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The mediating effect of pain on the association between multimorbidity and disability and impaired physical performance among community-dwelling older adults in southern China

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Abstract

Aim

To investigate the association between multimorbidity and disability and impaired physical performance, and to further evaluate the mediating effect of physical pain in this association.

Methods

1321 community-dwelling older adults, who were over 60 years old in southern China, were regarded as participants in this cross-sectional study. Subjects completed a multi-instrument questionnaire including essential characteristics and physical function assessments. Physical function was assessed by activities of daily living (ADL), instrumental activities of daily living (IADL), index of mobility scale (NAGI), index of basic physical activities scale (RB), and short physical performance battery (SPPB). Multimorbidity was defined as the simultaneous presence of two or more chronic conditions. Multivariable regression and mediation analyses were conducted and gender differences were explored.

Results

The prevalence of multimorbidity was 44.6% in our study. In gender stratification analysis, multimorbidity was significantly associated with ADL disability (OR = 2.16), IADL disability (OR = 1.97), NAGI disability (OR = 2.84), RB disability (OR = 2.65) and lower SPPB score (β = − 0.83) in women. The rate of pain increased with the number of chronic diseases and the multimorbidity patients with higher pain prevalence. Moreover, the presence of pain was also significantly associated with disability and impaired physical performance. Mediation analysis illustrated that pain was accounted for 16.5% to 22.1% of the adverse effects of multimorbidity on disability and impaired physical performance in women.

Conclusions

Multimorbidity was significantly associated with disability and impaired physical performance, and pain might be a mediating factor for adverse effects of multimorbidity on disability and impaired physical performance in women.

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Our data might not be shared directly, because it is our team work and informed consent should be attained from team members.

References

  1. Fortin M, Hudon C, Haggerty J et al (2010) Prevalence estimates of multimorbidity: a comparative study of two sources. BMC Health Serv Res 10:111

    PubMed  PubMed Central  Google Scholar 

  2. van den Akker M, Buntinx F, Metsemakers JF et al (1998) Multimorbidity in general practice: prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases. J Clin Epidemiol 51:367–375

    PubMed  Google Scholar 

  3. Fortin M, Lapointe L, Hudon C et al (2004) Multimorbidity and quality of life in primary care: a systematic review. Health Qual Life Outcomes 2:51

    PubMed  PubMed Central  Google Scholar 

  4. Williams JS, Egede LE (2016) The association between multimorbidity and quality of life, health status and functional disability. Am J Med Sci 352:45–52

    PubMed  Google Scholar 

  5. Rillamas-Sun E, LaCroix AZ, Bell CL et al (2016) The impact of multimorbidity and coronary disease comorbidity on physical function in women aged 80 years and older: the women’s health initiative. J Gerontol A Biol Sci Med Sci 71(Suppl 1):S54–S61

    PubMed  PubMed Central  Google Scholar 

  6. Guralnik JM, Ferrucci L (2003) Assessing the building blocks of function: utilizing measures of functional limitation. Am J Prev Med 25:112–121

    PubMed  Google Scholar 

  7. Ferraro KF, Su YP, Gretebeck RJ et al (2002) Body mass index and disability in adulthood: a 20-year panel study. Am J Public Health 92:834–840

    PubMed  PubMed Central  Google Scholar 

  8. Schoeni RF, Martin LG, Andreski PM et al (2005) Persistent and growing socioeconomic disparities in disability among the elderly: 1982–2002. Am J Public Health 95:2065–2070

    PubMed  PubMed Central  Google Scholar 

  9. Guralnik JM, Ferrucci L, Balfour JL et al (2001) Progressive versus catastrophic loss of the ability to walk: implications for the prevention of mobility loss. J Am Geriatr Soc 49:1463–1470

    CAS  PubMed  Google Scholar 

  10. Millan-Calenti JC, Tubio J, Pita-Fernandez S et al (2010) Prevalence of functional disability in activities of daily living (ADL), instrumental activities of daily living (IADL) and associated factors, as predictors of morbidity and mortality. Arch Gerontol Geriatr 50:306–310

    PubMed  Google Scholar 

  11. Fried LP, Guralnik JM (1997) Disability in older adults: evidence regarding significance, etiology, and risk. J Am Geriatr Soc 45:92–100

    CAS  PubMed  Google Scholar 

  12. Fried LP, Bandeen-Roche K, Kasper JD et al (1999) Association of comorbidity with disability in older women: the Women’s Health and Aging Study. J Clin Epidemiol 52:27–37

