Pain and pain-related interference with function in older Canadians: the Canadian study of health and aging

Purpose : The effect that pain has on everyday physical and psychological functioning in the older population is not well understood. The main objective of this study was to describe the extent of pain and pain-related disability in the Canadian population and examine the relationships between demographic and health-related variables and pain-related interference in physical and psychological functioning. Method : The data was obtained from the follow up study to The Canadian Study of Health and Ageing. Information from 5703 Canadians 70 years of age and older was analysed in this study. Results : Fifty-nine point three per cent of the women and 48.4% of the men reported having pain in the 4 weeks prior to the interview. Of those who reported pain, a greater proportion of women compared with men reported that pain at least moderately interfered with physical functioning (moving about, normal tasks, recreational activities, sleep) and psychological functioning (mood, enjoyment of life). The intensity of pain and chronic disease combinations were also shown to be significantly associated with pain-related interference with physical and psychological functioning. Conclusions : A large proportion of older Canadians reports pain and pain-related disability. Thorough pain assessment and management should be incorporated into the health programmes aimed at maximizing physical and psychological function in the older population.     

New directions in mental health practice with older people: Canadian strategies for mental health reform

Aim and objective.  The purpose of this article is to draw attention to problems in the Canadian health system that must be overcome if Canada is to ensure that older people can access the services they need.
Background.  Projections suggest that 20% of Canadians will be aged 65+ by 2021. If current prevalence rates for mental illness continue, this will result in a significant increase in the number of older Canadians with or at risk for mental illness and mental health problems.
Design.  Findings of the final report of the Standing Committee on Social Affairs, Science and Technology are summarized and related to the intended role and primary strategy of the proposed Canadian Mental Health Commission.
Methods.  The relevance of the Interprofessional Education for Collaborative Patient-Centred Practice initiative launched by Health Canada is then considered in light of the intention that the Commission adopt collaboration with relevant stakeholders as its primary strategy for achieving mental health reform.
Conclusions.  Fragmentation in service delivery must be overcome if older Canadians are to receive age appropriate mental health services when and where they need them. Yet there is little evidence that the degree of interprofessional collaboration required can be achieved.
Relevance to clinical practice The reforms advocated by the Senate Committee are widely embraced but evidence is needed on how mental health and other professionals can best learn to work together in the interests of older people and other mental health consumers.     

Diabetes, hyperglycemia, and inflammation in older individuals: the health, aging and body composition study

OBJECTIVE: The objective of this study was to assess the association of inflammation with hyperglycemia (impaired fasting glucose [IFG]/impaired glucose tolerance [IGT]) and diabetes in older individuals. RESEARCH DESIGN AND METHODS: Baseline data from the Health, Aging and Body Composition study included 3,075 well-functioning black and white participants, aged 70-79 years. RESULTS: Of the participants, 24% had diabetes and 29% had IFG/IGT at baseline. C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha) levels (P < 0.001) were significantly higher among diabetic participants and those with IFG/IGT. Odds of elevated IL-6 and TNF-alpha (>75th percentile) were, respectively, 1.95 (95% CI 1.56-2.44) and 1.88 (1.51-2.35) for diabetic participants and 1.51 (1.21-1.87) and 1.14 (0.92-1.42) for those with IFG/IGT after adjustment for age, sex, race, smoking, alcohol intake, education, and study site. Odds ratios for elevated CRP were 2.90 (2.13-3.95) and 1.45 (1.03-2.04) for diabetic women and men and 1.33 (1.07-1.69) for those with IFG/IGT regardless of sex. After adjustment for obesity, fat distribution, and inflammation-related conditions, IL-6 remained significantly related to both diabetes and IFG/IGT. CRP in women and TNF-alpha in both sexes were significantly related to diabetes, respectively, whereas risk estimates for IFG/IGT were decreased by adjustment for adiposity. Among diabetic participants, higher levels of HbA(1c) were associated with higher levels of all three markers of inflammation, but only CRP remained significant after full adjustment. CONCLUSIONS: Our findings show that dysglycemia is associated with inflammation, and this relationship, although consistent in diabetic individuals, also extends to those with IFG/IGT.     

