Health
More than half of older adults in the United States – an estimated 18.7 million people – have experienced bothersome pain in the previous month, impairing their physical function and underscoring the need for public health action on pain.
Many of those interviewed by investigators for a study published in the current issue of PAIN reported pain in multiple areas.
The interviews, which included assessments of cognitive and physical performance, were completed by trained survey research staff in the homes of study participants living in the community or in residential care facilities, such as retirement or assisted-living communities.
“Pain is common in older adults and one of the major reasons why we start slowing down as we age,” said lead investigator Kushang V. Patel, PhD, MPH, of the Center for Pain Research on Impact, Measurement, and Effectiveness in the Department of Anesthesiology and Pain Medicine at the University of Washington.
The researchers gained several insights from the new study:
- Bothersome pain afflicts half of community-dwelling older adults in the United States.
- The majority of older adults with pain reported having pain in multiple locations, such as in the back, hips, and knees.
- The percentage of people with pain did not differ by age, even when researchers accounted for dementia and cognitive performance.
- Pain was strongly associated with decreased physical capacity. Older adults with pain, particularly those with pain in multiple locations, had weaker muscle strength, slower walking speed, and poorer overall function than those without pain.
- The researchers analyzed data from the National Health and Aging Trends Study (NHATS), which was designed to investigate multiple aspects of functioning in later life and is funded by the U.S. National Institute on Aging, part of the National Institutes of Health. Investigators conducted in-person interviews with 7,601 adults ages 65 years and older who were enrolled in the NHATS in 2011. All were Medicare beneficiaries.
The overall prevalence of bothersome pain in the last month in the study group was 52.9 percent. Pain did not vary across age groups, and this pattern remained unchanged when accounting for cognitive performance, dementia, proxy responses, and residential-care living status.
Pain prevalence was higher in women and in older adults with obesity, musculoskeletal conditions, and depressive symptoms. The majority (74.9%) of older adults with pain reported multiple sites of pain.
Several measures of physical capacity, including muscle strength and lower-extremity physical performance, were associated with pain and multisite pain.
For example, self-reported inability to walk three blocks was 72 percent higher in participants with pain than without pain.
Participants with one, two, three, and four or more sites were 41 percent, 57 percent, 81 percent and 105 percent more likely to report inability to walk three blocks, respectively, than older adults without pain.
“Considering that pain is often poorly managed in the geriatric population, our findings underscore the need for public health action, including additional epidemiologic research and the development and translation of interventions aimed at improving pain and function in older adults,” Patel concluded.
Population aging is occurring in nearly every country of the world. Not only are the number and proportion of older adults increasing globally, but the older adult population itself is getting older as well.
Gains in life expectancy at older ages have fueled the rapid growth of the oldest-old segment of the population, although it is unclear whether improvements in functional status of older adults have kept pace.
Since disability in late life is a major predictor of medical and social service needs, investigating risk factors for functional decline is a major public health priority.
The study in PAIN by Patel and colleagues clearly identifies the high burden of pain in the older adult population.
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Prescribing an apple a day to all adults aged 50 and over would prevent or delay around 8,500 vascular deaths such as heart attacks and strokes every year in the United Kingdom – similar to giving statins to everyone over 50 years who is not already taking them – according to a study in the Christmas edition of The BMJ.
The researchers conclude that the 150 year old public health message: “An apple a day keeps the doctor away” is able to match more widespread use of modern medicine, and is likely to have fewer side effects.
The research takes into account people who are already appropriately taking statins to reduce their risk of vascular disease and therefore the authors stress that no-one currently taking statins should stop, although by all means eat more apples.
In the United Kingdom, lifestyle changes are the recommended first step to prevent heart disease. However, trial data suggest that statins can reduce the risk of vascular events, irrespective of a person's underlying risk of cardiovascular disease.
As such, calls are being made for greater use of statins at a population level, particularly for people aged 50 years and over.
Using mathematical models a team of researchers at the University of Oxford set out to test how a 150 year old proverb might compare with the more widespread use of statins in the UK population.
They analyzed the effect on the most common causes of vascular mortality of prescribing either a statin a day to those not already taking one or an apple a day to everyone aged over 50 years in the UK.
The researchers assumed a 70 percent compliance rate and that overall calorie intake remained constant.
They estimate that 5.2 million people are currently eligible for statin treatment in the UK and that 17.6 million people who are not currently taking statins would be offered them if they became recommended as a primary prevention measure for everyone over 50.
They calculate that offering a daily statin to 17.6 million more adults would reduce the annual number of vascular deaths by 9,400, while offering a daily apple to 70 percent of the total UK population aged over 50 years (22 million people) would avert 8,500 vascular deaths.
However, side effects from statins mean that prescribing statins to everyone over the age of 50 is predicted to lead to over a thousand extra cases of muscle disease (myopathy) and over ten thousand extra diagnoses of diabetes.
Additional modeling showed a further 3 percent reduction in the annual number of vascular deaths when either apples or statins were prescribed to everybody aged over 30. However the number of adverse events is predicted to double.
“This study shows that small dietary changes as well as increased use of statins at a population level may significantly reduce vascular mortality in the UK,” said the authors.
“This research adds weight to calls for the increased use of drugs for primary prevention of cardiovascular disease, as well as for persevering with policies aimed at improving the nutritional quality of UK diets,” they concluded.
Dr Adam Briggs of the BHF Health Promotion Research Group at Oxford University said: “The Victorians had it about right when they came up with their brilliantly clear and simple public health advice: 'An apple a day keeps the doctor away.' It just shows how effective small changes in diet can be, and that both drugs and healthier living can make a real difference in preventing heart disease and stroke.”
Briggs added, “While no-one currently prescribed statins should replace them for apples, we could all benefit from simply eating more fruit.”
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