Analysis: New research is ongoing to examine how various risk factors can interact to increase the risk of developing pain in older adults
Pain can be a significant restriction to the quality of life and well-being of older adults. Globally, one in five older adults are affected by pain, while it is estimated that 1 in 3 older adults in Ireland are affected. It is the leading cause of disability worldwide, and the associated societal costs and economic burden are predicted to further increase as the global population ages. This presents a huge challenge to the future sustainability of health services, the economy, and the healthy ageing of people.
Yet despite these know challenges, pain is still considerably under-researched in older adults and risk factors associated with the development of pain have not been well established. With an increasingly ageing population, we need to consider how best to care for our elderly.
Previously, pain has been linked to a range of risk factors, which include mental health, physical health (such as comorbid health complaints, disability etc) and lifestyle factors (including physical activity levels, body mass index, smoking, alcohol, sleep problems). Research in the past has predominantly looked at how these factors are individually related to a greater risk of pain, but little consideration has been made to how these factors would interact to increase the risk of developing pain.
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Rather than treating pain as a stand-alone clinical symptom, there may be better value for healthcare systems - and better outcomes for patients - if an older person’s overall health prior to the development of pain is more comprehensively considered. Is it possible to identify groups of older adults who share similar risk behaviours and who are more likely to develop pain in later life? If we could identify such groups, we could promote active healthy ageing and facilitate tailored interventions for pain according to the risk factors relevant to each group.
Identifying risk groups
Recently our team in the University of Limerick used statistical methods to identify groups of older Irish adults, based on their risk factors. Data was taken from The Irish Longitudinal Study on Aging and four distinct groups were identified: Low Risk (51 percent), Physical Health Risk (28 percent), Mental Health Risk (13 percent) and High Risk (eight percent).
Low Risk: individuals with positive mental and physical health,
Physical Health Risk: individuals with positive mental health, but poor physical health,
Mental Health Risk: individuals with positive physical health, but poor mental health,
High Risk: individuals with poor mental and poor physical health.
By identifying groups of older adults based on risk factors, we can identify which individuals are most at risk of developing pain in later life. The benefit of this research for older adults is that it could facilitate the development of tailored interventions to combat pain developing and promote healthy ageing.
Implications for preventing and managing pain in older adults
For example, the work conducted in UL found that individuals in the High Risk group were at a considerably increased risk of developing pain, compared to those in the Low Risk group (35 percent developed pain within two years compared to 13 percent). Individuals in the High Risk group would require more resources and support to prevent or postpone the development of pain, compared to those in the Low Risk group.
Simply treating pain as a stand-alone clinical symptom may be of limited value if an older person’s systemic health, social circumstances and overall life are not considered
Findings also showed that the proportion of individuals developing pain in the Physical Health Risk and Mental Health Risk groups was relatively similar (23 percent compared to 20 percent), yet they appear to develop future pain for very different reasons (poor physical health versus poor mental health). This highlights the need to consider the overall health of our older adults, not just the physical part that is painful, and tailor our interventions and health services accordingly.
Ideally, treatment would also then match an individual’s specific needs. For example, the data in our study demonstrates that those in the Physical Health Risk group were unlikely to report depression (five percent) compared to those in the Mental Health Risk group (84 percent). Considering the role for depression to impact treatment response, it would be reasonable to tailor the treatment of people in the Mental Health Risk profile to take into account treatment of their comorbid depression. Similar practices could be applied for other risk factors which differed between the groups.
These findings demonstrate how important the role of general health and lifestyle is in the development of pain in older adults. Simply treating pain as a stand-alone clinical symptom may be of limited value if an older person’s systemic health, social circumstances and overall life are not considered comprehensively.
This research, which was published in PAIN, was conducted by a multidisciplinary research team at the University of Limerick composed of Aoife O’Neill (Department of Mathematics and Statistics, UL), Dr Kieran O’Sullivan (Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Qatar; School of Allied Health, UL; and Health Research Institute, UL), Dr. Mary O’Keefe (Sydney School of Public Health, University of Sydney; School of Allied Health, UL; and Health Research Institute, UL), Prof. Ailish Hannigan (Graduate Entry Medical School, UL; and Health Research Institute, UL), Prof. Cathal Walsh (Department of Mathematics and Statistics, UL; and Health Research Institute, UL) and Dr. Helen Purtill (Department of Mathematics and Statistics, UL; and Health Research Institute, UL).
The views expressed here are those of the author and do not represent or reflect the views of RTÉ