Pain behavior and the development of pain-related disability: the importance of guarding

OBJECTIVE: To examine prospectively the association between the 4 categories of objectively assessed pain behavior and various disability outcomes. In the present study, relationships among the 4 categories of pain behavior and various disability-related outcomes were examined. METHODS: One hundred forty-eight workers were identified within 6 weeks of a first episode of low-back pain in the workplace. During a physical examination, observations were made of guarding, words, sounds, and facial expressions of pain. Three months later, participants were evaluated with respect to return to work and standardized self-report measures of pain-related disability. Administrative records were examined to determine the number of days lost and costs associated with their rehabilitation. RESULTS: Only guarding showed consistent prospective associations with all disability outcomes. When examined in the context of other variables that have been associated with disability in the same population, guarding showed consistent independent associations. DISCUSSION: Guarding behavior may play a role in the transition from acute to chronic pain. The findings underscore the multidimensional nature of pain behavior and suggest that there is value in examining overt pain behaviors in prospective studies of the development of chronic occupational pain disability.     

Pain and pain-related fear are associated with functional and social disability in an occupational setting: evidence of mediation by pain-related fear.

This study examined the role of work-related, psychosocial and psychological factors in predicting functional and social disability in working employees. In a cross-sectional design, 890 working employees (reporting at least 1 day of back pain during the past year) completed self-report measures of back pain, disability, pain-related fear, negative and positive affectivity, job satisfaction, job stress and physical work load. Regression analyses revealed that pain intensity was a strong predictor of functional (beta = .69, p < .001) and social disability (beta = .67, p < .001). Fear of (re)injury due to movement (beta = .25, p < .001; beta = .28, p < .001) had additional predictive value in both models. Further, (singular) mediation tests indicated that fear for (re)injury partially mediated the relation between pain intensity and disability, and between negative affectivity and disability. Finally, path analyses revealed both fear and pain intensity as mediators between negative affectivity and disability. Overall, our findings point at the relevance of the cognitive-behavioral model of avoidance in occupational settings.     

Pain, frailty and comorbidity on older men: the CHAMP study

Intrusive pain is likely to have a serious impact on older people with limited ability to respond to additional stressors. Frailty is conceptualised as a functional and biological pattern of decline accumulating across multiple physiological systems, resulting in a decreased capacity to respond to additional stressors. We explored the relationship between intrusive pain, frailty and comorbid burden in 1705 community-dwelling men aged 70 or more who participated in the baseline phase of the CHAMP study, a large epidemiological study of healthy ageing based in Sydney, Australia. 9.4% of men in the study were frail (according to the commonly-used Cardiovascular Health Study frailty criteria).Using a combination of self-report and clinical measures, we found an association between frailty and intrusive pain that remained after accounting for demographic characteristics, number of comorbidities, self-reported depressed mood and arthritis (adjusted odds ratio 1.7 (95% confidence interval (CI) 1.1-2.7), p=0.0149). The finding that adjusting for depressed mood, but not a history of arthritis, attenuated the relationship between frailty and intrusive pain points to a key role for central mechanisms. Additionally, men with the highest overall health burden (frail plus high comorbid burden) were most likely to report intrusive pain (adjusted odds ratio 3.0 (95% CI 1.6-5.5), p=0.0004). These findings provide support for the concept that intrusive pain is an important challenge for older men with limited capacity to respond to additional physical stressors. To our knowledge, this is the first study to explore specifically the relationship between pain and frailty.     

The health meanings and practices of older Greek–Canadian widows

Folk health and illness beliefs and practices were abstracted from a large-scale study of older Greek-Canadian widows conceptualized within Leininger's theory of Cultural Care Diversity and Universality using ethnographic, ethnonursing, and life health-care history methods. Data were collected using observation-participation and interviews in three Greek-Canadian communities with 12 widowed key informants and 30 general informants. Interview inquiry guides, Leininger's Life History Health Care Protocol, and field journal recordings assisted data collection. Data were analysed using Leininger's phases of analysis for qualitative data. A major health theme which was abstracted from the raw data and patterns was: health for Greek-Canadian widows meant a state of well-being, ability to perform daily role activities, and avoidance of pain and illness. The findings, which also included folk health care and illness beliefs and practices, will stimulate future nursing research related to health and nursing care of people of diverse cultures.     

