adults reported falls, fall-injury and multiple falls respectively. Older adults who suffered from sleep problems had higher odds of falls [adjusted odds ratio (aOR): 1.43, confidence interval (CI): 1.30-1.58], fall-injuries, [aOR:1.50,CI:1.30-1.73] and multiple falls [aOR:1.41,CI:1.24-1.62]. Similarly, older adults who were troubled with pain were more likely to report falls [aOR:1.80, CI:1.67-1.95], fall-injuries [aOR:1.66, CI:1.48-1.87] and multiple falls [aOR:1.90,CI:1.69-2.12]. The percent of the mediated effect of pain when examining the association between sleep problems and fall outcomes were reported to be 17.10%, 13.56% and 18.78% in case of falls, fall-injuries and multiple falls respectively. The current study finds evidence that pain mediates the association of sleep problems and falls, fall-injuries, and multiple falls among older Indian adults. Both sleep problems and pain are modifiable risk factors that need attention for fall prevention strategies.
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Devine M, Ma C, Tian J, Antony B, Cicuttini F, Jones G, Pan F. Association of Pain Phenotypes with Risk of Falls and Incident Fractures. Biomedicines 2022; 10:biomedicines10112924. [PMID: 36428490 PMCID: PMC9687743 DOI: 10.3390/biomedicines10112924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: To compare whether falls risk score and incident fracture over 10.7 years were different among three previously identified pain phenotypes. Methods: Data on 915 participants (mean age 63 years) from a population-based cohort study were studied at baseline and follow-ups at 2.6, 5.1 and 10.7 years. Three pain phenotypes were previously identified using the latent class analysis: Class 1: high prevalence of emotional problems and low prevalence of structural damage; Class 2: high prevalence of structural damage and low prevalence of emotional problems; Class 3: low prevalence of emotional problems and low prevalence of structural damage. Fractures were self-reported and falls risk score was measured using the Physiological Profile Assessment. Generalized estimating equations model and linear mixed-effects model were used to compare differences in incident fractures and falls risk score over 10.7 years between pain phenotypes, respectively. Results: There were 3 new hip, 19 vertebral, and 121 non-vertebral fractures, and 138 any site fractures during 10.7-year follow-up. Compared with Class 3, Class 1 had a higher risk of vertebral (relative risk (RR) = 2.44, 95% CI: 1.22-4.91), non-vertebral fractures (RR = 1.20, 95% CI: 1.01-1.42), and any site fractures (RR = 1.24, 95% CI: 1.04-1.46) after controlling for covariates, bone mineral density and falls risk score. Class 2 had a higher risk of non-vertebral and any site fracture relative to those in Class 3 (non-vertebral: RR = 1.41, 95% CI: 1.17-1.71; any site: RR = 1.44, 95% CI: 1.20-1.73), but not vertebral fracture. Compared with Class 3, Class 1 had a higher falls risk score at baseline (β = 0.16, 95% CI: 0.09-0.23) and over 10.7-year (β = 0.03, 95% CI: 0.01-0.04). Conclusions: Class 1 and/or Class 2 had a higher risk of incident fractures and falls risk score than Class 3, highlighting that targeted preventive strategies for fractures and falls are needed in pain population.
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Affiliation(s)
- Maxim Devine
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia
| | - Canchen Ma
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia
| | - Jing Tian
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia
| | - Benny Antony
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University Medical School, Commercial Road, Melbourne 3181, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia
| | - Feng Pan
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia
- Correspondence: ; Tel.: +61-3-6226-7700; Fax: +61-3-6226-7704
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Lu Z, Ye P, Er Y, Zhan Y, Deng X, Duan L. Body pain and functional disability predict falls in Chinese older adults: a population-based cohort study. Aging Clin Exp Res 2022; 34:2515-2523. [PMID: 36008646 DOI: 10.1007/s40520-022-02192-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/24/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Falls are major health care concerns for older adults. Pain is associated with increased falls in older adults. However, the impact of pain on functional disability and how this might predispose Chinese older adults to fall is unclear. AIM The aim of the current study was to examine whether functional disability mediates the association of any pain, back and/or shoulder pain (B-S pain) and leg and/or knees pain (L-K pain) with falls and serious falls. METHODS The study included 7619 community-dwelling older adults aged 60 years and above from the China Health and Retirement Longitudinal Study. Baseline data were from Wave 3 and fall outcomes were from Wave 4. Functional disability was measured by the ADLs and IADLs scales. We used a logistic regression model to investigate associations between pain and fall outcomes and KHB method to estimate the mediating effects of ADL/IADL disability on pain-fall relationship. RESULTS After fully adjusting for covariates, the three pain measures (any pain, back and/or shoulder pain, leg and/or knees pain) were significantly associated with fall outcomes. When body pain was compared with no body pain, the proportion mediated by the ADL disability was 28.43% for falls, while the proportion mediated by IADL disability was 17.96% for falls. For associations between specific parts of body pain and falls, the proportions mediated by the ADL disability were 34.18% and 35.89% in back and/or shoulder pain and leg and/or knees pain, respectively, but the proportions reduced to 21.98% and 20.82% when mediated by the IADL disability. However, there were no significant contributions of ADL/IADL disability for the association between specific part of body pain and serious falls. CONCLUSIONS Pain in general and pain in specific body sites were significantly associated with an increased risk of fall among older adults living in community in China. Functional disability partially mediated the relationship of pain with falls.
