Is Tai Chi beneficial for multisite pain syndrome in older adults?

Chronic musculoskeletal pain is prevalent and undertreated in older adults. In particular, multisite pain is associated with serious functional consequences and falls and appears to be a novel geriatric syndrome. The causes of multisite pain are often multifactorial, and emerging evidence supports a complex pathway whereby multisite pain leads to cognitive problems, mobility decline, fear of falling, falls, and reduced participation in life roles. A few pharmacologic approaches are safe and effective for older adults with chronic multisite pain and evidence for effectiveness of non-pharmacologic treatments for this common condition is very limited. Compared to light physical exercise, mind-body exercise may prove to be more beneficial for older adults living with chronic pain. Tai Chi, as a movement-based mind-body exercise, can relieve pain symptoms, improve cognition and physical function, and lower risk for falls in older adults. However, little is known about the potential benefits of Tai Chi for older adults with multisite pain syndrome. Future large-scale randomized-controlled trials are needed to investigate the effectiveness of Tai Chi in alleviating pain and lowering fall risk in older adults with multisite pain, and the biological mechanisms that underlie its potential benefits to chronic pain, physical and cognitive functions, and falls in this at-risk population.

Association of oral care with periodontitis and glycemic control among US adults with diabetes.

BACKGROUND: Studies indicate that treating periodontitis may benefit glycemic control among people with diabetes. It is unclear whether oral self-care such as flossing may reduce risk for periodontitis and improve glycemic control among people with diabetes. The purpose of this study was to examine associations between oral care, specifically, flossing and preventive dental care, with periodontitis and glycemic control, among US dentate adults with diabetes. METHODS: We analyzed data from the National Health and Nutrition Examination Survey 2011-2014 for 892 participants aged 30 years and older with diabetes who completed the periodontal examination and lab test for hemoglobin A1c (HbA1c). Sampling weights were applied. Multivariable logistic regression and multivariable linear modeling were performed to examine the associations of flossing and preventive dental services on periodontal health and HbA1c levels, respectively, controlling for sociodemographic characteristics, health behaviors, and other risk factors. RESULTS: Among U.S. dentate adults with diabetes, 52.1% of flossers and 72.1% of non-flossers had periodontitis (p < 0.001). Flossers were 39% less likely to have periodontitis (Adj. OR 0.61, 95% CI 0.43-0.88) compared to non-flossers. Flossers had an average HbA1c reading 0.30% (95% CI 0.02%-0.58%) lower than non-flossers, adjusted for covariates (p = 0.037). Preventive dental visits were associated with reduced risk for periodontitis (Adj. OR 0.54, 95%CI, 0.38-0.75) but not glycemic control. CONCLUSION: Flossing was associated with periodontal health and glycemic control among US adults with diabetes. Although further research is needed, the findings support that oral self-care may be particularly beneficial for adults with diabetes.

Chronic pain and circumstances of falls in community-living older adults: an exploratory study.

BACKGROUND: Chronic pain is a risk factor contributing to mobility impairment and falls in older adults. Little is known about the patterns of circumstances of falls among older adults with chronicpain. OBJECTIVE: To examine the relationship between chronic pain and circumstances of falls including location, activities at the time of falls and self-reported causes of falls in older adults. DESIGN: Prospective cohort study. SETTING: Communities in/around Boston, Massachusetts. SUBJECTS: The MOBILIZE Boston Study enrolled 765 adults aged ≥70 years. METHODS: Pain severity, fall occurrence and fall circumstances were recorded using monthly calendar postcards and fall follow-up interviews during a 4-year follow-up period. Generalised estimating equation models were performed to examine the relation between monthly pain ratings and circumstances of the first fall in the subsequent month. RESULTS: Compared to fallers without chronic pain, fallers with moderate-to-severe pain had around twice the likelihood of reporting indoor falls (aOR = 1.93, 95%CI: 1.32-2.83), falls in living or dining rooms (aOR = 2.06, 95%CI: 1.27-3.36), and falls due to health problems (aOR = 2.08, 95%CI: 1.16-3.74) or feeling dizzy or faint (aOR = 2.10, 95%CI: 1.08-4.11), but they were less likely to report falls while going down stairs (aOR = 0.48, 95%CI: 0.27-0.87) or falls due to a slip or trip (aOR = 0.67, 95%CI: 0.47-0.95) in the subsequent month. CONCLUSIONS: Given the exploratory nature of the study, these findings should be interpreted with caution. Future studies may investigate whether better pain management and tailored fall prevention in older people with chronic pain could lead to fewer falls.