Pain in older adults with dementia

Background

We aimed to explore the existing use of pain assessment tools and guidelines, and develop understanding of the practical considerations required to facilitate their use within the nursing home, hospital and community settings.

Methods

A self-administered web-based survey was conducted with nurses, health and social care workers with an interest in the assessment of pain in older adults with cognitive impairment. The survey was distributed to participants in Austria, Belgium, Denmark, Germany, The Netherlands, Switzerland and United Kingdom.

Results

Only a minority of staff reported use of (inter-)national or local standards or specific pain assessment tools in daily practice. A range of tools were reported as being used, which varied across country. While participants generally reported that these pain assessment tools were easy/very easy to use, many participants reported that they were difficult to interpret. Assessment is generally performed whilst providing nursing care. This was highlighted in 70–80% of all participating countries. While many of these tools rely on facial expression of pain, facial expressions were considered to be the least useful in comparison to other items. Furthermore findings showed that nurses employed in long-term care settings did not feel that they were educated enough in pain assessment and management.

Conclusion

Our findings suggest that pain education is required across all countries surveyed. This should include a focus on guidelines and standards for assessment and subsequent management of pain. Findings suggest that clinical staff find interpreting facial expressions in relation to pain more difficult.

     

Correlates of quality of life in older adults with diabetes: the diabetes & aging study

OBJECTIVE

To evaluate associations between health-related quality of life (HRQL) and geriatric syndromes, diabetes complications, and hypoglycemia in older adults with diabetes.

RESEARCH DESIGN AND METHODS

A race-stratified random sample of 6,317 adults with type 2 or type 1 diabetes, aged 60 to 75 years, enrolled in Kaiser Permanente Northern California, who completed a survey that included a HRQL instrument based on the Short Form 8-item health survey. Administrative records were used to ascertain diagnoses of geriatric syndromes, diabetes complications, and hypoglycemia. Associations were estimated between HRQL and exposures in exposure-specific and combined exposure models (any syndrome, any complication, or hypoglycemia). Conservatively, differences of ≥3 points were considered the minimally important difference in HRQL scores.

RESULTS

HRQL was lower with nearly all exposures of interest. The lowest physical HRQL was associated with amputation. In combined exposure models, geriatric syndromes (−5.3 [95% CI −5.8 to −4.8], P < 0.001) and diabetes complications (−3.5 [−4.0 to −2.9], P < 0.001) were associated with lower physical HRQL. The lowest mental HRQL was associated with depression, underweight (BMI <18 kg/m²), amputation, and hypoglycemia. In combined exposure models, only hypoglycemia was associated with lower mental HRQL (−4.0 [−7.0 to −1.1], P = 0.008).

CONCLUSIONS

Geriatric syndromes and hypoglycemia are associated with lower HRQL to a comparable degree as diabetes complications. Addressing geriatric syndromes and avoiding hypoglycemia should be given as high a priority as preventing diabetes complications in older adults with diabetes.Diabetes care guidelines traditionally have focused on blood pressure, cholesterol, and glycemic control to reduce diabetes complications. These guidelines are based on studies performed in middle-aged adults, and the applicability of these studies to the care of older adults with diabetes is unclear (1). The care of older adults is more complicated than younger adults because they are at an elevated risk for geriatric syndromes (i.e., depression and falls), pharmacotherapy-related hypoglycemia, and diabetes complications (2). Care planning is complicated even further by this population’s limited life expectancy and high rates of comorbidity and functional disability (1).Geriatric and general diabetes care guidelines recognize the importance of maximizing health-related quality of life (HRQL) for older adults with diabetes (1,2). However, little research exists on the correlates of HRQL in older adults with diabetes. Nearly all studies have compared HRQL in older adults with diabetes with HRQL in those without diabetes (3–5). Specifically, only one study of older adults has evaluated associations between HRQL and diabetes complications (6).In this study, we compared the associations between HRQL and geriatric syndromes, diabetes complications, and hypoglycemia in older adults with diabetes.     

