Chronic pain found to increase risk of falls in older adults

BOSTON, 30 nov 2009 – Chronic pain is experienced by as many as two out of three older adults. Now, a new study finds that pain may be more hazardous than previously thought, contributing to an increased risk of falls in adults over age 70. The findings appear in the November 25 issue of The Journal of the American Medical Association (JAMA).

"It's clear that pain is not just a normal part of aging and that pain is often undertreated in older adults," explains lead author Suzanne Leveille, PhD, RN, who conducted the research while a member of the Division of Primary Care at Beth Israel Deaconess Medical Center (BIDMC) and is currently on the faculty at the University of Massachusetts Boston. "Our findings showed that older adults who reported chronic musculoskeletal pain in two or more locations – mainly in the joints of the arms and legs – as well as individuals who reported more severe pain or pain that interfered with daily activities were more likely to experience a fall than other individuals."

Leveille used data gathered as part of MOBILIZE Boston (Maintenance of Balance, Independent Living, Intellect and Zest in the Elderly), a cohort study headquartered at the Institute for Aging Research at Hebrew SeniorLife and led by Principal Investigator Lewis Lipsitz, MD. One of the goals of the study is to gain a better understanding of what causes falls in older adults in order to develop new ways to prevent falls from occurring.

Between September 2005 and January 2008, 749 adults over the age of 70 enrolled in the MOBILIZE study were interviewed about their health, including being asked questions about pain. They also underwent a physical assessment by a nurse. Over the next 18 months, the participants recorded any falls they had on monthly calendar postcards that were then mailed to the Institute for Aging Research.

"At the beginning of the study, 40 percent of the participants reported experiencing chronic pain in more than one joint area and 24 percent reported chronic pain in a single joint," explains Leveille. "During the 18-month study period, the 749 participants reported a total of 1,029 falls, with more than half the participants falling at least once during this period." Data analysis revealed that compared with study participants who reported no pain, the participants who experienced chronic pain in two or more joints had a 50 percent greater risk of falling.

"Our results suggest that pain should be added to the list of risk factors for falls, as persons who have chronic pain in two or more joints, and those who have moderate to severe pain or disabling pain, are at significantly higher risk," says Leveille. "Assessment and management of chronic pain is a key part of health care for many older adults."

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This study was funded by a grant from the National Institute on Aging and support from Pfizer, Inc.

Study coauthors include Robert Shmerling, MD, of BIDMC; Hebrew SeniorLife Institute for Aging Research investigators Richard Jones, ScD, Dan Kiely, MPH, Douglas Kiel, MD, and Lewis Lipsitz, MD; Jonathan Bean, MD, of Spaulding Rehabilitation Hospital; Jeffrey Hausdorff, PhD, of Tel-Aviv Sourasky Medial Center; and Jack Guralnik, MD, PhD, of the National Institute on Aging.

About BIDMC: Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School and consistently ranks in the top four in National Institutes of Health funding among independent hospitals nationwide. BIDMC is a clinical partner of the Joslin Diabetes Center and is a research partner of the Dana-Farber/Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox. For more information, visit www.bidmc.org.