Mediation of pain in the association of sleep problems with falls among older adults in India

Abstract

Body pain, sleep problems and falls are commonly reported among the elderly population. This study aimed to explore the mediating role of pain in the association of sleep problems with fall-outcomes (falls, fall-injury, and multiple falls) among older adults. Cross-sectional data from the baseline survey of Longitudinal Aging Study in India (LASI), 2017–18 were used. The total sample size for the study was 28,285 older adults aged 60 years and above. Falls and fall-related injuries among older adults in the last two years were self-reported. The Jenkins Sleep Scale (JSS-4) was used to assess sleep problems while pain was assessed using questions on whether respondents reported that they were troubled by pain and they required some form of medication or treatment for the relief of pain. Multivariable logistic regression and mediation analyses were conducted to fulfill the study objectives. While 13% older adults suffered from sleep problems, 38.83% were troubled with pain. Additionally, 12.63%, 5.64% and 5.76% older adults reported falls, fall-injury and multiple falls respectively. Older adults who suffered from sleep problems had higher odds of falls [adjusted odds ratio (aOR): 1.43, confidence interval (CI): 1.30–1.58], fall-injuries, [aOR:1.50,CI:1.30–1.73] and multiple falls [aOR:1.41,CI:1.24–1.62]. Similarly, older adults who were troubled with pain were more likely to report falls [aOR:1.80, CI:1.67–1.95], fall-injuries [aOR:1.66, CI:1.48–1.87] and multiple falls [aOR:1.90,CI:1.69–2.12]. The percent of the mediated effect of pain when examining the association between sleep problems and fall outcomes were reported to be 17.10%, 13.56% and 18.78% in case of falls, fall-injuries and multiple falls respectively. The current study finds evidence that pain mediates the association of sleep problems and falls, fall-injuries, and multiple falls among older Indian adults. Both sleep problems and pain are modifiable risk factors that need attention for fall prevention strategies.

Associations between intrinsic capacity, functional difficulty, and fall outcomes among older adults in India

“…Consequently, there remains the possibility of underestimation or overestimation of the burden of falls due to recall bias 27 . Nevertheless, the prevalence of falls, multiple falls, and fall-related injuries in the present study were consistent with prior evidence from India 49 , 62 .…”

“…The higher prevalence of functional disability corroborates the argument of WHO that the prevalence of disability among older adults is increasing drastically due to the combined effect of demographic and epidemiological transitions 61 . Further, in the past 2 years, a significant percentage of older adults reported falling (12.36%), which is lesser than the estimates projected by research conducted in other nations 49 . The pooled prevalence of falls was found to be 31% in a systematic review and meta-analysis of the burden of falls among older Indians 27 .…”

“…Additionally, information on multiple falls was calculated from the question on the number of falls in the last 2 years. Those who reported falls more than once were considered as having multiple falls 49 .…”

“…Previous research has identified a number of determinants of functional difficulty and falls, such as socio-demographics, household factors, lifestyle factors 55 and health-related factors 49 , 56 . The study used socio-demographic variables such as age (recoded as 60–69, 70–79 and 80 +), sex (male and female), education (recoded as none, primary, secondary and higher), marital status (recoded as married, widowed and others which included separated, divorced and never married) and work status (recoded as never worked, currently working, not working and retired).…”

Timed Up and Go test score and factors associated with a moderate-to-high risk of future falls in patients scheduled for vascular surgeries—a cross-sectional study

“…In the study conducted by Li et al ( 47 ), it was confirmed that people suffering from pain were 73% more exposed to falls than those that did not feel pain. The study of Muhammad et al ( 48 ) also provides evidence that pain is a fall risk factor. In addition, the meta-analysis conducted by Stubbs et al ( 49 ) indicated that in the case of older adult people that reported pain, the risk of falls was 56% greater than in the case of people that did not feel pain.…”