Chronic musculoskeletal pain and the occurrence of falls in an older population

Abstract

Context: Chronic pain is a major contributor to disability in older adults; however, the potential role of chronic pain as a risk factor for falls is poorly understood.

Objective: To determine whether chronic musculoskeletal pain is associated with an increased occurrence of falls in a cohort of community-living older adults.

Design, setting, and participants: The Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) Boston Study is a population-based longitudinal study of falls involving 749 adults aged 70 years and older. Participants were enrolled from September 2005 through January 2008.

Main outcome measure: Participants recorded falls on monthly calendar postcards mailed to the study center during an 18-month period.

Results: There were 1029 falls reported during the follow-up. A report of 2 or more locations of musculoskeletal pain at baseline was associated with greater occurrence of falls. The age-adjusted rates of falls per person-year were 1.18 (95% confidence interval [CI], 1.13-1.23) for the 300 participants with 2 or more sites of joint pain, 0.90 (95% CI, 0.87-0.92) for the 181 participants with single-site pain, and 0.78 (95% CI, 0.74-0.81) for the 267 participants with no joint pain. Similarly, more severe or disabling pain at baseline was associated with higher fall rates (P < .05). The association persisted after adjusting for multiple confounders and fall risk factors. The greatest risk for falls was observed in persons who had 2 or more pain sites (adjusted rate ratio [RR], 1.53; 95% CI, 1.17-1.99), and those in the highest tertiles of pain severity (adjusted RR, 1.53; 95% CI, 1.12-2.08) and pain interference with activities (adjusted RR, 1.53; 95%CI, 1.15-2.05), compared with their peers with no pain or those in the lowest tertiles of pain scores.

Conclusions: Chronic pain measured according to number of locations, severity, or pain interference with daily activities was associated with greater risk of falls in older adults.

Figure 1. Age-adjusted fall rates according to pain measures^a

^a Age-adjusted rates and 95% confidence intervals derived using the direct method, adjusted to the age distribution of the study cohort. ^bJoint pain groups: no pain, single site, multisite pain BPI=Brief Pain Inventory, Pain Severity tertiles=0–0.99, 1.0–3.25, 3.26–10 Pain Interference tertiles= 0, 0.1–1.9, 2–10. * compared to lowest category, p-value <0.05, ** <0.01, *** <0.001