Chronic pain in the frail elderly mediates sleep disorders and influences falls

Honda, Hiroya; Ashizawa, Ryota; Kiriyama, Kazuya; Take, Koki; Hirase, Tatsuya; Yoshimoto, Yoshinobu

doi:10.1016/j.archger.2021.104582

Cited by 12 publications

(5 citation statements)

References 40 publications

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“…It also has enough accuracy for use in clinical trials and studies with acceptable SEM. Furthermore, investigating the convergent validity revealed a moderate to high correlation between the total score of FES-I, which was consistent with other instruments in the similar studies such as SHARE frailty, 40 , 41 GAI 42 , 43 and UCLA Loneliness 44 - 46 except GDS, which was not statistically significant ( p = 0.675).…”

Section: Discussionsupporting

confidence: 85%

Psychometric Properties of the Falls Efficacy Scale-International, Cut-off Points, and Validating its Short Version Among Iranian Older People

Norouzi¹,

Ghoochani²,

Kaveh³

et al. 2023

Oman Med J

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Objectives: Older people have a fear of falling, which is far more difficult than falling itself. We measured the extent of this feeling using a short and valid Falls Efficacy Scale-International (FES-I) 7-item questionnaire for the aging community in Iran. Methods: The present psychometric work deals with outlining the validation and translation of FES-I (short version) among 9117 Persian-speaking elderly people with a mean age of 70.2±8.3 years (54.1% female and 45.9% male) in July 2021. Investigations were performed on confirmatory factor analysis, exploratory factor analysis, internal consistency, and construct validity along with test-retest reliability, receiver operating characteristic analysis, inter-rater, and convergent validity. Results: 72.4% of the subjects were living alone, 92.9% required support in activities of daily living , and 93.0% experienced falling in the past two years. A one-factor solution was assigned by exploratory factor analysis for FES-I. Thus, this model was proved by the confirmatory factor analysis with valid fit indices. Based on Cronbach’s alpha, intra-cluster correlation coefficient, and McDonald’s omega (≥ 0.80), internal consistency was confirmed. The exact cut-off value was represented by the receiver operating characteristic analysis for male/female and between with/without fear of falling among older samples with higher measures of specificity and sensitivity. Moreover, a significant effect of age, aging in place, loneliness, hospitalization rate, frailty, and sense of anxiety (effect size ≥ 0.80, p ≤ 0.05) on fear of falls was detected using analysis of variance.Conclusions: The psychometric properties of the original scale were preserved by the Persian version of FES-I seven items as a self-reported measure of fear of falling. It could be assuredly a measure in both community and clinical settings. The possible uses and limitations of the Iranian FES-I were also discussed.

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Section: Discussionsupporting

confidence: 85%

Psychometric Properties of the Falls Efficacy Scale-International, Cut-off Points, and Validating its Short Version Among Iranian Older People

Norouzi¹,

Ghoochani²,

Kaveh³

et al. 2023

Oman Med J

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“…Although the mechanism by which chronic pain is associated with fall-related injury is still unclear, a previous study investigating the mediators of chronic pain and falls revealed that the presence of a sleep disorder is a mediator of chronic pain and falls [40]. In addition, reactive balance, reduced strength, concern about falls, and foot reaction times have been suggested to be mediators of chronic pain and falls [18,41,42].…”

Section: Discussionmentioning

confidence: 99%

Chronic pain in older adults with disabilities is associated with fall-related injuries: a prospective cohort study

Honda,

Ashizawa,

Kameyama

et al. 2024

Eur Geriatr Med

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Previous studies have shown an association between chronic pain and the occurrence of falls in community-dwelling older adults; however, the association between chronic pain and fall-related injuries in older adults with disabilities is unclear. This study aimed to determine the association between chronic pain and fall-related injuries in older adults with disabilities. MethodsThis 24-month prospective cohort study included older adults aged 65 years or older using Japanese long-term care insurance services. Chronic pain, de ned as "pain that has persisted for more than three months to date," was assessed using a face-to-face questionnaire. Fall-related injuries, de ned as "injuries requiring hospitalization or outpatient treatment due to a fall," were assessed using a fall calendar. Data were analyzed using a Cox proportional hazards model, with fall-related injury as the dependent variable, chronic pain as the independent variable, and confounders as covariates. ResultsAmong 133 included participants, 15 experienced fall-related injuries. After adjusting for age and sex as covariates, chronic pain was signi cantly associated with fall-related injuries (hazard ratio: 5.487, 95% con dence interval: 1.211-24.853, p = 0.027). ConclusionsChronic pain was associated with fall-related injuries in older adults with disabilities. In this population, a greater focus should be placed on treating chronic pain to reduce the occurrence of falls.