Frontline healthcare workers' mental distress, top concerns, and assessment on hierarchy of controls in response to COVID-19: a cross-sectional survey study.

BACKGROUND: The existing studies showed that frontline healthcare workers during an epidemic experienced unusual stressors and mental distress which even lasted for years after the crisis. It is important to learn about their concerns early to mitigate the negative impact as well as to evaluate disease control from experiences on the front lines for improving responses to the outbreak. The study aimed to provide insights on how to strengthen public health responses to protect healthcare workers both physically and mentally, and effectively control the disease in light of hierarchy of controls. METHODS: A cross-sectional survey was distributed online via Qualtrics to frontline healthcare workers during the COVID-19 through a university's nursing program and received 267 valid responses from 103 certificated nursing assistants, 125 nurses, and 39 other health professionals. A descriptive data analysis with a Chi-square test at a two-sided 0.05 level of significance was performed on factors that potentially affected mental health of healthcare workers and effectiveness of disease control at workplace in five domains. The themes were summarized on open-ended questions. RESULTS: About 30% of the respondents showed the symptom of depression and needed a further investigation. The influencing factors in five domains were examined. Engineering and administrative controls, as well as PPE were widely used in response to COVID-19. The respondents assessed the state and workplace responses to COVID-19 better than the federal government responses. The workplace responses were considered most effective. Multiple factors with a statistically significant correlation with effectiveness of the disease control at workplace were identified. CONCLUSIONS: The study suggested that timely responses at policy level will be more effective than other measures in early prevention and control of the pandemic, mental distress should be addressed in addition to PPE, and nursing programs should consider providing a situation-specific career coaching or counseling for students. A longitudinal study at a larger scale is warranted to capture the variation of time change with the disease control evolvement and across geographic regions.

Participation in cognitive activities is associated with foot reaction time and gait speed in older adults.

BACKGROUND: Given the evidence of the links between cognition and mobility, participation in cognitive activities may benefit neuromotor performance and mobility in older adults. AIMS: To examine the association between participation in cognitive activities and foot reaction time (RT) and gait speed in community-dwelling older adults. METHODS: The MOBILIZE Boston Study II (MBSII) re-enrolled 354 community-dwelling older adults aged ≥ 70 years from the original MBS cohort. Of these, 310 completed the performance testing and we excluded three participants who had Parkinson's disease. Cognitive Activities Scale (CAS) assessed participation in 17 cognitive activities. Simple and Choice foot RT (SRT, CRT, msec) and gait speed (m/s) were measured using a sensored GAITRite® gait mat. RESULTS: The average age of the 307 participants was 84 years; 79% were white and 65% were women. The average CAS score was 25.5 ± 11.7, indicating participation in approximately 26 activities per week on average. The average foot SRT was 245 ± 57msec and average CRT was 323 ± 85msec. Usual-paced gait speed was 0.9 ± 0.3 m/s on average. More frequent participation in cognitive activities was associated with shorter SRT (ß = - 0.759, p = 0.015) and CRT (ß = - 1.125, p = 0.013), and faster gait speed (ß = 0.003, p = 0.026), after adjusting for potential confounders. DISCUSSION: Participation in cognitively stimulating activities may be beneficial for neuromotor performance and mobility in older adults. CONCLUSIONS: Prospective and intervention studies are needed to determine whether participation in cognitive activities may prevent mobility decline over time, and thus reduce fall risk.

Disparities in Preventive Oral Health Care and Periodontal Health Among Adults With Diabetes.

