Tuesday, December 1, 2009

Aches, Pains in Elderly Increase Hazardous Falls

Chronic pain to some extent is experienced by as many as 2 of every 3 older adults. Now, a new study reports that such pain may be more hazardous than previously thought, contributing to an increased risk of falls in persons 70 years of age and older.

Writing in the Journal of the American Medical Association (JAMA), Suzanne G. Leveille and coauthors write, “Falls rank among the 10 leading causes of death in older adults in the United States, resulting in more than $19 billion in health care costs annually. Despite a growing body of scientific evidence supporting associations between a number of risk factors and falls, efforts to translate these findings into effective fall prevention strategies have been limited. …. Pain contributes to functional decline and muscle weakness and is associated with mobility limitations that could predispose to falls.”

The researchers — at Beth Israel Deaconess Medical Center and the University of Massachusetts-Boston — prospectively studied 749 adults, age 70 and older from September 2005 through January 2008. Pain was assessed via questionnaires, and participants recorded falls on monthly basis during an 18-month period. At the beginning of the study, 40% of participants reported chronic pain in more than one joint area and 24% reported chronic pain in only one joint area. A total of 1,029 falls were reported by participants during the study. Compared with participants who reported no pain or those in the lowest groups of pain scores, significantly increased rates of falls were found in participants with 2 or more sites of pain, in those reporting the highest levels of pain severity, and in subjects whose pain interfered with daily activities. Persons reporting even very mild pain also had a somewhat elevated odds of falling in any given month.

The authors suggest there may be several possible mechanisms for the relationship between pain and falls, including neuromuscular effects of pain leading to leg muscle weakness or slowed responses to an impending fall. “Another factor may be gait alterations or adaptations to chronic pain that lead to instability and subsequent balance impairments. Chronic pain may serve as a distractor or, in some way, interfere with cognitive activity needed to prevent a fall,” they write.

Practice Pointers: This study provides evidence suggesting that the common aches and pains of old age can be a greater hazard than previously thought. “Daily discomfort may accompany not only difficulties in performing daily activities but equally as important may be a risk for falls and possibly fall-related injuries in the older population,” the authors note. Sedating effects of analgesics, particularly opioids, might be thought of as contributing to falls, but this was not found in this study. In fact, the authors note that underuse of analgesics could contribute to falls due to unrelieved pain effects. A randomized controlled trial would help assess the extent to which improved pain control might reduce falls in this population; meanwhile, this study implies that, beyond compassionate reasons for relieving pain in older patients, there could be serious consequences of falls associated with ignoring or inadequately treating common pain complaints.

Reference: Leveille SG, Jones RN, Kiely DK, et al. Chronic Musculoskeletal Pain and the Occurrence of Falls in an Older Population. JAMA. 2009(Nov);302(20):2214-2221 [see abstract].