Resources and Functional Maintenance Among Older Adults With Persistent Pain: A Harmonised Analysis of Three International Cohorts

Background

Persistent pain in later life is associated with functional decline. Identifying resources associated with preserved daily function may broaden pain research beyond symptom burden alone.

Objective

To examine six prespecified resource indicators—physical activity, depressive symptoms, recall performance, current partner status, education and wealth—in relation to subsequent maintenance of independence in activities of daily living (ADL).

Methods

This longitudinal observational study analysed adults aged 50 years or older with pain at both the initial and baseline assessments in the Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA) and the Survey of Health, Ageing and Retirement in Europe (SHARE). ADL maintenance was defined as no difficulty in all five prespecified ADL activities at baseline and no difficulty in all five at follow-up. Indicator-specific risk ratios were estimated using modified Poisson regression with robust variance and pooled using random-effects meta-analysis. The six meta-analysis P values were adjusted using the Holm procedure. Each indicator used a separate complete-case sample; no common six-indicators sample was constructed.

Results

The descriptive samples comprised 8,279 HRS person-windows contributed by 4,688 unique participants, 1,200 ELSA participants and 6,995 SHARE participants; indicator-specific denominators varied. Physical activity was associated with a higher probability of ADL maintenance across all three cohorts (pooled risk ratio, 1.145; 95% CI, 1.097–1.195; P = .005; Holm-adjusted P = .032) and was the only prespecified hypothesis to meet the Holm-adjusted criterion. The other five hypotheses did not meet this criterion; failure to do so should not be interpreted as evidence that the corresponding associations were absent. Several of these pooled estimates showed substantial heterogeneity.

Conclusions

Among older adults with persistent pain, physical activity was associated with a higher probability of ADL maintenance, and the physical activity hypothesis was the only one of the six prespecified hypotheses to meet the Holm-adjusted criterion in the three-cohort meta-analysis. These observational findings support further study of physical activity and functional maintenance but do not establish causal benefit.

Key Points

• Three international ageing cohorts were harmonised to evaluate associations between six resource-related indicators and subsequent ADL maintenance among older adults with persistent pain.

• Physical activity was consistently associated with a higher probability of ADL maintenance and was the only one of the six prespecified hypotheses to meet the Holm-adjusted criterion.

• The other five hypotheses did not meet the prespecified Holm-adjusted criterion, and several pooled estimates showed substantial heterogeneity.

• The findings are observational and do not establish that increasing physical activity would preserve ADL independence.