INTRODUCTION: People with diabetes are more vulnerable to periodontal disease than those without; thus, practicing preventive oral health care is an important part of diabetes self-care. Our objective was to examine disparities in preventive oral health care among US adults with diabetes. METHODS: We performed a secondary analysis of data from the National Health and Nutrition Examination Survey (NHANES) 2011-2016. Periodontal examinations were conducted in adults aged 30 and older. We compared the weighted prevalence of periodontal disease and the practice of preventive oral health care, including practicing dental interproximal cleaning (flossing or using other interproximal cleaning devices) and use of preventive dental services, among people with and without diabetes. Multivariable logistic regressions were performed to examine the relationship between the presence of diabetes, periodontal disease, and preventive oral health care practices. RESULTS: Weighted prevalence of periodontal disease in the US population was higher among adults with diabetes than those without (58.0% vs 37.6%). This difference persisted after controlling for sociodemographic characteristics and smoking status. People with diabetes were more likely to have periodontal disease (adjusted odds ratio [aOR] 1.39; 95% CI, 1.17-1.65), less likely to practice daily interproximal cleaning (aOR 0.85; 95% CI, 0.75-0.95), and less likely to visit a dentist for preventive care in the past year (aOR 0.86; 95% CI, 0.76-0.96) than people without diabetes. CONCLUSION: Adults with diabetes reported suboptimal preventive oral health care behaviors in use of preventive dental services and interproximal dental cleaning than people without diabetes, despite their health disparity related to periodontal disease. Educating people to improve their preventive oral health care is essential for good oral health and diabetes self-management.

Factors associated with nutrition risk among community-dwelling older adults in Thailand.

This study was to investigate socio-demographic, chronic conditions and health factors associated with nutrition risk among Thai community-dwelling older adults. This was a cross-sectional study, involving 330 participants aged ≥ 60 years living in low-income suburban Chiang Mai, Northern Thailand. Of the 330 participants, 54.8% were at nutritional risk based on the Mini Nutritional Assessment. Multivariate analysis indicated factors significantly associated with nutritional risk were: aged ≥80 years (OR:8.59, 95% CI = 2.94-25.11), low income (OR: 2.35, 95% CI = 1.15-4.78), living alone (OR: 2.02, 95% CI = 0.20-0.78), moderate to severe pain (OR: 5.88, 95% CI = 2.30-15.02), dyslipidemia (OR: 5.12, 95% CI = 2.23-11.77), osteoarthritis (OR: 2.49, 95% CI = 1.14-5.48), poor physical performance (OR: 1.49, 95% CI = 1.70-3.15), and ≥1 fall in the previous year (OR: 2.22, 95% CI = 1.21-4.07). Results point to the need for multifactorial interventions to reduce risk for geriatric nutrition problems. Further studies are needed to determine effective solutions to the problem of malnutrition among older adults.

Patients Evaluate Visit Notes Written by Their Clinicians: a Mixed Methods Investigation.

BACKGROUND: Patients actively involved in their care demonstrate better health outcomes. Using secure internet portals, clinicians are increasingly offering patients access to their narrative visit notes (open notes), but we know little about their understanding of notes written by clinicians. OBJECTIVE: We examined patients' views on the clarity, accuracy, and thoroughness of notes, their suggestions for improvement, and associations between their perceptions and willingness to recommend clinicians to others. DESIGN: We conducted an online survey of patients in 3 large health systems, June-October 2017. We performed a mixed methods analysis of survey responses regarding a self-selected note. PARTICIPANTS: Respondents were 21,664 patients aged 18 years or older who had read at least 1 open note in the previous 12 months. MAIN MEASURES: We asked to what degree the patient recalled understanding the note, whether it described the visit accurately, whether anything important was missing, for suggestions to improve the note, and whether they would recommend the authoring clinician to others. KEY RESULTS: Nearly all patients (96%) reported they understood all or nearly all of the self-selected note, with few differences by clinician type or specialty. Overall, 93% agreed or somewhat agreed the note accurately described the visit, and 6% reported something important missing from the note. The most common suggestions for improvement related to structure and content, jargon, and accuracy. Patients who reported understanding only some or very little of the note, or found inaccuracies or omissions, were much less likely to recommend the clinician to family and friends. CONCLUSIONS: Patients overwhelmingly report understanding their visit notes and usually find them accurate, with few disparities according to sociodemographic or health characteristics. They have many suggestions for improving their quality, and if they understand a note poorly or find inaccuracies, they often have less confidence in their clinicians.

Walking Speed Affects Gait Coordination and Variability Among Older Adults With and Without Mobility Limitations.

