Association of Self-Reported Functional Limitations among a National Community-Based Sample of Older United States Adults with Pain: A Cross-Sectional Study

Characteristics associated with activities of daily living (ADL), instrumental activities of daily living (IADL), functional, or other activity limitation among United States adults with asthma

OBJECTIVE

The objective of this study was to explore the characteristics associated with having a limitation, which included any activities of daily living (ADL), instrumental activities of daily living (IADL), functional, or other activity limitations, among adults with asthma in the United States (US).

METHODS

This cross-sectional study included US adults (≥18 years) with asthma in the 2021 Medical Expenditure Panel Survey. A multivariable logistic regression model assessed the association between the following characteristics and the dependent variable (having a limitation, which included ADL, IADL, functional, or other activity limitation): age, sex, race, ethnicity, education, employment, income, marriage, exercise, smoking, pain, overall health, and mental health.

RESULTS

The sample included 2325 (limitation n = 940, no limitation n = 1385) US adults with asthma, which represented an estimated weighted population of 37 210 236 (limitation n = 11 104 087, no limitation n = 26 106 149). In this analysis, characteristics associated with having a limitation (versus no limitation) included: age ≥65 versus 18-39 years (odds ratio (OR)=6.6, 95% confidence interval (CI)=3.8-11.4), age 40-64 versus 18-39 years (OR = 2.4, 95% CI = 1.5-3.9), unemployed versus employed (OR = 2.6, 95% CI = 1.7-4.0), low versus middle/high income (OR = 1.5, 95% CI = 1.0-2.2), not married versus married (OR = 1.8, 95% CI = 1.2-2.7), smoker versus nonsmoker (OR = 3.0, 95% CI = 1.7-5.3), quite a bit/extreme versus little/moderate pain (OR = 2.8, 95% CI = 1.8-4.3), fair/poor versus good overall health (OR = 3.3, 95% CI = 2.0-5.3), and fair/poor versus excellent/very good overall health (OR = 6.3, 95% CI = 3.5-11.4).

CONCLUSIONS

In conclusion, these findings offer some insight into having a limitation among US adults with asthma, although a future prospective study is needed to establish evidence of causality.

Factors associated with physical and psychological wellness of American adults with asthma

Objective: The study objective was to investigate the factors associated with the physical and psychological wellness of United States (US) adults with asthma.Methods: This cross-sectional analysis used a sample of 2329 US adults with asthma in the 2021 Medical Expenditure Panel Survey data. A logistic regression model investigated the association of the following factors and the dependent variables (physical wellness and psychological wellness): age, sex, race, ethnicity, education, employment, healthcare provision, marriage, income, regular physical activity, current smoker, pain, and limitations. Nationally representative estimates were produced through a weighted analysis. The data structure was maintained using cluster and strata variables. The alpha limit was 0.05.Results: Factors associated with higher odds of reporting good physical wellness included: private (versus no) healthcare provision (odds ratio [OR] = 2.63, 95% confidence interval [CI] = 1.10-6.26), good (versus poor) psychological wellness (OR = 6.83, 95% CI = 4.35-10.72), regular (versus no regular) physical activity (OR = 2.18, 95% CI = 1.42-3.34), little/moderate (versus quite a bit/extreme) pain (OR = 3.51, 95% CI = 2.38-5.15) and no (versus any) limitation (OR = 3.73, 95% CI = 2.30-6.06). In the psychological wellness model, those aged ≥70 (OR = 6.18, 95% CI = 2.72-14.07), 60-69 (OR = 4.64, 95% CI = 2.13-10.10), and 50-59 (OR = 4.96, 95% CI = 2.24-11.02) versus those aged 18-29, and good (versus poor) physical wellness (OR = 6.89, 95% CI = 4.34-10.94) were associated with higher odds of reporting good versus poor psychological wellness.Conclusion: These results may be helpful at targeting resources to optimize the wellness of US adults with asthma. Additional studies are needed to determine any temporal associations between these findings.

Bodily pain severity and emotional pain experience in old age: Analyses of potential mediators from representative Ghanaian aging survey

OBJECTIVES

Data on the association between pain and emotional health outcomes in old age primarily come from high-income samples. This study examines the cross-sectional association of bodily pain with emotional pain in a representative sample from Ghana, a lower-middle-income sub-Saharan African country. The study also investigates the potential mediators in the association.