    CAS  PubMed  Google Scholar 

  13. Gijsen R, Hoeymans N, Schellevis FG et al (2001) Causes and consequences of comorbidity: a review. J Clin Epidemiol 54:661–674

    CAS  PubMed  Google Scholar 

  14. Koller D, Schon G, Schafer I et al (2014) Multimorbidity and long-term care dependency—a five-year follow-up. BMC Geriatr 14:70

    PubMed  PubMed Central  Google Scholar 

  15. Wolff JL, Starfield B, Anderson G (2002) Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med 162:2269–2276

    PubMed  Google Scholar 

  16. Britt HC, Harrison CM, Miller GC et al (2008) Prevalence and patterns of multimorbidity in Australia. Med J Aust 189:72–77

    PubMed  Google Scholar 

  17. Patel KV, Guralnik JM, Dansie EJ et al (2013) Prevalence and impact of pain among older adults in the United States: findings from the 2011 National Health and Aging Trends Study. Pain 154:2649–2657

    PubMed  Google Scholar 

  18. Butchart A, Kerr EA, Heisler M et al (2009) Experience and management of chronic pain among patients with other complex chronic conditions. Clin J Pain 25:293–298

    PubMed  PubMed Central  Google Scholar 

  19. Cederbom S, Denison E, Bergland A (2017) A behavioral medicine intervention for community-dwelling older adults with chronic musculoskeletal pain: protocol for a randomized controlled trial. J Pain Res 10:845–853

    PubMed  PubMed Central  Google Scholar 

  20. Matos M, Bernardes SF, Goubert L (2016) The relationship between perceived promotion of autonomy/dependence and pain-related disability in older adults with chronic pain: the mediating role of self-reported physical functioning. J Behav Med 39:704–715

    PubMed  Google Scholar 

  21. Rapo-Pylkko S, Haanpaa M, Liira H (2016) Subjective easiness of pain assessment measures in older people. Arch Gerontol Geriatr 65:25–28

    PubMed  Google Scholar 

  22. Smith AW, Reeve BB, Bellizzi KM et al (2008) Cancer, comorbidities, and health-related quality of life of older adults. Health Care Finance Rev 29:41–56

    Google Scholar 

  23. Wang XX, Lin WQ, Chen XJ et al (2017) Multimorbidity associated with functional independence among community-dwelling older people: a cross-sectional study in Southern China. Health Qual Life Outcomes 15:73

    PubMed  PubMed Central  Google Scholar 

  24. Jensen MP, McFarland CA (1993) Increasing the reliability and validity of pain intensity measurement in chronic pain patients. Pain 55:195–203

    CAS  PubMed  Google Scholar 

  25. Rodriguez CS (2001) Pain measurement in the elderly: a review. Pain Manag Nurs 2:38–46

    CAS  PubMed  Google Scholar 

  26. Katz S, Akpom CA (1976) A measure of primary sociobiological functions. Int J Health Serv 6:493–508

    CAS  PubMed  Google Scholar 

  27. Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9:179–186

    CAS  PubMed  Google Scholar 

  28. Qian J, Ren X (2016) Association between comorbid conditions and BADL/IADL disability in hypertension patients over age 45: based on the China health and retirement longitudinal study (CHARLS). Medicine (Baltimore) 95:e4536

    Google Scholar 

  29. Nagi SZ (1976) An epidemiology of disability among adults in the United States. Milbank Mem Fund Q Health Soc 54:439–467

    CAS  PubMed  Google Scholar 

  30. Rosow I, Breslau N (1966) A Guttman health scale for the aged. J Gerontol 21:556–559

    CAS  PubMed  Google Scholar 

  31. Dong X, Chang ES, Simon MA (2014) Physical function assessment in a community-dwelling population of U.S. Chinese older adults. J Gerontol A Biol Sci Med Sci 69(Suppl 2):S31

    PubMed  PubMed Central  Google Scholar 

  32. Guralnik JM, Simonsick EM, Ferrucci L et al (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49:M85–M94

    CAS  PubMed  Google Scholar 

  33. Fowler-Brown A, Wee CC, Marcantonio E et al (2013) The mediating effect of chronic pain on the relationship between obesity and physical function and disability in older adults. J Am Geriatr Soc 61:2079–2086

