Incorporating Persistent Pain in Phenotypic Frailty Measurement and Prediction of Adverse Health Outcomes

Abstract

Background: Frailty, a syndrome of physiological deficits, is prevalent among older adults and predicts elevated risk of adverse health outcomes. Although persistent pain predicts similar risk, it is seldom considered in frailty measurement. This article evaluated the construct and predictive validity of including persistent pain in phenotypic frailty measurement. Methods: Frailty and persistent pain were operationalized using data from the Health and Retirement Study (2006-2012 waves). Among a subset of adults aged 65 and older (n = 3,652), we used latent class analysis to categorize frailty status and to evaluate construct validity. Using Cox proportional hazards models, we compared time to incident adverse outcomes (death, fall, hospitalization, institutionalization, and functional disability) between frailty classes determined by either including or excluding persistent pain as a frailty component. Results:In latent class models, persistent pain occurred with other frailty components in patterns consistent with a medical syndrome. Frail and intermediately frail classes determined by including persistent pain were more strongly associated with all adverse outcomes compared with frail and intermediately frail classes determined excluding persistent pain. Frail respondents had significantly greater risk of death compared with nonfrail respondents when frailty models included rather than excluded persistent pain (respectively, hazard ratio [HR] = 3.87, 95% confidence interval [CI] = 2.99-5.00 (including pain); HR = 2.10, 95% CI = 1.71-2.59 (excluding pain). Conclusions: Findings support consideration of persistent pain as a component of the frailty phenotype. Persistent pain assessment may provide an expedient method to enhance frailty measurement and improve prediction of adverse outcomes.

Chronic Pain and Related Factors in Patients Aged ≥80 Years

“…Current studies also support our findings (26,27). In addition, Lohman et al (28) found that the inclusion of persistent pain as an additional criterion for frailty led to a potentially better prediction of incident adverse outcomes. In addition, chronic pain among community-dwelling older adults is a risk factor for worsening frailty (29).…”

Impact of frailty on chronic pain, activities of daily living and physical activity in community‐dwelling older adults: A cross‐sectional study

“…In addition, Lohman et al . suggested that consideration of chronic pain might provide an expedient method to enhance assessment of frailty among older adults . The present findings were consistent with the results of these studies, and highlighted that assessment of chronic pain is important for community‐dwelling older adults with frailty.…”

Suffering in silence: a qualitative study of older adults’ experiences of living with long-term musculoskeletal pain at home

“…In addition, there is a need to take into account that healthcare problems such as pain and the situation as a whole often is accompanied with comorbidities and frailty. A holistic approach is needed in the overall management of pain to provide appropriate health care (Lohman et al 2017;Nijs et al 2020;Reid et al 2015;Vadivelu et al 2011), a care that guides and supports the older adults based on their needs (Gillsjö et al 2013).…”