Nov. 30, 2009 - Senior citizens who reported
chronic musculoskeletal pain in two or more locations, higher levels of
severe pain, or pain that interfered with daily activities were more
likely to experience a fall than older adults who did not reports these
types of pain, according to a study in the November 25 issue of the
Journal of the American Medical Association (JAMA).
"Falls rank among the 10 leading causes of death in
older adults in the United States, resulting in more than $19 billion in
health care costs annually. Despite a growing body of scientific
evidence supporting associations between a number of risk factors and
falls, efforts to translate these findings into effective fall
prevention strategies have been limited," according to the study report.
One-point decrease on social activity scale was
equivalent to being approximately five years older at the start of the
study - risk of death, disability jump
Few reports have examined chronic pain as a risk
for falls in older adults, the authors note. "Pain contributes to
functional decline and muscle weakness and is associated with mobility
limitations that could predispose to falls."
Suzanne G. Leveille, Ph.D., R.N., of Beth Israel
Deaconess Medical Center and the University of Massachusetts-Boston, and
colleagues conducted a study to determine whether chronic
musculoskeletal pain is associated with an increased occurrence of falls
in older adults.
The study included 749 adults, age 70 years and
older, who were enrolled in the study from September 2005 through
January 2008. Pain was assessed via questionnaires. Participants
recorded falls on monthly calendar postcards mailed to the study center
during an 18-month period.
At the beginning of the study, 40 percent of
participants reported chronic pain in more than one joint area and 24
percent reported chronic pain in only one joint area.
A total of 1,029 falls were reported by the 749
participants during and up to 18 months of follow-up.
Four hundred five participants (55 percent) fell at
least once during the follow-up.
Analysis indicated that compared with participants
who reported no pain, or those in the lowest groups of pain scores,
participants who reported two or more sites of pain had an increased
risk for falls. Those reporting the highest levels of pain severity also
had an increased rate of falls. Pain interference with activities was
also associated with a greater occurrence of falls.
The researchers write that they observed a strong
graded relationship in the short term between pain severity ratings each
month with risk for falls in the subsequent month.
"For example, among persons who reported severe or
very severe pain for any given month on their calendar postcard, there
was a 77 percent increased likelihood for a fall in the subsequent month
compared with those who reported no pain." Persons reporting even very
mild pain also had an elevated odds of falling in any given month.
The authors suggest there may be several possible
mechanisms for the pain-falls relationship, including neuromuscular
effects of pain, which could lead to leg muscle weakness or slowed
neuromuscular responses to an impending fall.
"Another factor may be gait alterations or
adaptations to chronic pain that lead to instability and subsequent
balance impairments. Chronic pain may serve as a distractor or, in some
way, interfere with cognitive activity needed to prevent a fall.
Successful avoidance or interruptions of a fall typically requires a
cognitively mediated physical maneuver."
"The findings provide evidence suggesting that the
common complaint of the aches and pains of old age is related to a
greater hazard than previously thought. Daily discomfort may accompany
not only difficulties in performing daily activities but equally as
important may be a risk for falls and possibly fall-related injuries in
the older population.
The significance of this work is in the
identification of chronic pain as an overlooked and potentially
important risk factor for falls in older adults. A randomized controlled
trial is needed to determine whether improved pain control could reduce
risk for falls among older patients with chronic pain," the researchers
conclude.
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