METHODS

Participants (N = 1201) from the Aging, Health, Psychological Well-being, and Health-seeking Behavior Study reported their experiences of bodily pain and emotional pain. Pain severity was assessed over the last 30 days using a cross-culturally validated item from the Medical Outcomes Study Short Form-36, while emotional pain was assessed with seven emotional distress items on a 4-level scale over the last 30 days. Multivariable logistic regressions and bootstrapping models assessed the hypothesized association.

RESULTS

Mean (SD) age was 66.1 (11.9) years, and 63.3 % were women. Compared to no pain, mild (odds ratio (OR) = 2.05, 95 %CI = 1.31-3.22), moderate (OR = 2.83, 95 %CI = 1.80-4.45), and severe bodily pains (OR = 3.55, 95 %CI = 1.93-6.55) had higher odds for emotional pain. The associations were stronger among women (than men) and the≥65 age group (than the 50-64 age group). Functional limitations (47.1 %), physical activity (26.4 %), and sleep problems (22.2 %) significantly mediated the association.

CONCLUSIONS

The positive cross-sectional association between bodily pain and emotional pain generalizes to a sub-Saharan African country. Psychosomatic factors largely accounted for this association. Efforts to improve emotional health may consider pain and the mediators. More studies are needed in low- and middle-income countries to gauge generalizability fully.

Limited Physical Functioning in United States Adults with Arthritis: Findings from the 2021 Medical Expenditure Panel Survey

There is little published research on limited physical functioning in United States (US) adults with arthritis. The objective of this cross-sectional 2021 Medical Expenditure Panel Survey (MEPS) database study was to investigate the variables associated with limited physical functioning in US adults with arthritis. Logistic regression tested the associations of predisposing, enabling, and need variables with the dependent variable (limited physical functioning). This study included 5102 US adults with arthritis, reflecting an estimated weighted population of 64,136,870 US adults with arthritis. In the final multivariable logistic regression model, age ≥ 70 and ages 60-69 (vs. 18-49 years), female (vs. male) sex, having quite a bit/extreme or moderate (vs. little) pain, and having 6+ or 4-5 (vs. 0-1) comorbid conditions were all associated with higher odds of the person stating they had limited physical functioning. Whereas high school or less (vs. more than high school), being employed (vs. unemployed), being married (vs. not married), having excellent/very good or good (vs. poor) general health, and exercise (vs. no exercise) were each associated with lower odds of the person reporting they had limited physical functioning. Future work may be considered to explore these variables in greater detail.

Association between pain burden and presence of any limitation among older adults (≥50 years of age) with pain who used opioids in the United States: Cross-sectional study using 2020 medical expenditure panel survey

This study aimed to assess the association between pain burden and presence of any limitation among older adults (≥50 years of age) with pain who used opioids in the United States. This cross-sectional study used 2020 Medical Expenditure Panel Survey data and included all adults aged 50 or older, who were alive for the 2020 calendar year, used an opioid at least once in the calendar year, and reported having pain in the past 4 weeks. Unadjusted and adjusted logistic regression models were developed to assess the association between any limitation (AL) (yes or no), pain burden (extremely, quite a bit, moderately, or little bit) and the control variables among a nationally representative sample of United States adults. A total of 844 of the 27,805 participants included in the dataset were eligible for the study. Of these, 71.2% (95% confidence interval (CI) = 67.2, 75.1%) reported the presence of AL. The adjusted logistic regression analysis showed that having extreme, quite a bit, or moderate pain (vs little pain) was associated with 10.30 (95% CI = 3.87, 27.40), 5.07 (95% CI = 2.77, 9.30), and 2.49 (95% CI = 1.40, 4.45), respectively, times greater odds of having AL. Furthermore, being unemployed (vs employed; adjusted odds ratio (aOR) = 5.26, 95% CI = 2.94, 9.09%), unmarried (vs married; aOR = 1.92, 95% CI = 1.12, 3.33%), having poor overall health (vs good overall health; aOR = 2.08, 95% CI = 1.08, 4.17), and residing in the Midwest (vs West; aOR = 2.04, 95% CI = 1.10, 3.80) were associated with greater odds of having AL. Extreme, quite a bit, and moderate pain burden were significantly associated with greater odds of reporting AL compared to little pain burden. Developing effective pain management strategies that address not only pain relief but also functional improvement among this population is of importance. Future research could then be conducted to determine the most effective pain management strategies that will provide pain relief and improve their functional abilities.