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Affiliation(s)
- Zhiming Lu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Pengpeng Ye
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.,School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Yuliang Er
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yongle Zhan
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong Special Administrative Region, China
| | - Xiao Deng
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Leilei Duan
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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Tse A, Ward S, McNeil J, Barker A, Cicuttini F, Fitzgibbon B, Hussain SM, Owen A, Wang YY, Wolfe R, Gilmartin-Thomas JFM. Severe low back or lower limb pain is associated with recurrent falls amongst older Australians. Eur J Pain 2022; 26:1923-1937. [PMID: 35862463 PMCID: PMC9546413 DOI: 10.1002/ejp.2013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 06/25/2022] [Accepted: 07/16/2022] [Indexed: 11/14/2022]
Abstract
Background Few studies have explored the impact of low back or lower limb pain severity on recurrent (≥2) falls in older adults. Objectives Investigate the association between the severity of low back or lower limb pain, and ≥2 falls or falls‐related injuries. Methods Community‐dwelling Australian males and females in the ASPREE Longitudinal Study of Older Persons (ALSOP), aged ≥70 years. Self‐reported, cross‐sectional questionnaire data regarding number of falls and falls‐related injuries in the last 12 months; and sites and severity of pain experienced on most days. Adjusted relative risks (RR) were estimated from multivariable Poisson regression models, for males and females separately. Results Of 14,892 ALSOP participants, 13% (n = 1983) reported ≥2 falls (‘recurrent fallers’) in the last 12 months. Males and females who reported severe low back, or severe lower limb pain on most days were more likely to report ≥2 falls in the last 12 months compared to those with mild pain (lower back: males RR = 1.70 and females RR = 1.5, p = 0.001; lower limb: males RR = 2.0, p < 0.001 and females RR = 1.4, p = 0.003). Female recurrent fallers who reported severe low back (RR = 1.3, p = 0.029) or lower limb (RR = 1.2, p = 0.024) pain on most days were more likely to report a falls‐related injury in the last 12 months compared to females with mild pain. Conclusion Severe low back or lower limb pain was associated with an increased likelihood of recurrent falls (males/females) or falls‐related injuries (females only). Assessment of severe low back and lower limb pain should be considered as a priority when undertaking falls‐risk evaluation. Significance Severe low back pain, or severe lower limb pain is associated with an increased likelihood of recurrent falls in older males and females, and an increased likelihood of falls‐related injuries in older female recurrent fallers. Assessment and management of severe low back and lower limb pain should be prioritized when undertaking falls‐risk assessment. Future longitudinal research is required to further interrogate this relationship and its underlying mechanisms.
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Affiliation(s)
- Amy Tse
- Aged Care Department, Bankstown-Lidcombe Hospital, New South Wales, Australia.,School of Health, University of New South Wales, New South Wales, Australia
| | - Stephanie Ward
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,Centre for Healthy Brain Ageing, University of New South Wales, New South Wales, Australia.,Dept of Geriatric Medicine, Prince of Wales Hospital, New South Wales, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Anna Barker
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,Silver Chain, Victoria, Australia
| | - Flavia Cicuttini
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Bernadette Fitzgibbon
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Sultana Monira Hussain
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,Department of Medical Education, Melbourne Medical School, The University of Melbourne, Victoria, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Yuan Yuan Wang
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Julia Fiona-Maree Gilmartin-Thomas
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,Institute for Health & Sport, Victoria University, Victoria, Australia.,Australian Institute for Musculoskeletal Science, Victoria, Australia
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11
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Biswas I, Adebusoye B, Chattopadhyay K. Risk factors for falls among older adults in India: A systematic review and meta‐analysis. Health Sci Rep 2022; 5:e637. [PMID: 35774830 PMCID: PMC9213836 DOI: 10.1002/hsr2.637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 02/12/2022] [Accepted: 02/17/2022] [Indexed: 12/19/2022] Open
Abstract
Background and Aim Falls are common among older adults in India. Several primary studies on its risk factors have been conducted in India. However, no systematic review has been conducted on this topic. Thus, the objective of this systematic review was to synthesize the existing evidence on the risk factors for falls among older adults in India. Methods JBI and Preferred Reporting Items for Systematic Reviews and Meta‐Analyse guidelines were followed, and two independent reviewers were involved in the process. This review included observational studies conducted among older adults (aged ≥ 60 years) residing in India, reporting any risk factor for falls as exposure and unintentional fall as the outcome. MEDLINE, EMBASE, PsycInfo, CINAHL, and ProQuest Dissertations and Theses were searched until September 24, 2020. Where possible, data were synthesized using random‐effects meta‐analysis. Results The literature search yielded 3445 records. Twenty‐two studies met the inclusion criteria of this systematic review, and 19 studies were included in the meta‐analysis. Out of the 22 included studies in the systematic review, 12 (out of 18) cross‐sectional studies, two case–control studies, and two cohort studies met more than 70% criteria in the respective Joanna Briggs Institute (JBI) checklists. Risk factors for falls among older adults in India included sociodemographic factors, environmental factors, lifestyle factors, physical and/or mental health conditions, and medical interventions. Conclusions This systematic review and meta‐analysis provided a holistic picture of the problem in India by considering a range of risk factors such as sociodemographic, environmental, lifestyle, physical and/or mental health conditions and medical intervention. These findings could be used to develop falls prevention interventions for older adults in India. Systematic Review and Meta‐Analysis Registration The systematic review and meta‐analysis protocol was registered with PROSPERO (registration number‐CRD42020204818).
