Pain in Homebound Older Adults: Association With Race and Ethnicity and Neighborhood Socioeconomic Deprivation

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ABSTRACT The Mount Sinai Older Adults Independence Center grant (P30AG028741) aims to examine the relationship of pain to quality of life, independence, function, and disability in older adults in general. The purpose of this proposal, for an administrative supplement to P30AG028741, is to expand the focus of the parent grant to characterize pain in a nationally representative sample of homebound older adults, assess disparities by race and ethnicity, and examine the impact of neighborhood socioeconomic deprivation on pain. There are over 7 million homebound older adults in the US. Despite having significant multimorbidity and high risk of hospitalization and mortality, just 11% of this population access medical care in the home. New models of home- based care, including home-based palliative care, are needed to address the complex needs of this population and should be informed by robust epidemiological studies in nationally representative samples. Given its prevalence, impact on well-being, and ready availability in national surveys, pain is an ideal metric to estimate the need for home-based palliative care in homebound older adults. To date, there have been no studies characterizing pain and its disparities in a nationally representative sample of older adults. Guided by a conceptual model informed by the National Institute of Minority Health and Health Disparities Research Framework, our proposed study aims to characterize pain in a nationally representative sample of homebound older adults and specifically examine (i) the association between race and ethnicity and pain; and (ii) the association between neighborhood socioeconomic deprivation and pain. The study sample will be drawn from the nationally representative National Health and Aging Trends Study and include 1730 older adults classified as homebound in 2015. In this cross-sectional study, we will undertake bivariate and multivariable analyses of survey data from the National Health and Aging Trends Study and linked data from American Community Survey to examine the association between race and ethnicity, neighborhood socioeconomic deprivation (measured as census tract Social Deprivation Index), and self/proxy-reported pain. This proposal directly addresses the objectives of the Notice of Special Interest (NOSI, NOT-AG-22-005) in enhancing understanding of the mechanisms (individual, neighborhood) underlying the pain experience, informing strategies to prevent and manage pain, and addressing equity in pain among homebound older adults. The study will be the first to examine pain in a nationally representative sample of homebound older adults and represents an important first step towards characterizing the symptom needs of homebound older adults and expanding the evidence base to plan home-based palliative care. The results will provide important insights into disparities in pain in this population and the association between neighborhood socioeconomic deprivation and symptoms. Additionally, the multilevel linked dataset we create will lay the groundwork for future research on the impact of neighborhood factors on diverse outcomes among homebound older adults.