THE COURSE AND CONSEQUENCES OF MUSCULOSKELETAL PAIN IN OLDER POPULATION

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The role of persistent pain as a risk factor for falls and functional losses in older persons is poorly understood and seldom addressed by researchers and clinicians alike. The aims of the proposed research are 1) to examine the prevalence, history and characteristics of persistent pain in the older population, 2) to investigate the role of persistent pain, classified according to location and severity, as a cause of falls and disability in older adults and 3) to explore mediating factors such as pain management, psychological factors, and the social and environmental contexts for their influence on the pain and function relationships. This 2-year epidemiologic investigation will use a prospective population-based design. The study cohort, to be recruited door-to-door, will include 800 English-speaking persons aged 70 and older living independently in the residential Southwest section of Boston. Persons with moderate to severe cognitive impairment or those who are unable to walk 20 feet without help will be excluded. At baseline, participants will undergo a 6-hour examination that will take place in two parts, one in the home and the other, in the clinic. Measures obtained at baseline and in 2 annual follow-up visits will be conducted by a trained nurse. The primary exposure measure will be pain classified according to location and severity. The primary endpoints will be time to first fall, recurrent falls, and disability in ADL, IADL, and mobility (walking and climbing stairs). Intermediate factors that will be examined include performance measures of balance, power/strength, and gait, use of conventional (analgesics and medical therapies) and non-conventional pain management approaches, psychological distress, self-efficacy, coping, social support and network, home hazards and use of mobility aids. This study will improve our understanding of the prevalence and functional consequences of persistent pain in the older population, and will inform development of new interventions to prevent and manage pain, falls, and disability.