OBJECTIVE: To determine if poorer gait variability and gait coordination among mobility-limited older adults is related to their slower walking speed. DESIGN: Cross-sectional analysis. SETTING: University research laboratory. PARTICIPANTS: Community-dwelling adults (N=69) 68 years or older with (Short Physical Performance Battery score ≤9; n=37) and without (n=32) mobility limitations. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The variability of step length, swing time percent, and step width. Gait coordination was assessed along with the Phase Coordination Index. RESULTS: The usual pace gait speed of those without mobility limitations was faster (1.22±0.14m/s vs 0.71±0.14m/s; P<.001) and less variable in all gait characteristics (all P<.001), with the exception of step width (P=.185), than those with limitations. When those without limitations slowed their walking pace (0.71m/s±0.14), their gait coordination became poorer (P<.001), and the variability of all gait characteristics increased (all P<.001) except for step width, which decreased (P=.002). When those without mobility limitations walked at a slow pace, they had better gait coordination (P=.008) and less variable step length (P=.014) and swing time percent (P=.036). The variability of stride time (P=.260) and step width (P=.385) were not significantly different than that of their peers with limitations. CONCLUSIONS: Increased variability in some gait characteristics of mobility-limited older adults appears to be related to their slower walking speed. Gait coordination and the variability of step length and swing time percent may reflect intrinsic differences in mobility-limited older adults that are independent of walking speed.

Chronic Pain Characteristics and Gait in Older Adults: The MOBILIZE Boston Study II.

OBJECTIVE: To investigate a proposed cognitively-mediated pathway whereby pain contributes to gait impairments by acting as a distractor in community-living older adults. DESIGN: A cross-sectional study of a population-based cohort of older adults. SETTING: Urban and suburban communities in a large metropolitan area. PARTICIPANTS: Community-living participants (N=302) 70 years and older recruited from a previous population-based cohort. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Gait parameters including gait speed, stride length, double support and swing characteristics, and variability were assessed under single- and dual-task conditions involving cognitive challenges (eg, counting backward). A joint pain questionnaire assessed pain distribution in the back and major joints. We examined pain-gait relationships using multivariable linear regression and bootstrapping mediation procedures. RESULTS: Forty-three percent of participants had pain in 2 or more musculoskeletal sites. Pain distribution was related to slower gait speed and other gait characteristics for all gait conditions. Associations persisted after adjustment for age, sex, education, body mass index, medication, and vision. Decrements in gait measures related to pain were comparable with decrements in gait related to dual-task conditions. There were no differences in dual-task cost among the pain distribution groups. Adjusted for confounders, pain-gait relationships appear mediated by selective attention. CONCLUSIONS: These findings suggest that chronic pain contributes to decrements in gait, including slower gait speed, and that it operates through a cognitively-mediated pathway. Further research is needed to understand the mechanisms via pain alters mobility and to develop interventions to improve mobility among older adults with chronic pain.

Effects of Tai Chi on beta endorphin and inflammatory markers in older adults with chronic pain: an exploratory study.

The purpose of this exploratory study was to examine the effects of Tai Chi on blood levels of beta endorphin (ß-endorphin) and inflammatory markers in older adults with chronic pain. Forty community-dwelling older adults with chronic pain were randomized to Tai Chi or light physical exercise, and each offered twice weekly for 12 weeks. Following the 12-week intervention, neither Tai Chi nor light physical exercise changed levels of ß-endorphin and inflammatory markers. However, in older adults who completed 70% or more classes, Tai Chi significantly lowered levels of ß-endorphin (p < 0.05), whereas light physical exercise did not change levels of ß-endorphin. The results suggest that Tai Chi may reduce levels of ß-endorphin in older adults with chronic pain. Future studies are needed to better understand the role of the opioid analgesic system and immune system in regulating pain with aging and the long-term effects of Tai Chi on pain-related biomarkers.

The Association Between Social Engagement, Mild Cognitive Impairment, and Falls Among Older Primary Care Patients.