Pain management of older people in care homes: a pilot study

This article presents the findings of a pilot study conducted within six care homes within a district of the UK. This is stage one of a programme of funded research designed to explore issues surrounding pain and older people living in care homes. The aim of the study was to determine the residents' perceptions of pain and identify their preferred pain management strategies. Staff working in the care homes were interviewed to identify their level of pain knowledge, and the problems perceived by them, as preventing their role in the management of pain within this group. A number of important issues were identified as barriers to reporting pain among the residents, along with important concerns for staff about communication and education. A serendipitous finding demonstrated some age-related differences in perceptions of pain. Recommendations are made for further research in this area.     

Multimorbidity in Canadians living in the community: Results from the Canadian Longitudinal Study of Aging

ObjectiveTo determine the mean number of chronic diseases in Canadians aged 45 to 85 years who are living in the community, and to characterize the association of multimorbidity with age, sex, and social position.DesignAn analysis of data from the Canadian Longitudinal Study on Aging. The number of self-reported chronic diseases was summed, and then the mean number of chronic health problems was standardized to the 2011 Canadian population. Analyses were conducted stratified on sex, age, individual income, household income, and education level.SettingCanada.ParticipantsA total of 21 241 community-living Canadians aged 45 to 85 years.Main outcome measuresOverall, 31 chronic diseases (self-reported from a list) were considered, as were risk factors that were not mental health conditions or acute in nature. Age, sex, education, and household and individual incomes were also self-reported.ResultsMultimorbidity was common, and the mean number of chronic illnesses was 3.1. Women had a higher number of chronic illnesses than men. Those with lower income and less education had more chronic conditions. The number of chronic conditions was strongly associated with age. The mean number of conditions was 2.1 in those aged 45 to 54; 2.9 in those 55 to 64; 3.8 in those aged 65 to 74, and 4.8 in those aged 75 and older (P < .05, ANOVA [analysis of variance]).ConclusionMultimorbidity is common in the Canadian population and is strongly related to age.     

Factors associated with successful aging in Brazilian community-dwelling older adults: When physical health is not enough

ObjectivesTo determine the main factors (physical, psychological, social and spiritual) associated with successful aging in community-dwelling older adults.MethodsA cross-sectional study of older adults was conducted evaluating successful aging (Successful Aging Scale-SAS) and its associated factors (sociodemographics, resilience, religiosity/spirituality, meaning in life, quality of life, social support, self-reported diseases, mental health, medications used, among others) using regression models.ResultsA total of 534 older adults were assessed. Linear regression models showed an association of higher SAS score with greater resilience (Beta = 0.371, p < 0.001), spiritual well-being - meaning (Beta = 0.174, p < 0.001) and quality of life - physical (Beta=0.203, p < 0.001), fewer diseases (Beta=-0.128, p < 0.001), greater meaning in life (Beta=0.116, p = 0.001), less loneliness (Beta=-0.133, p = 0.001), lower tobacco use (Beta=0.080, p = 0.013), greater quality of life – environment (Beta=-0.092, p = 0.013) and more frequent religious attendance (Beta=0.068, p = 0.035).ConclusionThe study results suggested that physical factors, although relevant, were not the main factors associated with successful aging.     

Pain in older adults: a prevalence study in the Mediterranean region of Catalonia.

Although information is available about the prevalence of pain in older adults in Anglo-Saxon and Scandinavian countries, very little is known about older adults in other parts of the world. This study reports the prevalence of pain in a randomly selected sample of older adults living in the Mediterranean region of Catalonia. Besides studying the existence of pain at the time of interview, the authors investigated several characteristics of the participants' pain experience: pain onset, number and location of pain sites, intensity of pain, number of days in pain, severity of pain, the extent to which pain interfered with daily life, and expressed needs in relation to pain. A cross-sectional survey was conducted of adults aged 65 years and over living in Catalonia. A total of 592 individuals participated in the study, and data was collected through personal interviews with participants. The prevalence of any pain was 73.5%, and similar across age groups but higher in females than in males. Among individuals suffering from pain, 94.2 were experiencing chronic pain (i.e., pain of three months' duration or more). The mean number of painful areas (out of 10) was 4.48. No clear pattern of the prevalence of regional pain was observed, although joints were the most frequently reported painful place. Pain interfered in the life of a considerable number of participants (35.5%), but no differences in the level of expressed needs was detected between those that were affected and those that were not. This study provides new evidence that pain is an important problem for the older adult, one that severely impacts on their health status, causing disability and reduced ability to function, particularly in older women.