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Affiliation(s)
- Isha Biswas
- Division of Epidemiology and Public Health, School of Medicine University of Nottingham Nottingham United Kingdom
| | - Busola Adebusoye
- Division of Epidemiology and Public Health, School of Medicine University of Nottingham Nottingham United Kingdom
| | - Kaushik Chattopadhyay
- Division of Epidemiology and Public Health, School of Medicine University of Nottingham Nottingham United Kingdom
- The Nottingham Centre for Evidence‐Based Healthcare: A JBI Centre of Excellence Nottingham United Kingdom
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Honda H, Ashizawa R, Kiriyama K, Take K, Hirase T, Arizono S, Yoshimoto Y. Chronic pain in the frail elderly mediates sleep disorders and influences falls. Arch Gerontol Geriatr 2022; 99:104582. [DOI: 10.1016/j.archger.2021.104582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/04/2021] [Accepted: 11/13/2021] [Indexed: 11/29/2022]
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13
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Lipidomic Profiling Identifies Serum Lipids Associated with Persistent Multisite Musculoskeletal Pain. Metabolites 2022; 12:metabo12030206. [PMID: 35323649 PMCID: PMC8953175 DOI: 10.3390/metabo12030206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 01/27/2023] Open
Abstract
Lipid mediators have been suggested to have a role in pain sensitivity and response; however, longitudinal data on lipid metabolites and persistent multisite musculoskeletal pain (MSMP) are lacking. This study was to identify lipid metabolic markers for persistent MSMP. Lipidomic profiling of 807 lipid species was performed on serum samples of 536 participants from a cohort study. MSMP was measured by a questionnaire and defined as painful sites ≥4. Persistent MSMP was defined as having MSMP at every visit. Logistic regression was used with adjustment for potential confounders. The Benjamini–Hochberg method was used to control for multiple testing. A total of 530 samples with 807 lipid metabolites passed quality control. Mean age at baseline was 61.54 ± 6.57 years and 50% were females. In total, 112 (21%) of the participants had persistent MSMP. Persistent MSMP was significantly associated with lower levels of monohexosylceramide (HexCer)(d18:1/22:0 and d18:1/24:0), acylcarnitine (AC)(26:0) and lysophosphatidylcholine (LPC)(18:1 [sn1], 18:2 [sn1], 18:2 [sn2], and 15-MHDA[sn1] [104_sn1]) after controlling for multiple testing. After adjustment for age, sex, body mass index, comorbidities, and physical activity, HexCer(d18:1/22:0 and d18:1/24:0) and LPC(15-MHDA [sn1] [104_sn1]) were significantly associated with persistent MSMP [Odds Ratio (OR) ranging from 0.25–0.36]. Two lipid classes—HexCer and LPC—were negatively associated with persistent MSMP after adjustment for covariates (OR = 0.22 and 0.27, respectively). This study identified three novel lipid signatures of persistent MSMP, suggesting that lipid metabolism is involved in the pathogenesis of persistent pain.
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Alzaabi HS, Walton LM, Arumugam A. Association between demographic characteristics, lower limb range of motion, functional performance, ability to dual task, quality of life and risk of falls in older adults of the United Arab Emirates - A cross-sectional study. Heliyon 2022; 8:e08869. [PMID: 35141442 PMCID: PMC8814690 DOI: 10.1016/j.heliyon.2022.e08869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/09/2022] [Accepted: 01/27/2022] [Indexed: 11/01/2022] Open
Abstract
Background Methods Results Conclusions
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15
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Cai Y, Leveille SG, Shi L, Chen P, You T. Chronic pain and circumstances of falls in community-living older adults: an exploratory study. Age Ageing 2022; 51:6509731. [PMID: 35061871 PMCID: PMC8782600 DOI: 10.1093/ageing/afab261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 10/18/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Chronic pain is a risk factor contributing to mobility impairment and falls in older adults. Little is known about the patterns of circumstances of falls among older adults with chronicpain. OBJECTIVE To examine the relationship between chronic pain and circumstances of falls including location, activities at the time of falls and self-reported causes of falls in older adults. DESIGN Prospective cohort study. SETTING Communities in/around Boston, Massachusetts. SUBJECTS The MOBILIZE Boston Study enrolled 765 adults aged ≥70 years. METHODS Pain severity, fall occurrence and fall circumstances were recorded using monthly calendar postcards and fall follow-up interviews during a 4-year follow-up period. Generalised estimating equation models were performed to examine the relation between monthly pain ratings and circumstances of the first fall in the subsequent month. RESULTS Compared to fallers without chronic pain, fallers with moderate-to-severe pain had around twice the likelihood of reporting indoor falls (aOR = 1.93, 95%CI: 1.32-2.83), falls in living or dining rooms (aOR = 2.06, 95%CI: 1.27-3.36), and falls due to health problems (aOR = 2.08, 95%CI: 1.16-3.74) or feeling dizzy or faint (aOR = 2.10, 95%CI: 1.08-4.11), but they were less likely to report falls while going down stairs (aOR = 0.48, 95%CI: 0.27-0.87) or falls due to a slip or trip (aOR = 0.67, 95%CI: 0.47-0.95) in the subsequent month. CONCLUSIONS Given the exploratory nature of the study, these findings should be interpreted with caution. Future studies may investigate whether better pain management and tailored fall prevention in older people with chronic pain could lead to fewer falls.
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Affiliation(s)
- Yurun Cai
- Address correspondence to: Yurun Cai, University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA 15261, USA. Tel: (412)-383-0766.
