Background & Aims
The aging population increases rapidly around the world due to longer life expectancy, medical development, and improvement of health care service [1]. The majority of older adults is healthy, but multimorbidity (including pain conditions) and frailty increase with age. Pain is a personal experience and pain characteristics are often measured such as intensity, frequency, extent, and duration [2]. Frailty is characterized by increased vulnerability to external stressors due to decline in homeostatic functions [3]. Previous studies have demonstrated an independent association between pain and frailty [4,5], but knowledge about this association with different pain characteristics is still limited. This study aimed to investigate the association between frailty and pain characteristics among older people with a high risk of hospitalization.
Methods
This study was embedded in a prospective, pragmatic, matched-control multicenter trial at 19 primary care practices in south-eastern Sweden [6]. In march 2017, we identified 1604 individuals aged 75 years older with a high risk of hospitalization using case-finding algorithm including 32 diagnostic codes of morbidities related to unplanned admission to hospital [7]. The current study population was restricted to all participants who replied one or more questions on pain characteristics and received Comprehensive Geriatric Assessment (CGA) assessed by a nurse-physician team (N=389). Data on pain aspects, physical and ADL functioning were collected in the self-reported questionnaires. We used multiple linear regression and logistic regression to determine the association of pain characteristics and frailty. The regression models were further adjusted for sociodemographic factors such as age, gender, and education.
Results
Mean age was 83.5±5.1 years and 51% were female. Over one-third of the participants were classified as frail (133, 34%) and reported frequent pain (from several times per week to constant every day) (142, 36.5%). A slightly over 40% participants reported pain lasting longer than 3 months (163, 41.9%) and having regional or widespread pain (165, 42.4%). In comparison to non-frail peers, frail participants reported higher pain intensity, more ADL-dependency, less physical active, and more anxiety/depression (p<0.01). In linear regression analysis, pain intensity explained a 4.4% variance in the severity of frailty while the ADL-staircase score and physical activity accounted for 43% variance. In the logistic regression analysis, pain frequency (Odds Ratio: 1.9, 95% Confidence Interval: 1.3-2.9) was associated with frailty. However, the models with ADL-staircase score had a higher explanatory power (??2: 0.37) in predicting frailty than those without this aspect (??2: 0.07 and 0.14).
Conclusions
Physical and ADL functioning had a stronger association with the severity of frailty compared to pain characteristics and psychological aspects (anxiety and depression). Among the pain characteristics, only pain frequency was positively associated with frailty. Our findings indicate that frailty is better predicted by ADL-staircase score than by pain characteristics.
References
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8.Deng LX, Patel K, Miaskowski C, Maravilla I, Schear S, Garrigues S, Thompson N, Auerbach AD, Ritchie CS: Prevalence and Characteristics of Moderate to Severe Pain among Hospitalized Older Adults. J Am Geriatr Soc 2018, 66(9):1744-1751.
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Presenting Author
Huan-Ji Dong
Poster Authors
Huanji Dong
MD, PhD
Department of Pain and Rehabilitations Centre, Region ?sterg?tland & Link?ping Univers
Lead Author
Joakim Yang
MS (5)
Linköping University, Faculty of Health sciences
Lead Author
Magnus Nord
MD
Linköping University Faculty of Health sciences
Lead Author
Maria Johansson
PhD
Linköping University Faculty of Health sciences
Lead Author
Anneli Peolsson
PhD
Linköping University Faculty of Health sciences
Lead Author
Topics
- Pain in Special Populations: Elderly