The Severity of Pain and Comorbidities Significantly Impact the Dependency on Activities of Daily Living among Musculoskeletal Patients in Jizan, Saudi Arabia

Limited research has been carried out on the effects of pain, comorbidity, and impaired function in musculoskeletal patients in Jizan, Saudi Arabia. A cross-sectional study was conducted on 115 patients (aged ≥ 55 years) with physician-diagnosed musculoskeletal conditions in Jizan to investigate the association between pain severity, comorbidities, and dependence on activities of daily living (ADLs). Self-reported questionnaires were used to collect data on pain, comorbidities, and physical function measured by ADLs. In ADLs, participants were categorized as dependent (n = 36) or independent (n = 79). Logistic regression analysis was employed to determine the predictors of dependence. The results showed that higher pain severity (adjusted odds ratio (OR): 1.69, 95% confidence interval (CI): 1.21-2.38, p = 0.002) and a greater number of comorbidities (adjusted OR: 1.52, 95% CI: 1.06-2.17, p = 0.021) were independently associated with dependence in ADLs. These associations remained significant even after controlling for covariates. This study concluded that patients with musculoskeletal conditions in Jizan who experience high levels of pain and comorbidities are at risk of dependence on basic daily activities. Therefore, addressing pain and comorbidities is crucial for maintaining independence and improving quality of life. Personalized rehabilitation programs are needed to manage these conditions in this region.

Associations of multiple (≥5) chronic conditions among a nationally representative sample of older United States adults with self-reported pain

OBJECTIVES

The association between an individuals' demographic and health characteristics and the presence of multiple chronic conditions is not well known among older United States (US) adults. This study aimed to identify the prevalence and associations of having multiple chronic conditions among older US adults with self-reported pain.

METHODS

This retrospective, cross-sectional study used data from the 2017 Medical Expenditure Panel Survey. Study subjects were aged ≥50 years and had self-reported pain in the past four weeks. The outcome variable was multiple (≥5) chronic conditions (vs. <5 chronic conditions). Hierarchical logistic regression models were used to identify significant associations between demographic and health characteristics and multiple chronic conditions with significance indicated at an a priori alpha level of 0.05. The complex survey design was accounted for when obtaining nationally-representative estimates.

RESULTS

The weighted population was 57,074,842 US older adults with pain, of which, 66.1% had ≥5 chronic conditions. In fully-adjusted analyses, significant associations of ≥5 comorbid chronic conditions included: age 50-64 vs. ≥65 years (adjusted odds ratio [AOR]=0.478, 95% confidence interval [CI]=0.391, 0.584); male vs. female gender (AOR=1.271, 95% CI=1.063, 1.519); white vs. other race (AOR=1.220, 95% CI=1.016, 1.465); Hispanic vs. non-Hispanic ethnicity (AOR=0.614, 95% CI=0.475, 0.793); employed vs. unemployed (AOR=0.591, 95% CI=0.476, 0.733); functional limitations vs. no functional limitations (AOR=1.862, 95% CI=1.510, 2.298); work limitations vs. no work limitations (AOR=1.588, 95% CI=1.275, 1.976); little/moderate vs. quite a bit/extreme pain (AOR=0.732, 95% CI=0.599, 0.893); and excellent/very good (AOR=0.375, 95% CI=0.294, 0.480) or good (AOR=0.661, 95% CI=0.540, 0.810) vs. fair/poor physical health.

CONCLUSIONS

Approximately 38 million of the 57 million US older adults with pain in this study had ≥5 chronic conditions in 2017. Several characteristics were associated with multiple chronic conditions, which may be important for health care professionals to consider when working with patients to manage their pain. This study was approved by The University of Arizona Institutional Review Board (2006721124, June 12, 2020).