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“…Speci cally, we observed that chronic pain mediates 25.2% of the overall effect of falls on frailty, underscoring the signi cance of chronic pain in in uencing frailty development. Previous research has shown that middle-aged and older adults who have experienced falls are more prone to developing chronic pain as a result of physical injury [17,37]. Some older adults may even experience a post-injury pain syndrome characterized by prolonged discomfort at initially non-painful injury sites [58].…”

Section: Discussionmentioning

confidence: 99%

“…Covariates regarding health-related factors at the individual level included chronic diseases, smoking behavior, drinking habit, and activities of daily living (ADL) as they have been previously associated with frailty in older adults [4,37,38]. Respondents were asked to report if they had any of the following chronic conditions: diabetes mellitus, hypertension, dyslipidemia, heart disease, cerebrovascular disease, chronic gastritis, chronic lung disease, chronic nephritis, rheumatoid arthritis, intervertebral disc disease, osteoporosis, ventilation disorder, hyperthyroidism, hypothyroidism, cancer, leukemia, chronic anemia, or other chronic diseases.…”

Section: Covariatesmentioning

confidence: 99%

The Mediating Effect of Chronic Pain on the Relationship between Falls and Frailty: A Cross-sectional Survey among Middle-aged and Older adults from Ethnic Minority Groups in Yunnan Province, China

Wen,

Deng,

Wang

et al. 2023

Preprint

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Background Falls are associated with an increased risk of frailty in middle-aged and older adults; however, the mediating role between falls and frailty remains unclear. The primary objective of this study is to examine the relationship between falls and frailty in middle-aged and elderly individuals residing in Yunnan Province, China, with a specific emphasis on exploring the potential mediating effect of chronic pain across different ethnic groups. Methods Employing a cross-sectional design, data collection was conducted from July to December 2022 in five selected counties. Baron and Kenny’s causal steps method was used to explore the mediating effect of chronic pain on the relationship between falls and frailty. Spearman correlation analysis, multiple linear regression models, and bootstrap method were employed for data analysis. Results A total of 2,710 respondents participated in this study. The prevalence of falls among middle-aged and older individuals was 12.77%, while the prevalence of frailty in the same population was observed to be 21.62%. Spearman correlation analysis revealed significant positive association between chronic pain and both falls (r=0.135, P<0.05) as well as frailty (r=0.383, P<0.05). Frailty also exhibited a significant positive correlation with falls (r=0.162, P<0.05). After adjusting for all covariates, the total effect of falls on frailty was estimated to be 1.065 (95% bootstrap CI: 0.804~1.326), with a direct effect estimate of 0.797 (95% bootstrap CI: 0.511~1.083). The indirect effect of chronic pain on this association was found to be approximately one-quarter at 0.268 (95% bootstrap CI: 0.170~0.366). The subgroup analysis discovered differences in the mediating effects across different ethnic groups; specifically, the proportions mediated by chronic pain were found to be 28.2%, 18.4%, and 21.5% for Han majority group, Zhiguo ethnic minorities, and other ethnic minority groups, respectively. Conclusion This study provides valuable insights into the intricate association between frailty, falls, and chronic pain among middle-aged and older adults from diverse ethnic backgrounds in a western province of China. Effective management strategies targeting chronic pain and falls prevention could serve as crucial interventions to address frailty.

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Chronic pain in the frail elderly mediates sleep disorders and influences falls

Cited by 12 publications

References 40 publications

Psychometric Properties of the Falls Efficacy Scale-International, Cut-off Points, and Validating its Short Version Among Iranian Older People

Psychometric Properties of the Falls Efficacy Scale-International, Cut-off Points, and Validating its Short Version Among Iranian Older People

Chronic pain in older adults with disabilities is associated with fall-related injuries: a prospective cohort study

The Mediating Effect of Chronic Pain on the Relationship between Falls and Frailty: A Cross-sectional Survey among Middle-aged and Older adults from Ethnic Minority Groups in Yunnan Province, China

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