Sandhi Patchay

Pain and the Risk for Falls in Community-Dwelling Older Adults: Systematic Review and Meta-Analysis

OBJECTIVE To conduct a systematic review and meta-analysis to establish the association between pain and falls in community-dwelling older adults. DATA SOURCES Electronic databases from inception until March 1, 2013, including Cochrane Library, CINAHL, EBSCO, EMBASE, PubMed, and PsycINFO. STUDY SELECTION Two reviewers independently conducted the searches and completed methodological assessment of all included studies. Studies were included that (1) focused on adults older than 60 years; (2) recorded falls over 6 or more months; and (3) identified a group with and without pain. Studies were excluded that included (1) participants with dementia or a neurologic condition (eg, stroke); (2) participants whose pain was caused by a previous fall; or (3) individuals with surgery/fractures in the past 6 months. DATA EXTRACTION One author extracted all data, and this was independently validated by another author. DATA SYNTHESIS A total of 1334 articles were screened, and 21 studies met the eligibility criteria. Over 12 months, 50.5% of older adults with pain reported 1 or more falls compared with 25.7% of controls (P<.001). A global meta-analysis with 14 studies (n=17,926) demonstrated that pain was associated with an increased odds of falling (odds ratio [OR]=1.56; 95% confidence interval [CI], 1.36-1.79; I(2)=53%). A subgroup meta-analysis incorporating studies that monitored falls prospectively established that the odds of falling were significantly higher in those with pain (n=4674; OR=1.71; 95% CI, 1.48-1.98; I(2)=0%). Foot pain was strongly associated with falls (n=691; OR=2.38; 95% CI, 1.62-3.48; I(2)=8%) as was chronic pain (n= 5367; OR=1.80; 95% CI, 1.56-2.09; I(2)=0%). CONCLUSIONS Community-dwelling older adults with pain were more likely to have fallen in the past 12 months and to fall again in the future. Foot and chronic pain were particularly strong risk factors for falls, and clinicians should routinely inquire about these when completing falls risk assessments.

The Avoidance of Activities due to Fear of Falling Contributes to Sedentary Behavior among Community-Dwelling Older Adults with Chronic Musculoskeletal Pain: A Multisite Observational Study

OBJECTIVE Physical inactivity and sedentary behavior (SB) are leading causes of mortality. We investigated if older adults with chronic musculoskeletal pain (CMP) are more sedentary than a group of similar age and sex without CMP and possible contributory factors to this. METHOD In this multisite observational study, 285 community-dwelling older adults (response rate 71%) took part. One hundred forty-four had CMP (78.4 years, 65.9% female), and 141 formed the comparison group without CMP. Details regarding falls were collected, and all participants completed the brief pain inventory (BPI), modified version of the survey of activities and fear of falling in elderly scale (mSAFFE), and the International Physical Activity Questionnaire (IPAQ) to measure SB. Data were analyzed with hierarchical regression analysis. RESULTS Older adults with CMP spent approximately 3 1/2 hours a day more being sedentary than the comparison group (11.5 hours vs 7.9, P<0.001). The addition of BPI interference and mSAFFE scores in the regression analysis resulted in an R(2) change of 10.4% in IPAQ scores, over and above the variance explained by the background demographic, medical, and mobility factors. Excessive concerns about the consequences of falling did not increase the variance in SB. Within the final model, mSAFFE scores were the largest independent predictor of SB (β=0.461, P<0.001). CONCLUSIONS Older adults with CMP are significantly more sedentary than those of a similar sex and age without CMP. It appears that the avoidance of activities due to fear of falling is a significant contributory factor to SB in older adults with CMP.

Is there a relationship between pain and psychological concerns related to falling in community dwelling older adults? A systematic review

Abstract Purpose: To systematically review and synthesise the research evidence linking pain to psychological concerns about falling in community dwelling older adults. Methods: A systematic review was conducted in accordance with the preferred reporting items of systematic reviews and meta-analysis statement (PRISMA). Major electronic databases were searched from inception until June 2013. Two authors independently conducted the searches, extracted data and completed methodological quality assessments. Articles were included if they measured one of the psychological concerns related to falling in a sample of community dwelling older adults with pain, or explored the association between the two. Results: Of a potential 892 articles, 12 met the eligibility criteria (n = 3398). The methodological quality of the included studies was variable and none of the included studies primary aim was to investigate the relationship between pain and psychological concerns related to falls. Two studies found significant differences in psychological concerns related to falls in older adults with pain and a control group. Nine out of 10 studies reported a significant correlation between pain and psychological concerns related to falls in their sample. Conclusion: This review provides provisional evidence that pain is associated with fear of falling (FOF), avoidance of activities due to FOF and falls efficacy in community dwelling older adults. Implications for Rehabilitation Pain is a common and pervasive problem in community dwelling older adults and can affect an individual’s mobility, levels of physical activity and increase their falls risk. Psychological concerns related to falls, such as fear of falling (FOF), falls efficacy and balance confidence are also common and troublesome issues in older adults, yet the association with pain has not been investigated with a systematic review. This review provides provisional evidence that pain may increase older adult’s risk of developing FOF, avoiding activities due to a FOF and impact their falls efficacy. In recognition of the findings of this review, clinicians working with older adults with pain should consider assessing psychological concerns related to falls and if necessary intervene if they identify an individual at risk.

Mobility Limitations and Fall‐Related Factors Contribute to the Reduced Health‐Related Quality of Life in Older Adults With Chronic Musculoskeletal Pain

To investigate (1) the prevalence of chronic musculoskeletal pain (CMP) among a sample of community‐dwelling older adults and (2) health‐related quality of life (HRQOL) in people with CMP, particularly the association with mobility limitations and falls‐related factors.

Older adults with chronic musculoskeletal pain are at increased risk of recurrent falls and the brief pain inventory could help identify those most at risk

Chronic musculoskeletal pain (CMP) and falls are common among community‐dwelling older adults. The study aims were: (i) to investigate the relationship between CMP and any falls (≥1), single falls and recurrent falls (≥2) in community‐dwelling older adults; and (ii) to determine the discriminative validity of the Brief Pain Inventory (BPI) to differentiate between non‐fallers and (a) any and (b) recurrent fallers.