    PubMed  PubMed Central  Google Scholar 

  34. Vancampfort D, Stubbs B, Koyanagi A (2017) Physical chronic conditions, multimorbidity and sedentary behavior amongst middle-aged and older adults in six low- and middle-income countries. Int J Behav Nutr Phys Act 14:147

    PubMed  PubMed Central  Google Scholar 

  35. Breen R, Karlson KB, Holm A (2013) Total, direct, and indirect effects in logit and Probit models. Sociol Methods Res 42:164–191

    Google Scholar 

  36. Marengoni A, Angleman S, Melis R et al (2011) Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev 10:430–439

    PubMed  Google Scholar 

  37. Rezaee ME, Pollock M (2015) Prevalence and associated cost and utilization of multiple chronic conditions in the outpatient setting among adult members of an employer-based health plan. Popul Health Manag 18:421–428

    PubMed  Google Scholar 

  38. Barberger-Gateau P, Rainville C, Letenneur L et al (2000) A hierarchical model of domains of disablement in the elderly: a longitudinal approach. Disabil Rehabil 22:308–317

    CAS  PubMed  Google Scholar 

  39. Williams JS, Egede LE (2016) The association between multimorbidity and quality of life, health status and functional disability. Am J Med Sci 352:45–52

    PubMed  Google Scholar 

  40. Su P, Ding H, Zhang W et al (2016) The association of multimorbidity and disability in a community-based sample of elderly aged 80 or older in Shanghai, China. BMC Geriatr 16:178

    PubMed  PubMed Central  Google Scholar 

  41. Baker TA, O’Connor ML, Krok JL (2014) Experience and knowledge of pain management in patients receiving outpatient cancer treatment: what do older adults really know about their cancer pain? Pain Med 15:52–60

    PubMed  Google Scholar 

  42. Stubbs B, Binnekade TT, Soundy A et al (2013) Are older adults with chronic musculoskeletal pain less active than older adults without pain? A systematic review and meta-analysis. Pain Med 14:1316–1331

    PubMed  Google Scholar 

  43. den Ouden ME, Schuurmans MJ, Arts IE et al (2011) Physical performance characteristics related to disability in older persons: a systematic review. Maturitas 69:208–219

    Google Scholar 

  44. Higgins DM, Buta E, Dorflinger L et al (2016) Prevalence and correlates of painful conditions and multimorbidity in national sample of overweight/obese Veterans. J Rehabil Res Dev 53:71–82

    PubMed  Google Scholar 

  45. Orfila F, Ferrer M, Lamarca R et al (2006) Gender differences in health-related quality of life among the elderly: the role of objective functional capacity and chronic conditions. Soc Sci Med 63:2367–2380

    PubMed  Google Scholar 

  46. Makino K, Lee S, Lee S et al (2018) Daily physical activity and functional disability incidence in community-dwelling older adults with chronic pain: a prospective cohort study. Pain Med. https://doi.org/10.1093/pm/pny263

    Article  Google Scholar 

  47. Ge L, Yap CW, Heng BH (2018) Sex differences in associations between multimorbidity and physical function domains among community-dwelling adults in Singapore. PLoS One 13:e0197443

    PubMed  PubMed Central  Google Scholar 

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Acknowledgements

This study was supported by the National Natural Science Foundation of China (No. 81872584), and the National 863 Young Scientist Program (No. 2015AA020940). The authors wish to thank the study participants for their contribution to the study. We are also grateful to all community health workers who participated in our research. Dr. Nan Liu, Dr. Pei-Xi Wang and Ms. Xin Peng is the guarantor of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Funding

This study was supported by the National Natural Science Foundation of China (No. 81872584), and the National 863 Young Scientist Program (No. 2015AA020940).

Author information

Authors and Affiliations

  1. Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, 511436, People’s Republic of China

    Xin Peng, XinYu Bao, YiXian Xie, XiaoXia Zhang, JunXuan Huang, Yan Liu, MengJiao Cheng & Nan Liu

  2. General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, 528244, People’s Republic of China

    PeiXi Wang

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  1. Xin Peng
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Correspondence to Nan Liu or PeiXi Wang.

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Statement of human rights

The study was approved by the Research Ethics Committee of the Guangzhou medial university. Written informed was obtained from all study participants prior to study entry.

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Peng, X., Bao, X., Xie, Y. et al. The mediating effect of pain on the association between multimorbidity and disability and impaired physical performance among community-dwelling older adults in southern China. Aging Clin Exp Res 32, 1327–1334 (2020). https://doi.org/10.1007/s40520-019-01324-1

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