Pain, Disablement Process and Frailty among Older Adults in the United States: Findings from the National Health and Aging Trends Study


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Background: Musculoskeletal pain is highly prevalent among older adults and the most common cause of disability. Objectives: To examine 1) whether sociodemographic characteristics, comorbidities, depression, obesity and sleep complaints are independently associated with pain; 2) the effect of pain on upper-lower extremity functional limitation and disability; and 3) the effect of pain on frailty over 6-years pf follow-up among older adults. Design: Longitudinal study. Subjects: 5,716 participants aged 65 years and older from the National Health and Aging Trends Study (2011-2017) with complete information on pain and all the covariates of interest. Measures: Pain and pain location (shoulder, wrist, hand, hips, knees, ankle, neck, and back) are the independent variables. Socio-demographics (age, gender, marital status, race/ethnicity and years of formal education), sleep complaints, depression, body mass index, and comorbidities are covariates. The outcome measures were: pain, upper-lower extremity functional limitation, limitations in activities of daily living (ADL’s), and frailty. Analysis: Descriptive statistics were used to compare sample characteristics by pain and outcome variables. General estimation equations models were performed to examine predictors of pain and pain as predictor of upper-lower extremity functional limitations, ADL disability, and frailty over time. Results: Prevalence of pain in American older adults was 52.3% at baseline. The most prevalent pain location was knee (41.3%), followed by back (37.4%) and shoulder (32.3%). The odds of reporting pain were 0.99 (95% CI 0.97-1.01) over time. Pain was an independent predictor of upper extremity (UE) functional limitations (OR 1.90, 95% CI-1.66-2.16), lower extremity (LE) functional limitations (OR 1.52, 95% CI 1.42-1.63), ADL disability (OR 1.82, 95% CI 1.58-2.09), and frailty (OR 1.86, 95% CI 1.60-2.16) over time. Conclusions: Prevalence of pain among American older adults was high (52%). Pain is a strong independent predictor of functional limitations, ADL disability, and frailty. These findings suggest that early intervention and better management of pain is needed to prevent/delay disability and frailty, enhance patient management, allocation of health care resources, maintain independence and lower the burden of pain in this population.



Pain, Functional limitation, Disability, Frailty, American older adults