Lohman Matthew C, Whiteman Karen L, Greenberg Rebecca L, Bruce Martha L
Department of Community and Family Medicine of the Dartmouth Geisel School of Medicine, Dartmouth Centers for Health and Aging, Lebanon, New Hampshire.
Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
J Gerontol A Biol Sci Med Sci. 2017 Feb;72(2):216-222. doi: 10.1093/gerona/glw212. Epub 2016 Oct 21.
Frailty, a syndrome of physiological deficits, is prevalent among older adults and predicts elevated risk of adverse health outcomes. Although persistent pain predicts similar risk, it is seldom considered in frailty measurement. This article evaluated the construct and predictive validity of including persistent pain in phenotypic frailty measurement.
Frailty and persistent pain were operationalized using data from the Health and Retirement Study (2006-2012 waves). Among a subset of adults aged 65 and older (n = 3,652), we used latent class analysis to categorize frailty status and to evaluate construct validity. Using Cox proportional hazards models, we compared time to incident adverse outcomes (death, fall, hospitalization, institutionalization, and functional disability) between frailty classes determined by either including or excluding persistent pain as a frailty component.
In latent class models, persistent pain occurred with other frailty components in patterns consistent with a medical syndrome. Frail and intermediately frail classes determined by including persistent pain were more strongly associated with all adverse outcomes compared with frail and intermediately frail classes determined excluding persistent pain. Frail respondents had significantly greater risk of death compared with nonfrail respondents when frailty models included rather than excluded persistent pain (respectively, hazard ratio [HR] = 3.87, 95% confidence interval [CI] = 2.99-5.00 (including pain); HR = 2.10, 95% CI = 1.71-2.59 (excluding pain).
Findings support consideration of persistent pain as a component of the frailty phenotype. Persistent pain assessment may provide an expedient method to enhance frailty measurement and improve prediction of adverse outcomes.
衰弱是一种生理功能缺陷综合征，在老年人中普遍存在，并预示着不良健康结局风险的升高。尽管持续性疼痛预示着类似的风险，但在衰弱测量中很少被考虑。本文评估了将持续性疼痛纳入表型衰弱测量的结构效度和预测效度。
使用健康与退休研究（2006 - 2012年波次）的数据对衰弱和持续性疼痛进行操作化定义。在65岁及以上成年人的一个子集中（n = 3652），我们使用潜在类别分析对衰弱状态进行分类并评估结构效度。使用Cox比例风险模型，我们比较了将持续性疼痛作为衰弱组成部分纳入或排除所确定的衰弱类别之间发生不良结局（死亡、跌倒、住院、入住机构和功能残疾）的时间。
在潜在类别模型中，持续性疼痛与其他衰弱组成部分同时出现的模式与一种医学综合征一致。与排除持续性疼痛所确定的衰弱和中度衰弱类别相比，纳入持续性疼痛所确定的衰弱和中度衰弱类别与所有不良结局的关联更强。当衰弱模型纳入而非排除持续性疼痛时，衰弱受访者与非衰弱受访者相比死亡风险显著更高（分别为，风险比[HR] = 3.87，95%置信区间[CI] = 2.99 - 5.00（包括疼痛）；HR = 2.10，95%CI = 1.71 - 2.59（排除疼痛））。
研究结果支持将持续性疼痛视为衰弱表型的一个组成部分。持续性疼痛评估可能提供一种便捷的方法来加强衰弱测量并改善对不良结局的预测。
