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

我们的移动波士顿研究(MBS)研究支持了我们的观点，即老年人的慢性疼痛直接 导致无法解释的跌倒风险增加。我们的结果表明，慢性多部位疼痛，报道 40%的MBS参与者在基线时，独立地与跌倒比率的增加有关 18个月的随访期与无疼痛组进行比较。结果表明，疼痛作为一种 摔倒的因素与平衡、力量和步态缓慢等活动限制无关。基于 越来越多的证据表明认知在老年人行动能力中的作用，同时研究表明大脑 随着慢性疼痛的认知改变，我们提出了一种新的模式！一种认知调节的途径 大脑中的疼痛和相关变化导致注意力能力下降和双重任务 行动不便，继而导致老年人跌倒。这个新的ROI项目，下一步 NLA资助的研究性疗养院项目，即波士顿动员项目的结束 研究(MBS)，将研究我们以人口为基础的老年队列中估计500名持续成员 居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 在MBS的老年人群中的注意力测试中表现较差；2)调查是否 慢性疼痛与在涉及认知的单任务和双任务步态测试中测量的步态改变有关 挑战；3)调查慢性疼痛和跌倒之间的关系是否受 双任务步态测试的注意力和表现；以及4)对区域大脑进行初步调查 50名患有多部位疼痛的老年人和50名老年人的MRI测量结构和体积 没有疼痛的人，从动员波士顿队列中随机选择。为了目标，我们将 使用线性回归和负二项模型进行多变量分析。长期目标 研究的重点是为新的干预措施制定临床和研究目标，以降低跌倒的风险 老年人慢性疼痛，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.