Pain and Frailty: Do they go hand in hand?

Dr Isabel Rodríguez is a Spanish Geriatrician who’s doing her PhD in Preventive Medicine and Public Health at the Universidad Autónoma de Madrid.  The purpose of her doctorate thesis is to investigate how pain affects ageing. Here she discusses her Age and Ageing paper Frequency, intensity and localization of pain as risk factors for frailty in older adults.

Population ageing is one of the greatest achievements of human progress, but is also one of its greatest challenges. With people living longer, health systems will have to cope with increases in multi-morbidity and disability. In this context, health systems need to explore strategies to prolong a good quality of life and delay the onset of dependence.

A disability is a deficit in physical or cognitive functioning that makes it more difficult for a person to do certain activities.  Among older people, such a lack of function usually occurs progressively and may translate into dependence, which is many times preceded by the frailty syndrome.  Frailty is a common geriatric syndrome which is manifested with symptoms of weakness, low gait speed, low physical activity, unintentional weight loss and poor mental status, and is characterized by increased vulnerability to even minor stressors such as urinary infections or falls. Frail individuals are not only at high risk of dependency, but also of hospitalisation and death. Although the prevalence of frailty varies, in European populations it is about 10% in those aged over 60 years.

Persistent pain is a frequent health problem in older adults. In the English Longitudinal Study of Ageing (ELSA), conducted on a representative sample of people aged ≥50 years in England, 18.1% and 6.6% reported suffering moderate and severe persistent pain, respectively.

Interestingly, the frequency of both pain and frailty increases with age, and they often co-exist. Because of this, and the fact that pain is also a risk factor for falls, functional limitation and death, persistent pain has been considered a cause, a consequence, or even an additional manifestation of frailty.

Recent studies support an association between pain and risk of frailty. In our study, with 1505 individuals aged ≥63 years from the Seniors-Enrica cohort in Spain, we observed that, compared to people with no pain, those with more frequent chronic pain were more likely to become frail. This risk was higher among those with more intensive pain and among those with ≥3 pain sites. Additionally, we found in our study that a higher frequency, intensity and number of locations of pain were associated with higher risk of exhaustion and low physical activity. These three different pain dimensions were consistently related to functional impairment, worse health-related quality of life, cognitive impairment, higher frequency of co-morbidities and increased use of health services. We also observed that chronic diseases such as cardiovascular and lung disease, diabetes, osteomuscular disease and depression, explained part of the association between pain and frailty.

What is most interesting is that these results suggest that establishing an effective pain management strategy may reduce the risk of frailty among the elderly who suffer from chronic pain, thus also reducing their risk of hospitalization, disability and even death.

Read the Age and Ageing paper Frequency, intensity and localization of pain as risk factors for frailty in older adults.

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