| | - Suzanne G Leveille
- Department of Nursing, University of Massachusetts Boston, Boston, MA, USA
| | - Ling Shi
- Department of Nursing, University of Massachusetts Boston, Boston, MA, USA
| | - Ping Chen
- Department of Computer Science and Engineering, University of Massachusetts Boston, Boston, MA, USA
| | - Tongjian You
- Department of Exercise and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
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16
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Iijima H, Aoyama T. Increased recurrent falls experience in older adults with coexisting of sarcopenia and knee osteoarthritis: a cross-sectional study. BMC Geriatr 2021; 21:698. [PMID: 34911490 PMCID: PMC8672583 DOI: 10.1186/s12877-021-02654-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 11/08/2021] [Indexed: 12/17/2022] Open
Abstract
Background Sarcopenia and knee osteoarthritis (OA) are two major risk factors for falls in older adults. The coexistence of these two conditions may exacerbate the risk of falls. This cross-sectional study aimed to test the hypothesis that older adults with coexisting sarcopenia and knee OA displayed an increased risk of falls experience. Methods Participants recruited from an orthopedic clinic were divided into four groups according to the presence of sarcopenia and radiographic knee OA: isolated sarcopenia, isolated knee OA, sarcopenia + knee OA, and control (i.e., non-sarcopenia with non-OA) groups. We used questionnaires to assess falls experience in the prior 12 months. We performed logistic regression analyses to evaluate the relationship between the four groups and falls experience. Results Of 291 participants (age: 60–90 years, 78.7% women) included in this study, 25 (8.6%) had sarcopenia + knee OA. Participants with sarcopenia + knee OA had 4.17 times (95% confidence interval: 0.84, 20.6) higher odds of recurrent falls (≥2 falls) than controls after adjustment for age, sex, and body mass index. The increased recurrent falls experience was not clearly confirmed in participants with isolated sarcopenia and isolated knee OA. Conclusions People with coexisting of sarcopenia and knee OA displayed increased recurrent falls experience. This study suggests a new concept, “sarcopenic knee OA”, as a subgroup associated with higher risk of falls, which should be validated in future large cohort studies. Trial registration. Not applicable. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02654-4.
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Affiliation(s)
- Hirotaka Iijima
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan. .,Department of System Design Engineering, Faculty of Science and Technology, Keio University, 3-14-1 Hiyoshi, Kohoku-ku, Yokohama, 223-8522, Japan. .,Japan Society for the Promotion of Science, Tokyo, Japan.
| | - Tomoki Aoyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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17
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Balogun SA, Srikanth V, van der Leeuw G, Callisaya ML. Prospective associations between pain at multiple sites and falls among community-dwelling older Australians. Intern Med J 2021; 53:503-509. [PMID: 34897950 DOI: 10.1111/imj.15659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 11/18/2021] [Accepted: 11/28/2021] [Indexed: 11/30/2022]
Abstract
AIM Pain at multiple sites is prevalent among older people. Yet, studies investigating the relationship between pain and falls focus largely on single-site pain. This study aims to examine the association between pain at multiple sites and falls among community-dwelling older Australians. METHOD Participants aged >60 years were randomly selected from the electoral roll. Falls were recorded prospectively over 12 months. Pain at multiple sites was assessed using a questionnaire. The total number of painful sites was calculated. Widespread pain was defined as pain in the upper-limb, lower-limb and in the axial skeletal region, with moderate to severe pain in at least one region. Log multinomial regression, with adjustment for confounders, was used to estimate whether widespread pain or number of painful sites increased the risk of a single (1 fall) and multiple falls (≥2 falls). RESULTS There were 299 participants (43% women; mean age 72±7.0 years). The mean (SD) of falls was 0.8±1.5. The frequencies of single and multiple falls were 23% (n=68) and 16% (n=49) respectively. A higher number of painful sites was associated with an elevated risk of a single fall (RR=1.08, 95% CI: 0.96, 1.27) and multiple falls (RR=1.20, 95% CI: 1.02, 1.41). However, the risk of multiple, but not single fall was substantial and statistically significant. Furthermore, compared to those without pain, individuals with widespread pain had an elevated risk of single (RR=1.87, 95% CI: 0.80, 5.09) and multiple falls (RR=3.94, 95% CI: 1.15, 13.51). However, the magnitude of effects of single fall was smaller and not statistically significant. CONCLUSIONS Falls risk should be ascertained for older people with pain, irrespective of whether they present with a single or multiple sites pain. Nevertheless, older adults with multisite pain may require additional attention as they appear to have a significantly elevated risk of multiple falls. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Saliu A Balogun
- Menzies Institute for Medical Research, University of Tasmania, Australia.,Peninsula Clinical School, Central Clinical School, Monash University, Clayton, Victoria, Australia, 3168
| | | | - Guusje van der Leeuw
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
| | - Michele L Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Australia.,Albert Einstein College of Medicine, New York, United States
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18
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Puto G, Repka I, Brzyski P. Pain measurement in the older people: evaluation of the psychometric properties of the Geriatric Pain Measure (GPM-24) - polish version. BMC Geriatr 2021; 21:560. [PMID: 34663222 PMCID: PMC8522084 DOI: 10.1186/s12877-021-02495-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 09/22/2021] [Indexed: 01/09/2023] Open
Abstract
Background Chronic pain in older people is of particular importance not only with regard to negative subjective experience but also as an indicator of the quality of medical care. Brief scales to assess pain may help health professionals with early recognition and treatment to avoid patient suffering. However, these scales should be adapted to the cultural context to provide valid assessments. The aim of this study was to evaluate the psychometric properties of the Polish translation of the Geriatric Pain Measure – 24 (GPM-24) in older people. Methods The study was conducted among 181 people aged 65 and over with chronic (noncancer) pain of varying intensity lasting more than 6 months. Construct validity was assessed using the principal component analysis (PCA) method with oblimin rotation. Criterion validity was evaluated by correlating the scores of the GPM-24 with the scores of the McGill-Melzack questionnaire (MPQ). The reliability of the GPM-24 was estimated in terms of internal consistency using Cronbach’s alpha coefficients. Results The PCA revealed a 6- component structure of the set of items that constituted the GPM-24. Most of these components were defined by items included in the same subscale, similar to the result obtained by the original scale’s authors. There were significant correlations between the GPM-24 and some dimensions of MPQ: affective (rho = 0.25, p = 0.001), present pain intensity (rho = 0.44, p < 0.001), pain rating index total (rho = 0.31, p < 0.001), and number of words chosen (rho = 0.26, p < 0.001). The value of the standardized Cronbach’s alpha equalled 0.89 and thus confirmed the high reliability of the GPM-24. Conclusions The Geriatric Pain Measure − 24 is a reliable and valid tool that is recommended for the monitoring and multidimensional assessment of chronic pain in older people in daily practice as well as in clinical trials. Trial registration Statutory research “Chronic pain in people over 65 years of age” K/ZDS/005733, conducted in 2015–2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02495-1.
