THE COURSE AND CONSEQUENCES OF MUSCULOSKELETAL PAIN IN OLDER POPULATION

持续性疼痛作为老年人福尔斯和功能丧失的危险因素的作用知之甚少，研究人员和临床医生也很少提及。拟议研究的目的是1）检查老年人群中持续性疼痛的患病率，病史和特征，2）调查根据位置和严重程度分类的持续性疼痛作为老年人福尔斯和残疾原因的作用，3）探索中介因素，如疼痛管理，心理因素，以及社会和环境背景对疼痛和功能关系的影响。这项为期2年的流行病学调查将采用基于人群的前瞻性设计。研究队列，将 该计划将挨家挨户招募800名70岁及以上独立居住在波士顿西南部住宅区的讲英语的人。患有中度至重度认知障碍或在没有帮助的情况下无法行走20英尺的人将被排除在外。在基线时，参与者将接受6小时的检查，该检查将分两部分进行，一部分在家中进行，另一部分在诊所进行。基线和2次年度随访访视时获得的测量值将由经过培训的护士进行。主要暴露指标将是根据部位和严重程度分类的疼痛。主要终点为至首次跌倒、复发性福尔斯和ADL、IADL和活动能力（行走和爬楼梯）残疾的时间。中间 将检查的因素包括平衡、力量/强度和步态的性能测量、传统（止痛剂和药物治疗）和非传统疼痛管理方法的使用、心理困扰、自我效能、应对、社会支持和网络、家庭危险和移动辅助设备的使用。这项研究将提高我们对老年人群中持续性疼痛的患病率和功能后果的理解，并将为预防和管理疼痛、福尔斯和残疾的新干预措施的开发提供信息。

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.