Musculoskeletal pain and incident disability in community-dwelling older adults

Objective. To test the hypothesis that the number of areas of musculoskeletal pain reported is related to incident disability. Methods. Subjects included 898 older persons from the Rush Memory and Aging Project without dementia, stroke, or Parkinson's disease at baseline. All participants underwent detailed baseline evaluation of self-reported pain in the neck or back, hands, hips, knees, or feet, as well as annual self-reported assessments of instrumental activities of daily living (IADLs), basic activities of daily living (ADLs), and mobility disability. Mobility disability was also assessed using a performance-based measure. Results. The average followup was 5.6 years. Using a series of proportional hazards models that controlled for age, sex, and education, the risk of IADL disability increased by ∼10% for each additional painful area reported (hazard ratio [HR] 1.10, 95% confidence interval [95% CI] 1.01-1.20) and the risk of ADL disability increased by ∼20% for each additional painful area (HR 1.20, 95% CI 1.11-1.31). The association with self-report mobility disability did not reach significance (HR 1.09, 95% CI 0.99-1.20). However, the risk of mobility disability based on gait speed performance increased by ∼13% for each additional painful area (HR 1.13, 95% CI 1.04-1.22). These associations did not vary by age, sex, or education and were unchanged after controlling for several potential confounding variables including body mass index, physical activity, cognition, depressive symptoms, vascular risk factors, and vascular diseases. Conclusion. Among nondisabled community-dwelling older adults, the risk of disability increases with the number of areas reported with musculoskeletal pain.