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Affiliation(s)
- Grażyna Puto
- Department of Internal and Environmental Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, Kopernika 25 Street, 31-501, Krakow, Poland.
| | - Iwona Repka
- Department of Clinical Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, Kopernika 25 Street, 31-501, Krakow, Poland
| | - Piotr Brzyski
- "Dziupla" Statistical Analyses Piotr Brzyski, Aleje Jerozolimskie 85/21, 02-001, Warsaw, Poland
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19
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Sleep efficiency affecting the occurrence of falls among the frail older adults. Geriatr Nurs 2021; 42:1461-1466. [PMID: 34656862 DOI: 10.1016/j.gerinurse.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/01/2021] [Accepted: 10/01/2021] [Indexed: 11/24/2022]
Abstract
The purpose of this study is to clarify whether reduced sleep efficiency affects the occurrence of falls among the frail older adults. This was a prospective cohort study. The subjects were frail older adult individuals living within a community, attending an older adult care center. Variables assessed include sleep efficiency, walking ability, history of cerebrovascular disease, depressive symptoms, cognitive impairment, chronic pain, frequency of sleeping medication use, and frequency of nocturnal urination. A fall calendar was used to record daily falls over a 6-month period beginning after administering a baseline survey. The Mann-Whitney U test was used to analyze the association between sleep efficiency and the occurrence of falls. Logistic regression analysis showed a significant association between falls and sleep efficiency. In conclusion, after adjusting for multiple confounders, reduced sleep efficiency did affect the occurrence of falls. Accordingly, approaches for improving sleep efficiency could offer new strategies toward fall prevention.
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20
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Sex Differences in Modifiable Fall Risk Factors. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2021.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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21
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Smith RD, McHugh GA, Quicke JG, Finney A, Lewis M, Dziedzic KS, Healey EL. The relationship between multisite peripheral joint pain and physical activity levels in older adults: A cross-sectional survey. Musculoskeletal Care 2021; 20:341-348. [PMID: 34582086 DOI: 10.1002/msc.1593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Research on levels of physical activity (PA) in those with peripheral joint pain have only focused on single sites, in the knee or hips. This study investigated the levels of PA in adults with single-site and multisite peripheral joint pain compared to adults with no joint pain. METHODS Analysis of a cross-sectional population survey mailed to adults aged ≥45 years (n = 28,443) was conducted. Respondents reported any peripheral joint pain in the last 12 months in either the hands, hips, knees or feet; PA levels were self-reported using the short telephone activity rating scale. The association between PA levels, peripheral joint pain and outcomes of health status (physical and mental component scores, using SF-12) pain intensity (10-point scale) and health-related quality of life (HRQoL) (EQ-5D) were investigated using analysis of variance and ordinal regressions. RESULTS Compared to those with no joint pain, all pain groups reported lower levels of PA: joint pain in one site (odds ratio = 0.91, 95% CI: 0.83-0.99); two sites (0.74, 0.67-0.81), three sites (0.65, 0.59-0.72) and four sites (0.47, 0.42-0.53). Across all joint pain groups, levels of PA were associated with pain intensity, physical health status, mental health status and HRQoL. DISCUSSION Adults with more sites of peripheral joint pain were more likely to report lower levels of PA. Those with more sites of pain and lower levels of PA reported poorer outcomes. Health care providers should be aware that those with multisite joint pain are most likely to have low levels of PA.
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Affiliation(s)
- Robert D Smith
- School of Nursing, The University of Hong Kong, Hong Kong
| | | | - Jonathan G Quicke
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK
| | - Andrew Finney
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK
| | - Martyn Lewis
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK
| | - Krysia S Dziedzic
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK
| | - Emma L Healey
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK
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22
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Cai Y, Leveille SG, Shi L, Chen P, You T. Chronic Pain and Risk of Injurious Falls in Community-Dwelling Older Adults. J Gerontol A Biol Sci Med Sci 2021; 76:e179-e186. [PMID: 33000168 DOI: 10.1093/gerona/glaa249] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Fall injuries are a leading cause of death in older adults. The potential impact of chronic pain characteristics on risk for injurious falls is not well understood. This prospective cohort study examined the relationship between chronic pain and risk for injurious falls in older adults. METHOD The MOBILIZE Boston Study enrolled 765 community-dwelling adults aged 70 years and older living in and around Boston, Massachusetts. Chronic pain characteristics, including pain severity, pain interference, and pain distribution, were measured at baseline using the Brief Pain Inventory subscales and a joint pain questionnaire. Occurrence of falls and fall-related injuries were recorded using monthly fall calendar postcards and fall follow-up interviews during the 4-year follow-up period. RESULTS Negative binomial regression models showed that pain interference and pain distribution, but not pain severity, independently predicted injurious falls adjusting for potential confounders. Participants in the highest third of pain interference scores had a 61% greater risk of injurious falls compared to those reporting little or no pain interference. Compared to no pain, multisite pain was associated with a 57% greater risk of injurious falls. Stratified by gender, the association was only significant in women. In the short term, moderate-to-severe pain in a given month was associated with increased risk of injurious falls in the subsequent month. CONCLUSIONS Global pain measures are associated with increased risk of injurious falls in older adults. Pain assessment should be incorporated into fall risk assessments. Interventions are needed to prevent fall injuries among elders with chronic pain.
