Musculoskeletal pain and use of analgesics in relation to mobility limitation among community‐dwelling persons aged 75 years and older

Abstract

Pain and factors related to it constitute serious health problems in the older population. This populationbased cross-sectional study aimed to investigate whether musculoskeletal pain is associated with mobility limitation and whether the relationship between pain and mobility limitation varies according to the use of analgesics among community-dwelling older people. A total of 622 community-dwelling participants aged 75 years and older (mean age 80.4, 74% women) were interviewed about presence and severity of musculoskeletal pain. Self-reported analgesic drug utilization was verified against medical records. Mobility limitation was assessed by the Timed Up & Go test (TUG) time of >13.5 s or inability to perform the test. Logistic regression was used to evaluate the pain-affect associations, with associations expressed as odds ratios with 95% confidence intervals (CI). After adjustment for several covariates, musculoskeletal pain remained independently associated with mobility limitation (odds ratio = 1.83; 95% CI 1.16, 2.89). The risk of mobility limitation was highest among those who reported severe or moderate pain (1.84; 1.13, 3.13) and among those who used analgesics (2.37; 1.37, 4.11). In conclusion, musculoskeletal pain increases the risk for mobility limitation. The present findings underline the importance of the careful assessment and pharmacological and nonpharmacological management of pain in promoting mobility in older age.

Diagnostic criteria for sarcopenia and physical performance

“…Using muscle strength to define sarcopenia has several limitations. To generate strength, other factors such as cardiovascular function, joint function, and neural control are involved (McCully and Posner 1995;Karttunen et al 2011;Hyatt et al 1990). Furthermore, muscle strength can be underestimated due to pain (Lauretani et al 2003;Rolland et al 2008).…”

Musculoskeletal pain characteristics associated with lower balance confidence in community-dwelling older adults

“…Specifically, research is required to investigate the impact of the severity of musculoskeletal pain, and also to see if the number of chronic pain sites (particularly multisite pain) is an important factor for balance confidence. Moreover, if musculoskeletal pain does contribute to balance confidence, this association could be influential in the impact that pain has on mobility and falls risk [3,5,17,18].…”

“…In Model 1, the number of pain sites (none, single, multisite), age and sex explained 34% of the variance in ABC scores (F [3,287] = 48.8, P<0.001, R 2 =0.338, adjusted R 2 =0.331). After adjusting for demographic, health and mobility factors, the number of pain sites continued to be independently associated with poorer balance confidence in Model 4 (β=-0.98, P=0.023).…”

“…Chronic musculoskeletal pain affects approximately 50% of community-dwelling older adults [1] and is a leading cause of disability in old age, associated with mobility and activities of daily living (ADL) difficulties [2,3]. Research has also demonstrated that both chronic musculoskeletal pain (particularly multisite) and pain severity are important risk factors for falls [4,5].…”

Instruments to Assess Mobility Limitation in Community-Dwelling Older Adults: A Systematic Review

“…4 laps of 100 m corridor (Boston) and a 20-m course marked by cones at each end, with 10 laps constituting 400 m (Pittsburgh) (Sayers et al, 2004) • 10 laps of 40 meters; Standing rest stop allowed not exceeding 60 s per stop (Marsh et al, 2011) Distance walked over 3 min and velocity for selfpaced gait (Shumway-Cook et al, 2003) Balance Berg Balance Test (Shumway-Cook et al, 2003;Shumway-Cook et al, 2002) Timed Up-and-Go (TUG) (Karttunen et al, 2012) 13.5 s or inability for mobility limitation Standard armed chair used; participants wore regular footwear; usual ambulatory device allowed; support from the arms rest of the chair if necessary…”