OBJECTIVES: To examine associations between mild cognitive impairment (MCI) and falls among primary care patients, and to investigate whether social engagement (SE) modifies these associations. DESIGN: Cross sectional analysis using baseline data from an observational cohort study. SETTING: Primary care. PARTICIPANTS: Community-dwelling older adults (N=430) at risk of mobility decline with a mean age of 76.6 years (range 65-96y). MAIN OUTCOME MEASURES: The number of falls in the past year was reported at the baseline interview. MCI was identified using a cutoff of 1.5 SD below the age-adjusted mean on at least 2 of the standardized cognitive performance tests. SE (eg, keeping in touch with friends and family, volunteering, participating social activities…) was assessed with the Late Life Function and Disability Instrument, and required a score above the median value 49.5 out of 100. RESULTS: MCI was present among 42% of participants and 42% reported at least 1 fall in the preceding year. Using generalized estimating equations, MCI was associated with a 77% greater rate of falls (P<.05). There was a statistically significant interaction between SE and MCI on the rate of falls (P<.01), such that at a high level of SE, MCI was not statistically associated with falls (P=.83). In participants with lower levels of SE, MCI is associated with 1.3 times greater rate of falls (P<.01). CONCLUSIONS: While MCI is associated with a greater risk for falls, higher levels of SE may play a protective role.

Chronic multisite pain: evaluation of a new geriatric syndrome.

BACKGROUND: Chronic musculoskeletal pain is highly prevalent in the older adults, and individuals with musculoskeletal pain frequently report pain in two or more sites. AIMS: To determine the prevalence and characteristics of multisite pain in relation to other geriatric syndromes and to evaluate whether multisite pain may represent a distinct geriatric syndrome. METHODS: The MOBILIZE Boston Study is a population-based cohort study of older adults that enrolled 749 participants aged 70 and older. Persistent pain in the back and major joint areas was assessed using a joint pain questionnaire. Assessment of other geriatric syndromes included urinary incontinence, fall history, ADL disability, and frailty. A number of risk factors for geriatric syndromes were assessed. RESULTS: The prevalence of multisite pain was 40% in this population of older adults. Many participants had more than one geriatric syndrome, indicating substantial overlap in the prevalence of these conditions. Nearly half (48%) of participants with urinary incontinence or falls, 61% with ADL disability, and 49% of those with frailty also had multisite pain. Shared risk factors for established geriatric conditions were similarly distributed among the elderly population who had multisite pain. Demographic and health characteristics associated with multisite pain and other geriatric syndromes, included gender (female), depression, number of comorbid conditions, and mobility limitations. CONCLUSION: Although prior studies have explored risk factors for chronic multisite pain, these findings reveal that multisite pain, often unexplained, bears many similarities to established geriatric syndromes. Multisite pain warrants further consideration as a unique geriatric syndrome.

Cost-effectiveness of the non-laboratory based Framingham algorithm in primary prevention of cardiovascular disease: A simulated analysis of a cohort of African American adults.

The non-lab Framingham algorithm, which substitute body mass index for lipids in the laboratory based (lab-based) Framingham algorithm, has been validated among African Americans (AAs). However, its cost-effectiveness and economic tradeoffs have not been evaluated. This study examines the incremental cost-effectiveness ratio (ICER) of two cardiovascular disease (CVD) prevention programs guided by the non-lab versus lab-based Framingham algorithm. We simulated the World Health Organization CVD prevention guidelines on a cohort of 2690 AA participants in the Atherosclerosis Risk in Communities (ARIC) cohort. Costs were estimated using Medicare fee schedules (diagnostic tests, drugs & visits), Bureau of Labor Statistics (RN wages), and estimates for managing incident CVD events. Outcomes were assumed to be true positive cases detected at a data driven treatment threshold. Both algorithms had the best balance of sensitivity/specificity at the moderate risk threshold (>10% risk). Over 12years, 82% and 77% of 401 incident CVD events were accurately predicted via the non-lab and lab-based Framingham algorithms, respectively. There were 20 fewer false negative cases in the non-lab approach translating into over $900,000 in savings over 12years. The ICER was -$57,153 for every extra CVD event prevented when using the non-lab algorithm. The approach guided by the non-lab Framingham strategy dominated the lab-based approach with respect to both costs and predictive ability. Consequently, the non-lab Framingham algorithm could potentially provide a highly effective screening tool at lower cost to address the high burden of CVD especially among AA and in resource-constrained settings where lab tests are unavailable.

Tai Chi for older adults with chronic multisite pain: a randomized controlled pilot study.

