Persistent Pain Substantially Affects Function, Well-being of U.S. Older Adults
Key findings
- This longitudinal study of 5,589 community-dwelling older adults in the U.S. used interview data from a nationally representative annual survey to assess the impact of persistent pain on physical function, cognition, and well-being
- 39% of older adults had persistent pain, and 28% reported intermittent pain, representing 12.3 million and 8.9 million older adults, respectively
- Multiple sites of pain (three or more) were the norm, reported by 64% of patients with persistent pain
- After adjustment for potential confounders, respondents with persistent pain were at 14% increased risk of clinically meaningful decline in physical function and 11% increased risk of decline in well-being compared to those with no bothersome pain
- Renewed focus is warranted on developing policies that support reimbursement for both nonpharmacologic and pharmacologic approaches to pain management
Despite the high prevalence of chronic pain among older adults, little is known about its impact on the outcomes that tend to matter most to them: physical function, cognition and overall well-being.
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Christine S. Ritchie, MD, MSPH, director of research in the Division of Palliative Care and Geriatric Medicine at Massachusetts General Hospital and director of the Center for Aging and Serious Illness, and colleagues have published the first nationally representative study of older adults that assessed the longitudinal effects of chronic pain.
In the Journal of the American Geriatrics Society, the team reports that pain contributed to clinically meaningful declines in physical function and well-being, although not cognition, over seven years.
Methods
The National Health and Aging Trends Study (NHATS), sponsored by the National Institute on Aging, conducts annual in-home surveys of community-dwelling Medicare beneficiaries. The research team included all 5,589 participants who responded to the question "In the last month, have you been bothered by pain?" at the 2011 and 2012 interviews.
The sample was 56% female and 82% white, and the median baseline age was 74 (IQR, 69–80).
The 2,215 participants (39%) who reported persistent pain (bothersome pain in both interview rounds) were compared with 1,538 (28%) who had intermittent pain (bothersome pain in only one interview round) and 1,836 (33%) who reported no bothersome pain.
The primary outcomes were:
- Physical function—A ≥2-point decline in the Gill Functional Score (range, 7–28), which assesses four self-care activities (eating, getting cleaned up, using the toilet, and dressing) and three mobility activities (going outside, getting around inside, and getting out of bed)
- Cognitive function—Development of possible or probable dementia, as classified on an NHATS-specific algorithm, in participants with no dementia at baseline, or development of probable dementia in those with possible dementia at baseline (respondents who had probable dementia at baseline were excluded)
- Well-being—A ≥2-point decline in an NHATS-specific score that considers four emotions (frequency of feeling cheerful, bored, full of life, or upset in the last month on a five-point Likert scale) and three items reflecting self-realization (extent of disagreement with statements about purpose in life, self-acceptance, and environmental mastery on a three-point Likert scale)
Prevalence of Pain
Once population weights were applied, the sample represented 31.9 million older adults:
- 12.3 million (39%) with persistent pain
- 8.9 million (28%) with intermittent pain
- 10.7 million (33%) with bothersome pain
30% of participants with persistent pain described pain in three or four sites, and 34% described pain in five or more sites (range, 5–13). The respective figures for respondents with intermittent pain were 20% and 8%.
Outcomes
Over a seven-year follow-up period after 2012, there were declines in:
- Physical function—64% of participants with persistent pain, 59% of those with intermittent pain, and 57% of those with no bothersome pain
- Cognitive function—25%, 24%, and 23%
- Well-being—48%, 45%, and 44%
In multivariable analyses adjusted for age, sex, race, education, marital status, depression, anxiety, and number of comorbid conditions, participants with persistent pain were:
- 14% more likely than those with no bothersome pain to meet the criterion for a meaningful decline in physical function (HR, 1.14; 95% CI, 1.05–1.23)
- Not significantly more likely to meet either criterion for a meaningful decline in cognitive function
- 11% more likely to meet the criterion for a meaningful decline in well-being (HR, 1.11; 95% CI, 1.01–1.21)
New Policies Warranted
In a previous study published in The Gerontologist, Dr. Ritchie and colleagues found that many older adults lack access to effective nonpharmacologic treatments and receive little guidance from their primary care providers about effective pain interventions.
The high prevalence of pain detected in this study and its negative consequences suggest the need for a renewed focus on policies that will support reimbursement for both nonpharmacologic and pharmacologic approaches to pain management.
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