Abstract
ObjectiveChronic musculoskeletal pain is common in older adults but the nature of its relationship with ageing is unclear. The objective for this study was to test the hypothesis that the onset of widespread pain would be associated with a decrease in healthy ageing.MethodsPopulation-based prospective cohort study. A “healthy ageing” index was constructed across biomedical, physical, psychosocial and lay components. Analysis was performed with 2949 adults aged 50 years and over who had complete index scores at baseline, 3 and 6-year follow-ups.ResultsAt three and six year follow-up, 365 (16.8%) and 259 (14.3%) experienced the onset of widespread pain. The onset of widespread pain during the six-year period was associated with a 25% and a 46% decrease in healthy ageing index scores; this decrease was independent of age, sex, education, social networks, smoking status, alcohol consumption and physical inactivity. The decrease in healthy ageing attenuated to 20% and 39% following adjustment for diagnosed musculoskeletal conditions and analgesic and non-steroidal use.ConclusionsThe onset of widespread pain was associated with a decrease in healthy ageing throughout the six-year period. When pain increased over time, the markers of unhealthy ageing increased also. Strong analgesia was associated with unhealthy ageing. Research could now usefully test whether early identification, improved treatment and prevention of pain prior to old age may facilitate healthy ageing.
Highlights
Chronic musculoskeletal pain is one of the most common disorders in older people [1]
This represents 30.1% of those who provided consent for medical record review and were alive at 6 year follow up and could have returned a questionnaire. This response rate is comparable with other population based cohorts (e.g. Asset and Health Dynamic Survey Among the Oldest Old (AHEAD) [13]). Compared to those subjects who had moved address, withdrew from the study or had incomplete data (n = 5826), those included in the analysis were younger, more likely to have gone onto further education (9.8% cf 11.7%; p,0.001), have better mental and physical health-related quality of life scores (Mean SF-12 [14] mental component: 55.1 cf 52.2 (p,0.001) and physical component (Mean SF-12 [14] physical health scores: 47.7 cf 42.0; p,0.001)), have higher baseline index scores indicating more healthy ageing (74.6 cf 78.5; p,0.001) and lower levels of cognitive impairment (49.7% cf 39.1%; p,0.001) and depression (Table 1)
Those who died after baseline (n = 836) had significantly lower baseline index scores (57.7; p,0.001); were older, had lower levels of health (Mean SF-12 mental health component: 47.3; Mean SF-12 physical health component: 30.9), higher levels of cognitive impairment (61.8%) and depression (34.8%) and a weaker relationship between widespread pain and health ageing (proportional difference: 87% (68%, 108%)) compared to those included in the analysis
Summary
Chronic musculoskeletal pain is one of the most common disorders in older people [1]. Whilst chronic pain in older people is often attributed to osteoarthritis and allied disorders, it is clear that this is a problem of chronic pain per se [2] which is not necessarily associated with advanced radiographic degeneration in the joint in which the symptoms occur [3] and commonly occurs in multiple bodily sites including non-joint sites [4]. In older people widespread pain is common [1] and is strongly associated with poor outcomes across multiple health domains including cognitive functioning, sexual functioning, and falls [6,7,8]. Healthy ageing can be characterized by functional independence, a multi-faceted state, involving preservation of biomedical, physical and psychosocial health that enables cognitive, physical and mental wellbeing, social participation and improved quality of life [10,11]. While conceptualizing and operationalizing the complexity of multiple outcomes is challenging, the construct of healthy ageing provides a useful method to capture outcomes across multiple domains [10]
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