BACKGROUND: Chronic pain is associated with poorer cognition and mobility, and fall risk in older adults. AIMS: To investigate the feasibility of a randomized controlled trial of mind-body exercise (Tai Chi) versus light physical exercise in older adults with multisite pain. METHODS: Adults aged ≥ 65 years with multisite pain who reported falling in the past year or current use of an assistive device were recruited from Boston area communities. Participants were randomized to either a Tai Chi or a light physical exercise program, offered twice weekly for 12 weeks. The primary outcomes were feasibility and acceptability. Secondary outcomes included pain characteristics, cognition, physical function, gait mobility, fear of falling, and fall rate. RESULTS: Of 176 adults screened, 85 were eligible, and 54 consented and enrolled (average age 75 ± 8 years; 96.30% white; 75.93% female). The dropout rate was 18% for Tai Chi and 12% for light physical exercise. For those completing the study, exercise class attendance rate was 76% for Tai Chi and 82% for light physical exercise. There were no significant group differences in most secondary outcomes. Tai Chi significantly lowered pain severity (4.58 ± 1.73 to 3.73 ± 1.79, p < 0.01) and pain interference (4.20 ± 2.53 to 3.16 ± 2.28, p < 0.05), reduced fear of falling (90.82 ± 9.59 to 96.84 ± 10.67, p < 0.05), and improved several single-task and dual-task gait variables, while light physical exercise did not change these measures. DISCUSSION AND CONCLUSIONS: This study demonstrated the feasibility and acceptability of conducting a larger randomized controlled trial in older adults with multisite pain. Study findings and challenges encountered will inform future research.

Persistence of pain quality in community-dwelling older adults with chronic non-cancer pain.

Longitudinal assessment of chronic geriatric pain is complicated by an age-associated plateau in pain severity and increase in widespread pain, calling for innovative measures such as pain quality descriptors that characterize how pain may feel. We characterized persistence of pain quality and its relation to severity, activity interference and distribution of sites, in a population-based sample of adults aged≥70 years with chronic pain (n = 398). Persistent pain quality was defined as reporting descriptors within the same category: sensory, cognitive/affective, or neuropathic at baseline and 18 months. A count variable indicated number of persistent categories. Pain quality was highly persistent. Adjusted for baseline covariates, individuals endorsing 3 persistent categories were 2-2.5x more likely to experience more widespread pain at 18 months compared to fewer persistent categories. No associations were noted in changes in pain severity or interference. A comprehensive pain assessment that includes diverse pain quality descriptors may improve individualized pain management.

Mobility limitations and fear of falling in non-English speaking older Mexican-Americans.

OBJECTIVE: To determine whether older Mexican-Americans who cannot speak and/or understand spoken English have higher rates of mobility limitations or fear of falling than their English-speaking counterparts. DESIGN: We conducted a cross-sectional analysis of 1169 community-dwelling Mexican-Americans aged 72-96 years from the 2000-2001 wave of the Hispanic Established Population for the Epidemiological Study of the Elderly. Mobility limitations were defined as having a Short Physical Performance Battery score ≤9, and fear of falling by participant report of being somewhat, fairly, or very afraid of falling. We determined the rates and odds ratios, for having mobility limitations and fear of falling as a function of English ability in those who were 72-96, <80, and ≥80 years of age. RESULTS: Among participants who were unable to speak and/or understand spoken English 85.7% had mobility limitations and 61.6% were afraid of falling, compared to 77.6% and 57.5%, respectively, of English speakers. Before adjusting for covariates, participants who did not speak and/or understand spoken English were more likely to have mobility limitations (odds ratio: 1.7; 95% CI: 1.3-2.4) but not fear of falling, compared to English speakers. Among those aged ≥80 years, but not those <80 years, who did not speak or understand English were more likely to have mobility limitations (odds ratio: 4.8; 95% CI:2.0-11.5) and fear of falling (odds ratio: 2.0; 95% CI:1.3-3.1). CONCLUSION: Older Mexican-Americans who do not speak or understand spoken English have a higher rate of mobility limitations and fear of falling than their English-speaking counterparts.

Pain severity and pharmacologic pain management among community-living older adults: the MOBILIZE Boston study.

