Sections of Geriatrics & Palliative Medicine Hematology/Oncology Department of Health Studies and Sociology, University of Chicago, Chicago, IL, USA.
Pain Med. 2012 Feb;13(2):190-7. doi: 10.1111/j.1526-4637.2011.01309.x. Epub 2012 Jan 13.
The objective of this study was to delineate the relationship between noncancer pain and cognitive impairment with social vulnerability.
The study was designed as a cross-sectional analysis of the Canadian Study of Health and Aging, 1996 wave.
Community-dwelling older adults in Canada.
3,776 study participants.
Pain was categorized as no or very mild pain vs moderate or severe pain. Cognitive impairment was dichotomized from the Modified Mini-Mental State Examination (0-100) to no (>77) or impairment (77 or <). Social vulnerability (outcome) was operationalized as the accumulation of 39 possible self-report variables related to social circumstance, scores range from 0 to 1, where higher scores indicate greater vulnerability. Additional covariates included demographics, depressed mood, comorbidity, and functional impairment. Bivariate and multivariate relationships between pain and cognitive impairment with social vulnerability were assessed using t-tests and linear regression, respectively.
Of 5,703 respondents, 1,927 were missing a component of the social vulnerability index and of these nine were missing a pain response, leaving 3,767 (66.1%) of the original sample. A total of 2,435 (64.6%) reported no/mild pain and 3,435 (91.2%) were cognitively intact. The mean (standard deviation) social vulnerability index was 9.97 (3.62) with scores ranging from 1.12 to 26.85. Moderate or severe pain 0.44 (95% confidence interval [CI] 0.21, 0.66, P < 0.01) and cognitive impairment 0.49 (95% CI 0.13, 0.86, P < 0.01) were independently associated with social vulnerability, but the interaction term was not statistically significant, 0.40 (95% CI -0.32,1.14, P = 0.27).
Pain and cognitive impairment are independently associated with social vulnerability. Improvements in pain management might mitigate social vulnerability in a growing number of older adults with either or both conditions.
本研究旨在描述非癌症疼痛与认知障碍和社会脆弱性之间的关系。
本研究是对 1996 年加拿大老龄化健康研究的横断面分析。
加拿大的社区居住老年人。
3776 名研究参与者。
疼痛分为无或轻度疼痛与中度或重度疼痛。认知障碍采用改良后的简易精神状态检查（0-100）分为无（>77）或障碍（77 或<）。社会脆弱性（结局）是通过 39 个与社会环境相关的自我报告变量的积累来操作化的，得分范围为 0 到 1，分数越高表示脆弱性越大。其他协变量包括人口统计学因素、抑郁情绪、合并症和功能障碍。使用 t 检验和线性回归分别评估疼痛和认知障碍与社会脆弱性之间的双变量和多变量关系。
在 5703 名应答者中，有 1927 名缺失社会脆弱性指数的一个组成部分，其中 9 名缺失疼痛反应，因此原始样本中有 3767 名（66.1%）。共有 2435 名（64.6%）报告无/轻度疼痛，3435 名（91.2%）认知完整。社会脆弱性指数的平均值（标准差）为 9.97（3.62），得分范围为 1.12 至 26.85。中度或重度疼痛（95%置信区间[CI]0.21-0.66，P<0.01）和认知障碍（95%CI0.13-0.86，P<0.01）与社会脆弱性独立相关，但交互项无统计学意义（95%CI-0.32-1.14，P=0.27）。
疼痛和认知障碍与社会脆弱性独立相关。在越来越多的患有疼痛或认知障碍或两者兼有的老年人中，改善疼痛管理可能会减轻他们的社会脆弱性。