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Affiliation(s)
- Yurun Cai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Nursing, University of Massachusetts Boston
| | - Suzanne G Leveille
- Department of Nursing, University of Massachusetts Boston.,Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Ling Shi
- Department of Nursing, University of Massachusetts Boston
| | - Ping Chen
- Department of Computer Science and Engineering, University of Massachusetts Boston
| | - Tongjian You
- Department of Exercise and Health Sciences, University of Massachusetts Boston
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23
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Sphingomyelin is involved in multisite musculoskeletal pain: evidence from metabolomic analysis in 2 independent cohorts. Pain 2021; 162:1876-1881. [PMID: 33273416 DOI: 10.1097/j.pain.0000000000002163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 11/25/2020] [Indexed: 01/05/2023]
Abstract
ABSTRACT Metabolic dysfunction has been suggested to be involved in musculoskeletal pain; however, few studies have identified metabolic markers associated with multisite musculoskeletal pain (MSMP). This study sought to identify metabolic marker(s) for MSMP by metabolomic analysis. The Tasmanian Older Adult Cohort Study (TASOAC) provided the discovery cohort with the Newfoundland Osteoarthritis Study (NFOAS) providing the replication cohort. Multisite musculoskeletal pain was assessed by a self-reported pain questionnaire and defined as painful sites ≥4 in both the TASOAC and the NFOAS. Furthermore, MSMP was also defined as painful sites ≥7, whereas non-MSMP was defined as either painful sites <7 or ≤1 in the NFOAS. Serum samples of the TASOAC received metabolic profiling using The Metabolomics Innovation Centre Prime Metabolomics Profiling Assay. The data on the identified metabolites were retrieved from NFOAS metabolomic database for the purpose of replication. A total of 409 participants were included in the TASOAC, 38% of them had MSMP. Among the 143 metabolites assessed, 129 passed quality control and were included in the analysis. Sphingomyelin (SM) C18:1 was significantly associated with MSMP (odds ratio [OR] per log µM increase = 3.96, 95% confidence interval, 1.95-8.22; P = 0.0002). The significance remained in multivariable analysis (OR per log µM increase = 2.70, 95% confidence interval, 1.25-5.95). A total of 610 participants were included in the NFOAS, and the association with SM C18:1 was successfully replicated with 3 MSMP definitions (OR ranging from 1.89 to 2.82; all P < 0.03). Our findings suggest that sphingomyelin metabolism is involved in the pathogenesis of MSMP, and the circulating level of SM C18:1 could serve as a potential marker in the management of MSMP.
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24
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Iijima H, Shimoura K, Aoyama T, Takahashi M. Low Back Pain as a Risk Factor for Recurrent Falls in People With Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2021; 73:328-335. [PMID: 31909877 DOI: 10.1002/acr.24136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 12/31/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Knee osteoarthritis (OA) has been suggested to increase the risk of falls. Low back pain (LBP) is a potential risk factor for falls in people with knee OA, but this issue has not been addressed adequately in previous studies. The objective of this study was to investigate the relationship between LBP and falls in people with knee OA in a 12-month period. METHODS Participants with knee OA (Kellgren/Lawrence [K/L] grade ≥1) completed questionnaires for LBP and falls that occurred in the preceding 12 months. Binary and ordinal logistic regression analyses were performed to assess the relationship between LBP or moderate-to-severe LBP (numeric rating scale ≥4 points) and any fall (≥1 fall) or recurrent falls (≥2 falls) after adjustment for age, sex, K/L grade, knee pain severity, and quadriceps strength. Sensitivity analyses were performed excluding people with sciatica, nonchronic LBP, K/L grade 1, and those receiving pain medications. RESULTS We included 189 participants (ages 61-90 years, 78.3% women) in this study. Of these participants, 41 (21.6%) reported falls in the preceding 12 months. People with any LBP (n = 101) and those with moderate-to-severe LBP (n = 45) had 2.7- and 3.7-times higher odds of recurrent falls, respectively. Sensitivity analyses revealed a strong correlation between moderate-to-severe LBP and recurrent falls. CONCLUSION Thorough investigation of LBP as a risk factor for recurrent falls in people with knee OA may provide a novel insight into the pathomechanics of recurrent falls in this population.
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Affiliation(s)
- Hirotaka Iijima
- Keio University, Yokohama, Graduate School of Medicine, Kyoto University, Kyoto, and Japan Society for the Promotion of Science, Tokyo, Japan
| | | | - Tomoki Aoyama
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
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25
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Stolt LROG, Kolish DV, Cardoso MRA, Tanaka C, Vasconcelos EFS, Pereira EC, Dellú MC, Pereira WMP, Aldrighi JM, Schmitt ACB. Accidental falls in middle-aged women. Rev Saude Publica 2020; 54:141. [PMID: 33331487 PMCID: PMC7726919 DOI: 10.11606/s1518-8787.2020054002579] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/05/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of accidental falls in women and to identify possible associations of sociodemographic, clinical and lifestyle variables with falls, in 2007 and 2014. METHODS Two cross-sectional studies were performed, in 2007 and 2014, within the Projeto de Saúde de Pindamonhangaba (PROSAPIN – Pindamonhangaba Health Project), with women aged between 35 to 75 years. Probabilistic samples were selected among women living in the municipality and participating in the Health Family Strategy. Data collection included: face-to-face interview, anthropometric examination and blood test. The outcome variable “have you fallen in the last six months?” was raised during the interview. The prevalence of falls in 2007 and 2014 were estimated by score with a 95% confidence interval (95%CI). Multiple logistic regression models were constructed to identify the association of independent variables with the occurrence of falls for each year based on the odds ratio (OR). We used the Stata 14.0 software for statistical analysis. RESULTS The prevalence of accidental falls were: 17.6% (95%CI 14.9–20.5) in 2007 and 17.2% (95%CI 14.8–19.8) in 2014. In 2007, factors associated with falls were: aged 50–64 years (OR = 1.81; 95%CI 1.17–2.80), high school (OR = 1.76; 95%CI 1.06–2.93), hyperuricemia (OR = 3.74; 95%CI 2.17–6.44), depression (OR = 2.07; 95%CI 1.31–3.27), poor sleep (OR = 1.78; 95%CI 1.12–2.82) and daytime sleepiness (OR = 1.86; 95%CI 1.16–2.99). In 2014, they were: aged 50–64 years (OR = 1.64; 95%CI 1.04–2.58), hyperuricemia (OR = 1.91; 95%CI 1.07–3.43) and depression (OR = 1.56; 95%CI 1.02–2.38), plus metabolic syndrome (OR = 1.60; 95%CI 1.03–2.47) and musculoskeletal pain (OR = 1.81; 95%CI 1.03–3.18). CONCLUSIONS Falls occur significantly in women aged 50 years or over, indicating that they are not restricted to older adults and that there is a need to initiate preventive measures earlier. Both studies showed similar magnitudes of occurrence of accidental falls and reinforced their multifactorial nature. In addition, hyperuricemia may be a potential new factor associated with falls.
