Article Review: Elder Falls Related to Chronic Pain

24 09 2010

Magazine: Duke Medicine Health News – February 2010 – Volume 16, No. 2 

Article Title:  “Elder Falls Related to Chronic Pain: Chronic pain may be an overlooked – and important – risk factor for falls in older adults.” 

Summary: 

Researchers studying older adults believe chronic pain plays a strong independent role in the number of falls occasioned.  The study showed that although impaired mobility and history of falling are the strongest precursors of falls, the link between pain and falls is independent of this.  The Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILITY) study was conducted at the College of Nursing and Health Sciences, at the University of Massachusetts – Boston.  Suzanne G. Leville, PhD, RN studied 749 adults, aged +70, to determine if chronic musculoskeletal pain was associated with an increase in falls. Participants reported their daily pain incidences according to a provided scale for 18-months. Pain was evaluated according to location, severity, and interference with daily activities. Researchers discovered a correlation between self-reported pain one month and an increase in the number of falls the next. The pain-fall link was classified into three categories showing muscular weakness and attention distraction which lead to fall rate increase. Older people living with chronic pain not only live with their current level, but also actively avoid more of it. This avoidance appears to create a situation wherein they are more prone to falls due to mental distraction and muscular weakness. After adjusting findings to rule out the potential of fall increase based on pain due to underlying conditions and pain medications contribution, researchers believe pain, itself, was still a strong independent risk factor. More study is needed. 

Four Main Points: 

  1. There is a correlation between pain reported one month and an increase in the number of falls the next.
  2. Although impaired mobility and history of falling are predictive of falls, chronic pain cannot be overlooked as an independent contributing factor.
  3. Neuromuscular effects weakness or delayed neuromuscular response to impending fall is a treatable cause because compensating for the pain can lead to unsteadiness and loss of balance.
  4. Chronic pain causes structural and functional changes in the brain that can lead to deceased attention, and poorer executive function[1] resulting in falls.

  

Learn and Application to Clients and Self: 

Falling and chronic pain can be made easier through body maintenance. The three pain-falls association categories can be worked with to lessen their severity: 

  1. Joint Condition: Osteoarthritis the main contributor. Working with their doctor to create an exercise plan to lessen the severity of osteoarthritis.
  2. Neuromuscular effects leading to muscle weakness caused by lack of exercise due to pain: Create an exercise plan that strengthens the body gradually but evenly so that one part is not overcompensating for the other leading to body imbalance and fall potential.
  3. Chronic pain causing decreased attention: Everyone feels this – when you hurt, you are distracted by the pain and more likely to fall. By increasing body awareness and confidence for the client that if they do feel themselves off balance, they are able to correct the situation, they will feel more in control of their pain and pay more attention in positive prevention rather than paranoid reaction.

 

[1] Executive Function: The cognitive function responsible for control/regulation of other abilities and behaviors.

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