疼痛、功能受限与衰老。
Pain, functional limitations, and aging.
作者信息
Covinsky Kenneth E, Lindquist Karla, Dunlop Dorothy D, Yelin Edward
机构信息
Department of Medicine, University of California at San Francisco, 4150 Clement, San Francisco, CA 94121, USA.
出版信息
J Am Geriatr Soc. 2009 Sep;57(9):1556-61. doi: 10.1111/j.1532-5415.2009.02388.x. Epub 2009 Aug 4.
OBJECTIVES
To examine the relationship between functional limitations and pain across a spectrum of age, ranging from mid life to advanced old age.
DESIGN
Cross-sectional study.
SETTING
The 2004 Health and Retirement Study (HRS), a nationally representative study of community-living persons aged 50 and older.
PARTICIPANTS
Eighteen thousand five hundred thirty-one participants in the 2004 HRS.
MEASUREMENTS
Participants who reported that they were often troubled by pain that was moderate or severe most of the time were defined as having significant pain. For each of four functional domains, subjects were classified according to their degree of functional limitation: mobility (able to jog 1 mile, able to walk several blocks, able to walk one block, unable to walk one block), stair climbing (able to climb several flights, able to climb one flight, not able to climb a flight), upper extremity tasks (able to do 3, 2, 1, or 0), and activity of daily living (ADL) function (able to do without difficulty, had difficulty but able to do without help, need help).
RESULTS
Twenty-four percent of participants had significant pain. Across all four domains, participants with pain had much higher rates of functional limitations than subjects without pain. Participants with pain were similar in terms of their degree of functional limitation to participants 2 to 3 decades older. For example, for mobility, of subjects aged 50 to 59 without pain, 37% were able to jog 1 mile, 91% were able to walk several blocks, and 96% were able to walk one block without difficulty. In contrast, of subjects aged 50 to 59 with pain, 9% were able to jog 1 mile, 50% were able to walk several blocks, and 69% were able to walk one block without difficulty. Subjects aged 50 to 59 with pain were similar in terms of mobility limitations to subjects aged 80 to 89 without pain, of whom 4% were able to jog 1 mile, 55% were able to walk several blocks, and 72% were able to walk one block without difficulty. After adjustment for demographic characteristics, socioeconomic status, comorbid conditions, depression, obesity, and health habits, across all four measures, participants with significant pain were at much higher risk for having functional limitations (adjusted odds ratio (AOR)=2.85, 95% confidence interval (CI)=2.20-3.69, for mobility; AOR=2.84, 95% CI=2.48-3.26, for stair climbing; AOR=3.96, 95% CI=3.43-4.58, for upper extremity tasks; and AOR=4.33; 95% CI=3.71-5.06, for ADL function).
CONCLUSION
Subjects with pain develop the functional limitations classically associated with aging at much earlier ages.
目的
研究从中年到高龄各年龄段人群功能受限与疼痛之间的关系。
设计
横断面研究。
研究背景
2004年健康与退休研究（HRS），一项针对全国50岁及以上社区居住人群的具有代表性的研究。
参与者
2004年HRS的18531名参与者。
测量方法
那些报告称自己大部分时间经常受到中度或重度疼痛困扰的参与者被定义为有明显疼痛。对于四个功能领域中的每一个，根据功能受限程度对受试者进行分类：活动能力（能够慢跑1英里、能够步行几个街区、能够步行一个街区、无法步行一个街区）、爬楼梯能力（能够爬几层楼梯、能够爬一层楼梯、无法爬一层楼梯）、上肢任务能力（能够完成3项、2项、1项或0项）以及日常生活活动（ADL）功能（能够毫无困难地完成、有困难但无需帮助能够完成、需要帮助）。
结果
24%的参与者有明显疼痛。在所有四个领域中，有疼痛的参与者功能受限率远高于无疼痛的受试者。有疼痛的参与者在功能受限程度上与年龄大20至30岁的参与者相似。例如，在活动能力方面，50至59岁无疼痛的受试者中，37%能够慢跑1英里，91%能够步行几个街区，96%能够毫无困难地步行一个街区。相比之下，50至59岁有疼痛的受试者中，9%能够慢跑1英里，50%能够步行几个街区，69%能够毫无困难地步行一个街区。50至59岁有疼痛的受试者在活动能力受限方面与80至89岁无疼痛的受试者相似，后者中4%能够慢跑1英里，55%能够步行几个街区，72%能够毫无困难地步行一个街区。在对人口统计学特征、社会经济地位、合并症、抑郁症、肥胖和健康习惯进行调整后，在所有四项测量中，有明显疼痛的参与者出现功能受限的风险要高得多（活动能力方面调整后的优势比（AOR）=2.85，95%置信区间（CI）=2.20 - 3.69；爬楼梯能力方面AOR = 2.84，95% CI = 2.48 - 3.26；上肢任务能力方面AOR = 3.96，95% CI = 3.43 - 4.58；ADL功能方面AOR = 4.33，95% CI = 3.71 - 5.06）。
结论
有疼痛的受试者在更早的年龄就出现了与衰老相关的典型功能受限。
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