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Affiliation(s)
- Lígia Raquel Ortiz Gomes Stolt
- Universidade Federal da Paraíba. Departamento de Fisioterapia. João Pessoa, PB, Brasil.,Universidade de São Paulo. Faculdade de Medicina. Programa de Pós-Graduação em Ciências da Reabilitação. São Paulo, SP, Brasil
| | - Daniel Vieira Kolish
- Articulab - Ortopedia Moderna Especializada. Fisioterapeuta em reabilitação ortopédica e facilitador de processos de trabalho e desenvolvimento de projetos. São Paulo, SP, Brasil
| | - Maria Regina Alves Cardoso
- Universidade de São Paulo. Faculdade de Saúde Pública. Departamento de Epidemiologia. São Paulo, SP, Brasil
| | - Clarice Tanaka
- Universidade de São Paulo. Faculdade de Medicina. Programa de Pós-Graduação em Ciências da Reabilitação. São Paulo, SP, Brasil.,Universidade de São Paulo. Faculdade de Medicina. Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional. São Paulo, SP, Brasil.,Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. Laboratório de Investigação em Fisioterapia. São Paulo, SP, Brasil
| | | | | | | | | | - José Mendes Aldrighi
- Universidade de São Paulo. Faculdade de Saúde Pública. Departamento de Saúde Materno-Infantil. São Paulo, SP, Brasil
| | - Ana Carolina Basso Schmitt
- Universidade de São Paulo. Faculdade de Medicina. Programa de Pós-Graduação em Ciências da Reabilitação. São Paulo, SP, Brasil.,Universidade de São Paulo. Faculdade de Medicina. Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional. São Paulo, SP, Brasil
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26
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Hirase T, Okubo Y, Menant J, Lord SR, Sturnieks DL. Impact of pain on reactive balance and falls in community-dwelling older adults: a prospective cohort study. Age Ageing 2020; 49:982-988. [PMID: 32417879 DOI: 10.1093/ageing/afaa070] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND pain is associated with increased postural sway and falls in older adults. However, the impact of pain on reactive balance induced by postural perturbations and how this might predispose older adults to falls is not known. OBJECTIVE to investigate whether any pain, back/neck pain and lower limb pain are associated with poor reactive balance and prospective fall outcomes in older adults. DESIGN 12-month prospective cohort study. SETTING community. SUBJECTS 242 community-dwelling older adults aged 70+ years. METHODS participants completed a questionnaire on the presence of pain and underwent force-controlled waist-pull postural perturbations while standing. Force thresholds for stepping, step initiation time, step velocity and step length were quantified. Falls were monitored with monthly falls calendars for 12-months. RESULTS participants with lower limb pain had significantly lower force thresholds for stepping. Those with any pain or pain in the back/neck had longer step initiation time, slower step velocity and shorter step length. The three pain measures (any pain, back/neck pain, lower limb pain) were significantly associated with multiple falls when adjusted for age, sex, body mass index, use of polypharmacy, strength and walking speed. In mediation analyses, there was a significant indirect effect of reactive balance for the relationship between back/neck pain and falls with fractures. CONCLUSIONS older people with pain have impaired reactive balance and an increased risk of falls. Reactive balance partially mediated the association between pain and fall-related fractures. Further research is required to confirm the findings of this study.
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Affiliation(s)
- Tatsuya Hirase
- Department of Physical Therapy Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
| | - Yoshiro Okubo
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Jasmine Menant
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Daina L Sturnieks
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
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Yiengprugsawan VS, Piggott J, Witoelar F, Blyth FM, Cumming RG. Pain and Its Impact on Functional Health: 7-Year Longitudinal Findings among Middle-Aged and Older Adults in Indonesia. Geriatrics (Basel) 2020; 5:geriatrics5020039. [PMID: 32580285 PMCID: PMC7345182 DOI: 10.3390/geriatrics5020039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/10/2020] [Accepted: 06/18/2020] [Indexed: 11/16/2022] Open
Abstract
Pain is a growing public health issue worldwide, but there is limited population-based evidence in low- and middle-income country settings. Using nationwide Indonesian Family Life Survey (IFLS) data in 2007 and 2014, this research sets out to investigate the associations between changes in pain status between two time points and its impact on functional health outcomes among middle-aged and older adults in Indonesia. Analyses focused on 7936 adults aged 50 years and older in 2014 who responded to both waves. Functional health was assessed using a composite score of functional limitations (range 20–100), representing difficulty in performing activities of daily living, and grip strength (kilograms). Multivariate linear regression models were used to analyse associations between pain measured in 2007 and 2014 and functional health in 2014. Severe pain in the latest wave of IFLS was associated with older age, female, lower education, having chronic conditions or depressive symptoms. Notably, those who reported ‘low–medium’ pain in 2007 and ‘severe’ pain in 2014 belonged to the most vulnerable group with worst functional health outcomes (4.96 points higher limitation scores and 1.17 kg weaker average grip strength). Findings have implications for public health policy in monitoring and management of pain including related co-morbidities as an increasingly critical component of population ageing.
