Improving pain and sleep in middle-aged and older adults: the promise of behavioral sleep interventions

Koffel, Erin; McCurry, Susan M.; Smith, Michael T.; Vitiello, Michael V.

doi:10.1097/j.pain.0000000000001423

Cited by 29 publications

(24 citation statements)

References 57 publications

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“…A recent study conducted among 1664 older adults revealed significant racial/ethnic differences in overall sleep quality and in individual sleep components among older adults [ 93 ]. Interventional studies show that different types of therapies are effective in reducing the pain related to disability, quality of sleep, and depression in older adults with chronic pain and low back pain [ 98 , 99 ]. However, future studies are needed to understand the role of different social, psychological, physical as well as pharmacological therapy in relation to sleep disturbance and low back pain among African American older adults.…”

Section: Discussionmentioning

confidence: 99%

Multi-Dimensional Impact of Chronic Low Back Pain among Underserved African American and Latino Older Adults

Bazargan

Loeza

Ekwegh

et al. 2021

IJERPH

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Chronic low back pain is one of the most common, poorly understood, and potentially disabling chronic pain conditions from which older adults suffer. The existing low back pain research has relied almost exclusively on White/Caucasian participant samples. This study examines the correlates of chronic low back pain among a sample of underserved urban African American and Latino older adults. Controlling for age, gender, race/ethnicity, education, living arrangement, and number of major chronic conditions, associations between low back pain and the following outcome variables are examined: (1) healthcare utilization, (2) health-related quality of life (HR-QoL) and self-rated quality of health; and (3) physical and mental health outcomes. Methods: We recruited nine hundred and five (905) African American and Latino older adults from the South Los Angeles community using convenience and snowball sampling. In addition to standard items that measure demographic variables, our survey included validated instruments to document HR-QoL health status, the Short-Form McGill Pain Questionnaire-2, Geriatric Depression Scale, sleep disorder, and healthcare access. Data analysis includes bivariate and 17 independent multivariate models. Results: Almost 55% and 48% of the Latino and African American older adults who participated in our study reported chronic low back pain. Our data revealed that having low back pain was associated with three categories of outcomes including: (1) a higher level of healthcare utilization measured by (i) physician visits, (ii) emergency department visits, (iii) number of Rx used, (iv) a higher level of medication complexity, (v) a lower level of adherence to medication regimens, and (vi) a lower level of satisfaction with medical care; (2) a lower level of HR-QoL and self-assessment of health measured by (i) physical health QoL, (ii) mental health QoL, and (iii) a lower level of self-rated health; and (3) worse physical and mental health outcomes measured by (i) a higher number of depressive symptoms, (ii) a higher level of pain, (iii) falls, (iv) sleep disorders, (v) and being overweight/obese. Discussion: Low back pain remains a public health concern and significantly impacts the quality of life, health care utilization, and health outcomes of underserved minority older adults. Multi-faceted and culturally sensitive interventional studies are needed to ensure the timely diagnosis and treatment of low back pain among underserved minority older adults. Many barriers and challenges that affect underserved African American and Latino older adults with low back pain simply cannot be addressed in over-crowded EDs. Our study contributes to and raises the awareness of healthcare providers and health policymakers on the necessity for prevention, early diagnosis, proper medical management, and rehabilitation policies to minimize the burdens associated with chronic low back pain among underserved older African American and Latino patients in an under-resourced community such as South Los Angeles.

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Section: Discussionmentioning

confidence: 99%

Multi-Dimensional Impact of Chronic Low Back Pain among Underserved African American and Latino Older Adults

Bazargan

Loeza

Ekwegh

et al. 2021

IJERPH

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“…Sleep problems may impact on pain in different ways, and are part of common associated symptomatology in different pain-related conditions affecting adults and older adults, such as low back pain, headache disorders or osteoarthritis [47][48][49]. As reported in a recent review [50] several hypotheses have been made. Disrupted sleep continuity (i.e.…”

Section: Discussionmentioning

confidence: 99%

Predictors of pain in general ageing populations: results from a multi-country analysis based on ATHLOS harmonized database

et al. 2020

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Background: Pain is a common symptom, often associated with neurological and musculoskeletal conditions, and experienced especially by females and by older people, and with increasing trends in general populations. Different risk factors for pain have been identified, but generally from studies with limited samples and a limited number of candidate predictors. The aim of this study is to evaluate the predictors of pain from a large set of variables and respondents. Methods: We used part of the harmonized dataset of ATHLOS project, selecting studies and waves with a longitudinal course, and in which pain was absent at baseline and with no missing at follow-up. Predictors were selected based on missing distribution and univariable association with pain, and were selected from the following domains: Sociodemographic and economic characteristics, Lifestyle and health behaviours, Health status and functional limitations, Diseases, Physical measures, Cognition, personality and other psychological measures, and Social environment. Hierarchical logistic regression models were then applied to identify significant predictors. Results: A total of 13,545 subjects were included of whom 5348 (39.5%) developed pain between baseline and the average 5.2 years' follow-up. Baseline risk factors for pain were female gender (OR 1.34), engaging in vigorous exercise (OR 2.51), being obese (OR 1.36) and suffering from the loss of a close person (OR 1.88) whereas follow-up risk factors were low energy levels/fatigue (1.93), difficulties with walking (1.69), self-rated health referred as poor (OR 2.20) or average to moderate (OR 1.57) and presence of sleep problems (1.80).

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“…Active pain treatment has been associated with improved sleep quality, with varying effects dependent on medications used and setting [187,188]. CBT-I is also a promising area in relation to improving chronic pain in older adults with insomnia [189].…”

Section: Pain and Disorders Associated With Painmentioning

confidence: 99%

Sleep Disturbance, Sleep Disorders and Co-Morbidities in the Care of the Older Person

Carthy

2021

Medical Sciences

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Sleep complaints can be both common and complex in the older patient. Their consideration is an important aspect of holistic care, and may have an impact on quality of life, mortality, falls and disease risk. Sleep assessment should form part of the comprehensive geriatric assessment. If sleep disturbance is brought to light, consideration of sleep disorders, co-morbidity and medication management should form part of a multifaceted approach. Appreciation of the bi-directional relationship and complex interplay between co-morbidity and sleep in older patients is an important element of patient care. This article provides a brief overview of sleep disturbance and sleep disorders in older patients, in addition to their association with specific co-morbidities including depression, heart failure, respiratory disorders, gastro-oesophageal reflux disease, nocturia, pain, Parkinson’s disease, dementia, polypharmacy and falls. A potential systematic multidomain approach to assessment and management is outlined, with an emphasis on non-pharmacological treatment where possible.

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Improving pain and sleep in middle-aged and older adults: the promise of behavioral sleep interventions

Cited by 29 publications

References 57 publications

Multi-Dimensional Impact of Chronic Low Back Pain among Underserved African American and Latino Older Adults

Multi-Dimensional Impact of Chronic Low Back Pain among Underserved African American and Latino Older Adults

Predictors of pain in general ageing populations: results from a multi-country analysis based on ATHLOS harmonized database

Sleep Disturbance, Sleep Disorders and Co-Morbidities in the Care of the Older Person

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