Lifestyle Aspects As A Predictor Of Pain Among Oldest-Old Primary Care Patients – A Longitudinal Cohort Study

Abstract

Purpose

Dealing with the high prevalence of pain among the oldest-old (+75) is becoming a major health issue. Therefore, the aim of the study was to uncover health-related lifestyle behaviors (HLB) and age-related comorbidities which may predict, influence and prevent pain in old age.

Patients and methods

In this longitudinal cohort study, data were obtained initially from 3.327 individuals aged 75+ from over 138 general practitioners (GP) during structured clinical interviews in 2003. Nine follow-ups (FU) were assessed until 2017. Available data from 736 individuals scoring in FU3 and FU7 were included in this analysis. Data were assembled in an ambulatory setting at participant’s homes. Associations were tested using a linear regression model (model 1) and ordered logistic regression model (model 2).

Results

Statistical analyses revealed increased likelihood to experience pain for participants with comorbidities such as peripheral arterial disease (PAD) (coef. 13.51, P>t = 0.00) or chronic back pain (CBP) (coef. 6.64, P>t = 0.003) or higher body mass index (BMI) (coef. 0.57, P>t = 0.015) and, female gender (coef. 6.00, SE 3.0, t = 2.02, P>t = 0.044). Participants with medium education and former smokers showed significantly lower pain rating (coef. −5.05, P>t = 0.026; coef. −5.27, P>t = 0.026). Suffering from chronic back pain (OR = 2.03), osteoarthritis (OR = 1.49) or depressive symptoms (OR = 1.10) raised the odds to experience impairments in daily living due to pain. Physical activity showed no significant results.

Conclusion

Chronic conditions such as PAD, or CBP, female gender and higher BMI may increase the risk of experiencing more pain while successful smoking cessation can lower pain ratings at old age. Early and consistent support through GPs should be given to older patients in order to prevent pain at old age.

Keywords:

• oldest-old
• health-related aspects
• pain prevention
• longitudinal cohort study
• chronic conditions

Acknowledgement

We want to thank both all participating patients and their general practitioners for their good collaboration.

Ethics Approval And Consent To Participate

Data were derived from the AgeCoDe (study part one: Baseline until FU2, and two: FU3 until FU6) and AgeQualiDe (study part three: FU7 until FU9) study. All GP patients who participated in the study provided written informed consent prior to their participation. The study has been approved by the local ethics committees of all participating study centers and comply with the ethical standards of the Declaration of Helsinki.

• Ethics Commission of the Medical Association Hamburg (reference number: OB/08/02, 2817/2007, and MC-390/13)

• Ethics Committee of the Medical Faculty of the Rheinische Friedrich-Wilhelms-University of Bonn (reference number: 050/02, 258/07, and 369/13)

• Medical Ethics Commission II of the Medical Faculty Mannheim/Heidelberg University (reference number: 2026.4/2002, 2007-253E-MA, and 2013-662N-MA)

• Ethics Committee of the Faculty of Medicine of the University of Leipzig (reference number: 143/2002, 309/2007, and 333-13-18112013)

• Ethical Committee of the Medical Faculty of the Heinrich-Heine-University Düsseldorf (reference number: 2079/2002, 2999/2008, and 2999)

• Ethics Committee of the Faculty of Medicine of the Technical University of Munich (reference number: 713/02, and 713/02 E)

Data Sharing

Due to ethical restrictions involving patients’ data, underlying data are only available on reasonable request. Interested parties may contact the Working Group Medical Statistics and IT-Infrastructure, Institute for General Practice, Hannover Medical School, Hannover, Germany (Birgitt Wiese; [email protected]).

Author Contributions

Members of the AgeCoDe/AgeQualiDe research study group have been involved in the following matters: Analyzing and interpreting data and drafting the manuscript: TM, BW, ME. Substantial contribution to the analysis and interpretation of the data and drafting of the manuscript: TM, ME, BW. Substantial acquisition of data: KH, AF, TM, JW, SW, DW, CB, SR, AP, EM, MP, LK, MW. Substantial contribution to the conception and design of the study: BW, HB, HHK, SW, MW, MS, WM, SGRH. Revised the manuscript critically for important intellectual content: all authors. All authors (TM, ME, HHK, CB, SR, AP, SW, JW, EM, DW, AF, MP, KH, BW, LK, MW, SGRH, WM, MS) read and approved the final version of the manuscript and accept direct responsibility for the manuscript. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Disclosure

Dr Marion Eisele reports grants from the German Federal Ministry of Education and Research, during the conduct of the study. Prof. Dr. Hans-Helmut König reports grants from the German Federal Ministry of Education and Research (BMBF), during the conduct of the study. The authors declare no other conflicts of financial interests or other interests in relation to the present study.