University of Chicago, Section of Geriatrics and Palliative Medicine, Chicago, IL 60637, USA.
Pain Med. 2010 Nov;11(11):1680-7. doi: 10.1111/j.1526-4637.2010.00987.x.
Determine if the multidimensional pain-related experience differs between cognitively intact and impaired older adults.
Cross-sectional analysis of the Canadian Study of Health and Aging.
Community-dwelling older adults.
Pain reports were dichotomized from a 5-point scale into no/very mild vs moderate and greater. Cognition measured by the Modified Mini Mental State Exam (0-100) was dichotomized into cognitively intact (>77) and cognitively impaired (≤77). Five self-rated Instrumental Activities of Daily Living (IADL) were dichotomized into no impairment vs any impairment. The Mental Health Inventory consists of five self-rated questions about psychological state and well-being, with scores ranging from 0 to 30; scores >11 indicate depression. Self-rated health was dichotomized into very good/pretty good and not too good/poor/very poor. Additional covariates included demographics and co-morbidities.
Of the 5,549 (97.3%) eligible participants, 1,991 (35.9%) reported pain of moderate intensity or greater, and 1,028 (18.5%) were cognitively impaired. Among cognitively impaired participants, moderate or greater pain report was associated with functional impairment odds ratio (OR) = 1.74 (1.15, 2.62; P < 0.01), depressed mood OR = 1.69 (1.18, 2.44; P < 0.01), and lower self-rated health OR = 2.35 (1.69, 3.30; P < 0.01). Among cognitively intact participants, pain report was similarly associated with functional impairment OR = 1.40 (1.20,1.63); P < 0.01), depressed mood OR = 1.88 (1.59,2.23; P < 0.01), and lower self-rated health OR = 2.34 (1.94,2.82; P < 0.01).
Pain self-report in both cognitively intact and impaired community-dwelling persons is associated with a similar multidimensional experience. These findings confirm the need for comprehensive evaluation of pain and related outcomes in all older adults, with appropriate pharmacologic and nonpharmacologic management.
确定认知功能正常和受损的老年人之间多维疼痛相关体验是否存在差异。
加拿大老龄化健康研究的横断面分析。
社区居住的老年人。
疼痛报告从 5 分制中分为无/轻度疼痛与中度和重度疼痛。认知功能采用改良的 Mini Mental State 检查（0-100）进行评估，分为认知功能正常（>77）和认知功能受损（≤77）。五项自我评估的工具性日常生活活动（IADL）分为无功能障碍与任何功能障碍。心理健康量表由五个自我评估的问题组成，涉及心理状态和幸福感，得分范围为 0 至 30；得分>11 表示抑郁。自我评估的健康状况分为非常好/相当好和不太好/差/非常差。其他协变量包括人口统计学和合并症。
在 5549 名（97.3%）合格参与者中，1991 名（35.9%）报告有中度或更强烈的疼痛，1028 名（18.5%）认知受损。在认知受损的参与者中，中度或更强烈的疼痛报告与功能障碍的比值比（OR）为 1.74（1.15，2.62；P < 0.01）、抑郁情绪 OR 为 1.69（1.18，2.44；P < 0.01）和较低的自我评估健康 OR 为 2.35（1.69，3.30；P < 0.01）。在认知功能正常的参与者中，疼痛报告也与功能障碍 OR = 1.40（1.20，1.63）；P < 0.01）、抑郁情绪 OR = 1.88（1.59，2.23；P < 0.01）和较低的自我评估健康 OR = 2.34（1.94，2.82；P < 0.01）相关。
在认知功能正常和受损的社区居住人群中，疼痛自我报告与类似的多维体验相关。这些发现证实了在所有老年人中全面评估疼痛及相关结局的必要性，包括适当的药物和非药物治疗。