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Affiliation(s)
- Vasoontara Sbirakos Yiengprugsawan
- Australian Research Council Centre of Excellence in Population Ageing Research (CEPAR), Business School, University of New South Wales, Kensington 2033, Australia;
- Correspondence: or ; Tel.: +61-2-9385-5298
| | - John Piggott
- Australian Research Council Centre of Excellence in Population Ageing Research (CEPAR), Business School, University of New South Wales, Kensington 2033, Australia;
| | - Firman Witoelar
- Crawford School of Public Policy, The Australian National University, Canberra 2601, Australia;
| | - Fiona M Blyth
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (F.M.B.); (R.G.C.)
- Centre for Education and Research on Ageing (CERA), Concord Repatriation General Hospital, Sydney 2139, Australia
| | - Robert G Cumming
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (F.M.B.); (R.G.C.)
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28
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Welsh VK, Mallen CD, Ogollah R, Wilkie R, McBeth J. Investigating multisite pain as a predictor of self-reported falls and falls requiring health care use in an older population: A prospective cohort study. PLoS One 2019; 14:e0226268. [PMID: 31826023 PMCID: PMC6905547 DOI: 10.1371/journal.pone.0226268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 11/24/2019] [Indexed: 11/21/2022] Open
Abstract
Older people are continuing to fall despite fall prevention guidelines targeting known falls’ risk factors. Multisite pain is a potential novel falls’ risk factor requiring further exploration. This study hypothesises that: (1) an increasing number of pain sites and widespread pain predicts self-reported falls and falls recorded in primary and secondary healthcare records; (2) those relationships are independent of known falls’ risk factors and putative confounders. This prospective cohort study linked data from self-completed questionnaires, primary care electronic health records, secondary care admission statistics and national mortality data. Between 2002–2005, self-completion questionnaires were mailed to community-dwelling individuals aged 50 years and older registered with one of eight general practices in North Staffordshire, UK(n = 26,129) yielding 18,497 respondents. 11,375 respondents entered the study; 4386 completed six year follow-up. Self-reported falls were extracted from three and six year follow-up questionnaires. Falls requiring healthcare were extracted from routinely collected primary and secondary healthcare data. Increasing number of pain sites increased odds of future 3 year (odds ratio 1.12 (95% confidence interval: 1.01–1.24)) and 6 year self-reported fall (odds ratio 1.02 (1.00–1.03)) and increased hazard of future fall requiring primary healthcare (hazard ratio 1.01 (1.00–1.03)). The presence of widespread pain increased odds of future 3 year (odds ratio 1.27 (0.92–1.75)) and 6 year fall (odds ratio 1.43(1.06–1.95)) and increased hazard of future fall requiring primary healthcare (hazard ratio 1.27(0.98–1.65)). Multisite pain was not associated with future fall requiring secondary care admission. Multisite pain must be included as a falls’ risk factor in guidelines to ensure clinicians identify their older patients at risk of falls and employ timely implementation of current falls prevention strategies.
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Affiliation(s)
- Victoria K. Welsh
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, United Kingdom
- * E-mail:
| | - Christian D. Mallen
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, United Kingdom
| | - Reuben Ogollah
- Faculty of Medicine & Health Sciences, South Block, Queen’s Medical Centre, Nottingham, United Kingdom
| | - Ross Wilkie
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, United Kingdom
| | - John McBeth
- Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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Pan F, Tian J, Aitken D, Cicuttini F, Jones G. Pain at Multiple Sites Is Associated With Prevalent and Incident Fractures in Older Adults. J Bone Miner Res 2019; 34:2012-2018. [PMID: 31237964 DOI: 10.1002/jbmr.3817] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/21/2019] [Accepted: 06/15/2019] [Indexed: 01/01/2023]
Abstract
Musculoskeletal pain is common and typically occurs at multiple sites. Pain has been shown to be associated with falls risk; however, whether an increased risk for falls associated with multisite pain (MSP) translates into an increased risk of fractures has not been investigated. This study aimed to examine the association of number of painful sites with prevalent and incident fractures. Data from a longitudinal population-based study of older adults (mean age 63 years) were utilized. Follow-up was performed at 2.6, 5.1, and 10.7 years later, respectively. Presence/absence of pain at the neck, back, hands, shoulders, hips, knees, and feet was assessed by questionnaire at baseline. Participants were classified into three groups according to the total number of painful sites: zero to two, three to four, and five to seven. Fractures were self-reported at each time point. BMD was measured by DXA. Falls risk was calculated based on the Short-Form Physiological Profile Assessment. Log-binomial regression was used for the analyses. There were 450 fractures at baseline and 154 new fractures reported during a mean follow-up period of 10.7 years (range 9.2 to 12.5 years). In multivariable analyses, number of painful sites was associated with prevalent fractures at any and nonvertebral site. Furthermore, participants with five to seven painful sites had an increased risk of incident fractures at any site (RR 1.69; 95% CI, 1.13 to 2.53); major site, including the femur, radius, ulnar, vertebral, rib, and humerus (RR 2.17; 95% CI 1.12 to 4.22); and vertebral site (RR 6.44, 95% CI, 1.64 to 25.33) compared with those with pain at zero to two sites. These associations remained statistically significant after further adjustment for falls risk and BMD. Pain at multiple sites was associated with incident fracture risk in a dose-response manner, suggesting that widespread pain is an independent contributor to fracture risk. The potential for pain management in fracture prevention warrants further exploration. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Feng Pan
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, 7000, Australia
| | - Jing Tian
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, 7000, Australia
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, 7000, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University Medical School, Commercial Road, Melbourne, 3181, VIC, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, 7000, Australia
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