Lifestyle Aspects As A Predictor Of Pain Among Oldest-Old Primary Care

Tina Mallon,¹ Marion Eisele,¹ Hans-Helmut König,² Christian Brettschneider,² Susanne Röhr,³ Alexander Pabst,³ Siegfried Weyerer,⁴ Jochen Werle,⁴ Edelgard Mösch,⁵ Dagmar Weeg,⁵ Angela Fuchs,⁶ Michael Pentzek,⁶ Kathrin Heser,⁷ Birgitt Wiese,⁸ Luca Kleineidam,⁹ Michael Wagner,⁹ Steffi Riedel-Heller,³ Wolfgang Maier,^7,9 Martin Scherer¹

¹Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; ²Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; ³Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany; ⁴Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany; ⁵Department of Psychiatry, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; ⁶Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany; ⁷Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany; ⁸Work Group Medical Statistics and IT-Infrastructure, Institute for General Practice, Hannover Medical School, Hannover, Germany; ⁹DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany

Correspondence: Tina Mallon
Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Tel +49-40-741057164
Fax +49-40-741053681
Email [email protected]

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