Attention Demands of Chronic Pain and Risk for Falls in Older Adults

我们的MOBILIZE波士顿研究（MBS）研究支持我们的论点，即老年人的慢性疼痛直接 导致无法解释的福尔斯跌倒风险增加。我们的研究结果表明，慢性多部位疼痛，报告 在基线时，40%的MBS参与者，与治疗期间福尔斯跌倒率的增加独立相关。 随访18个月，与无疼痛的患者进行比较。结果表明，疼痛作为一种 导致福尔斯跌倒的因素与平衡、力量和诸如缓慢步态的移动性限制无关。基于 越来越多的证据表明，认知在老年人的运动中起着重要作用， 和认知变化与慢性疼痛，我们提出了一个新的模式！认知介导的途径 由此疼痛和大脑中的相关变化导致注意力能力降低和双重任务 活动受限，并随后导致老年人的福尔斯跌倒。这个新的ROI项目，下一步是 国家情报局资助的研究型疗养院项目的结束，被称为“移动波士顿” 研究（MBS），将研究估计500名继续成员，我们的人口为基础的队列老年人 住在波士顿地区的人。我们的具体目标是：1）调查慢性疼痛是否有助于 MBS老年人群在注意力测试中表现较差; 2）调查是否 慢性疼痛与单任务和双任务步态测试中测量的步态改变相关， 挑战; 3）调查慢性疼痛和福尔斯之间的关系是否受到以下因素的影响： 双任务步态测试的注意力和表现;和4）进行区域脑的初步调查 MRI测量了50名患有多部位疼痛的老年人的结构和体积， 没有疼痛的人，从MOBILIZE Boston队列中随机选择。为了实现目标，我们将 使用线性回归和负二项模型进行多变量分析。远景目标 这项研究旨在为新的干预措施开发临床和研究目标，以降低福尔斯的风险， 慢性疼痛的老年人，并最终改善临床和康复护理。

Our MOBILIZE Boston Study (MBS) research supports our thesis that chronic pain in older persons directly contributes to an unexplained increase in risk for falls. Our results show that chronic multisite pain, reported by 40% of MBS participants at baseline, is independently associated with an increased rate of falls during the 18 month follow-up compared to those without pain. The results show that the role of pain as a contributor to falls is independent of balance, strength, and mobility limitations such as slow gait. Based on accumulating evidence ofthe role of cognition in mobility in older adults coupled with research showing brain and cognitive changes with chronic pain, we propose a new mode! of a cognitively-mediated pathway whereby pain and associated changes in the brain contribute to reduced attentional capacity and dual task mobility limitations and subsequently to falls in older adults. This new ROI project, the next step following the conclusion ofthe NlA-funded Research Nursing Home Program Project, known as the MOBILIZE Boston Study (MBS), will study an estimated 500 continuing members of our population-based cohort of older persons living in the Boston area. Our specific aims are: 1) to investigate whether chronic pain contributes to poorer performance in tests of attention in the older population of the MBS; 2) to investigate whether chronic pain is associated with gait alterations measured in single and dual task gait tests involving cognitive challenges; 3) to investigate whether the relationship between chronic pain and falls is influenced by attention and performance on dual task gait tests; and 4) to conduct a pilot investigation of regional brain structure and volume measured by MRI in 50 older adults who have multisite pain compared to 50 older persons who have no pain, randomly selected from the MOBILIZE Boston cohort. For the aims, we will perform multivariable analyses using linear regression and negative binomial modeling. The long-term goal ofthe research is to develop clinical and research targets for new interventions to reduce risk of falls among older adults with chronic pain, and ultimately to improve clinical and rehabilitative care.