Does Pain Predict Frailty in Older Men and Women? Findings From the English Longitudinal Study of Ageing (ELSA)
Does Pain Predict Frailty in Older Men and Women? Findings From the English Longitudinal Study of Ageing (ELSA)
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DOI：
10.1093/gerona/glw226
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发表时间：
2017-03-01
影响因子：
5.1
通讯作者：
Lee, David M.
中科院分区：
文献类型：
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作者：
Wade, Katie F.;Marshall, Alan;Lee, David M.
背景：疼痛被认为是衰老过程中的一种压力源，可能加速健康和功能的衰退。我们的目的是研究自我报告的疼痛与老年男性和女性虚弱发展或恶化之间的纵向关联。方法：研究人群包括5316名生活在英格兰私人家庭的男性和女性，平均年龄64.5岁，参加了英国老龄化纵向研究（ELSA）。本研究使用了ELSA第2和第6波的数据，随访8年。在第二阶段，参与者被问及他们是否“经常被疼痛困扰”，对于那些回答“是”的人，进一步收集有关他们疼痛强度（轻度、中度或重度）的信息。社会经济地位（SES）通过当前/最近的职业和净财富信息进行评估。生成脆弱指数（FI），将存在脆弱定义为FI > 0.35。在第2波没有虚弱的患者中，第2波疼痛和第6波虚弱之间的关系使用逻辑回归进行检验。我们使用负二项回归模型研究疼痛是否能预测第2波和第6波之间FI的变化。对两种模型都进行了年龄、性别、生活方式因素、抑郁症状和社会经济因素的调整。结果：在第2波中，455名（19.7%）男性和856名（28.7%）女性报告他们经常经历中度或重度疼痛。在第2波非虚弱的5159名参与者中，328名（6.4%）在第6波时虚弱。第2波的平均FI为0.11（标准差[SD] = 0.1），第6波为0.15 （SD = 0.1）。在调整了年龄、性别、体重指数、生活方式因素和抑郁症状后，与第二波无疼痛的受试者相比，报告中度疼痛（比值比[OR] = 3.08, 95%可信区间[CI] = 2.28, 4.16）或重度疼痛（OR = 3.78, 95% CI = 2.51, 5.71）的受试者在第六波时明显更容易虚弱。在进一步调整职业类别和/或净财富水平后，这种关联仍然存在。与那些没有疼痛的人相比，那些有轻度、中度或重度疼痛的人也更有可能发展成更严重的虚弱，正如使用FI评估的那样，这种关联在SES调整后仍然存在。没有证据表明疼痛和虚弱之间的联系受到性别的影响。结论：在老年男性和女性中，疼痛与虚弱的风险和强度增加有关。社会经济因素促成了脆弱性的发生；虽然在我们的研究中并没有解释疼痛和虚弱之间的关系。
Background: Pain has been suggested to act as a stressor during aging, potentially accelerating declines in health and functioning. Our objective was to examine the longitudinal association between self-reported pain and the development, or worsening, of frailty among older men and women.Methods: The study population consisted of 5,316 men and women living in private households in England, mean age 64.5 years, participating in the English Longitudinal Study of Ageing (ELSA). Data from Waves 2 and 6 of ELSA were used in this study with 8 years of follow-up. At Wave 2, participants were asked whether they were "often troubled with pain" and for those who reported yes, further information regarding the intensity of their pain (mild, moderate, or severe) was collected. Socioeconomic status (SES) was assessed using information about the current/most recent occupation and also net wealth. A frailty index (FI) was generated, with the presence of frailty defined as an FI > 0.35. Among those without frailty at Wave 2, the association between pain at Wave 2 and frailty at Wave 6 was examined using logistic regression. We investigated whether pain predicted change in FI between Waves 2 and 6 using a negative binomial regression model. For both models adjustments were made for age, gender, lifestyle factors, depressive symptoms, and socioeconomic factors.Results: At Wave 2, 455 (19.7%) men and 856 (28.7%) women reported they often experienced moderate or severe pain. Of the 5,159 participants who were nonfrail at Wave 2, 328 (6.4%) were frail by Wave 6. The mean FI was 0.11 (standard deviation [SD] = 0.1) at Wave 2 and 0.15 (SD = 0.1) at Wave 6. After adjustment for age, gender, body mass index, lifestyle factors, and depressive symptoms, compared to participants reporting no pain at Wave 2 those reporting moderate (odds ratio [OR] = 3.08, 95% confidence interval [CI] = 2.28, 4.16) or severe pain (OR = 3.78, 95% CI = 2.51, 5.71) were significantly more likely to be frail at Wave 6. This association persisted after further adjustment for either occupational class and/or net wealth level. Compared to those without pain, those with mild, moderate, or severe pain were also more likely to develop worsening frailty, as assessed using the FI, and this association persisted after adjustment for SES. There was no evidence that the association between pain and frailty was influenced by gender.Conclusion: Pain is associated with an increased risk and intensity of frailty in older men and women. Socioeconomic factors contribute to the occurrence of frailty; though in our study do not explain the relationship between pain and frailty.