BACKGROUND: Concerns about polypharmacy and medication side effects contribute to undertreatment of geriatric pain. This study examines use and effects of pharmacologic treatment for persistent pain in older adults. METHODS: The MOBILIZE Boston Study included 765 adults aged ≥70 years, living in the Boston area, recruited from 2005 to 2008. We studied 599 participants who reported chronic pain at baseline. Pain severity, measured using the Brief Pain Inventory (BPI) severity subscale, was grouped as very mild (BPI <2), mild (BPI 2-3.99), and moderate to severe (BPI 4-10). Medications taken in the previous 2 weeks were recorded from medication bottles in the home interview. RESULTS: Half of participants reported using analgesic medications in the previous 2 weeks. Older adults with moderate to severe pain were more likely to use one or more analgesic medications daily than those with very mild pain (49 versus 11%, respectively). The most commonly used analgesic was acetaminophen (28%). Opioid analgesics were used daily by 5% of participants. Adjusted for health and demographic factors, pain severity was strongly associated with daily analgesic use (moderate-severe pain compared to very mild pain, adj. OR 7.19, 95% CI 4.02-12.9). Nearly one third of participants (30%) with moderate to severe pain felt they needed a stronger pain medication while 16% of this group were concerned they were using too much pain medication. CONCLUSION: Serious gaps persist in pain management particularly for older adults with the most severe chronic pain. Greater efforts are needed to understand barriers to effective pain management and self-management in the older population.

Coordination Impairments Are Associated With Falling Among Older Adults.

Background/Study Context: Approximately one third of older adults over the age of 65, and over 40% of those over 80 years, fall each year, leading to fractures, morbidity, and mortality. Annual direct medical costs due to falls in the United States are approximately $19.2 billion. The identification of new treatable risk factors for falls has the potential to advance their prevention and rehabilitation. METHODS: A cross-sectional study of 127 community-dwelling adults aged 67-99 years was conducted. An electronic gait walkway was used to assess gait coordination, measured as the Phase Coordination Index during normal speed walking. A motion capture system was used to assess rhythmic interlimb antiphase ankle coordination, measured as the standard deviation of ankle relative phase. Having fallen in the previous year was self-reported retrospectively. Odds ratios for falling as a function of coordination quartiles were determined using multivariable logistic regression. RESULTS: Adjusting for age, sex, body mass index, number of chronic conditions, Mini-Mental State Examination score, gait speed, and the variability of step length, time, and width, the odds ratios for falling based upon being in the 4th (the poorest) quartiles of gait or ankle coordination were 5.5 (95% confidence interval [CI]: 1.2-24.7) and 8.2 (95% CI: 2.2-31.3), respectively, and 3.7 (95% CI: 1.0-13.8) for the 3rd quartile of gait coordination, compared with the best (the 1st) coordination quartiles. Similar results were found in regression without adjustment for gait characteristics. CONCLUSION: The results support the hypothesis that impaired gait and rhythmic interlimb ankle coordination are associated with a history of falls in the past year. Prospective longitudinal research is needed to determine the possible direction of causality between falls and impaired coordination.

Rhythmic Interlimb Coordination Impairments Are Associated With Mobility Limitations Among Older Adults.

Background/Study Context: Mobility limitations affect more than 25% of adults aged 70 years or older. This study tested the hypothesis that impairments in ankle and shoulder coordination are associated with mobility limitations among older adults. METHODS: his study consisted of conducted a cross-sectional analysis from a sample of community-dwelling older adults (N = 130) aged ≥67 years. Motion capture equipment was used to collect kinematic data during rhythmic antiphase coordination of the right and left: (a) ankles moving in dorsi-plantarflexion; and (b) glenohumeral ("shoulder") moving in flexion-extension while paced by an auditory metronome. Coordination variability was measured as the standard deviation of the relative phase between right and left body segments. Mobility limitations were defined as a score of ≤9 on the Short Physical Performance Battery (SPPB). Odds ratios for mobility limitations as a function of coordination variability quartiles were determined using multivariable logistic regression. RESULTS: Adjusting for age, gender, body mass index, number of chronic conditions and Mini-Mental State Examination score, the odds ratios for mobility limitation (SPPB score ≤9) were 7.38 (95% confidence interval [CI]: 2.20-24.78) and 15.40 (95% CI: 4.31-55.07) for the 3rd and 4th (the poorest) ankle coordination quartiles, respectively, and 6.73 (95% CI: 2.11-21.51) for the 4th shoulder coordination quartile, compared with the best (the 1st) coordination quartiles. CONCLUSION: The results supported the hypothesis that impaired interlimb ankle and shoulder coordination are associated with the manifestation of mobility limitations. These findings indicate the need for further study of the role of coordination impairments as potential contributors to poor mobility among older adults.