Kawashima Arisa, Komatsu Ayane, Jin Xueying, Shimada Hiroyuki, Arai Hidenori, Saito Tami
Department of Social Science, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.
Division of Integrated Health Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya City, Aichi Prefecture, 461-8673, Japan.
Eur Geriatr Med. 2025 Sep 8. doi: 10.1007/s41999-025-01299-5.
To investigate the longitudinal association between chronic pain and decline in activity of daily living (ADL) among community-dwelling older adults aged ≥ 60 years.
In this systematic review of prospective longitudinal studies with narrative synthesis, a comprehensive literature search was conducted using PubMed and Embase using free-text words and MeSH terms on February 3, 2025. Longitudinal studies that quantitatively assessed ADL at two or more time points and pain at least once were included. Interventional studies, qualitative research, and non-English publications were excluded. Titles, abstracts, and full texts were screened by multiple independent reviewers based on the eligibility criteria. The included studies' methodological quality was evaluated using the Study Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.
Seven studies (9,786 participants) met the inclusion criteria. These prospective cohort studies suggest that chronic musculoskeletal pain, particularly knee or back pain, is associated with declines in basic ADL, instrumental ADL, lower extremity physical function, and mobility disability. Most studies evaluated pain based on frequency, severity, or impact on function, whereas one study used the number of pain sites. The reported effect sizes varied, with adjusted odds ratios for ADL decline ranging from 1.31 to 2.38 and hazard ratios from 1.49 to 3.47. Meta-analysis was not feasible because of the heterogeneity in the measures used to assess pain and ADL.
This review indicates that chronic pain is associated with ADL decline in community-dwelling older adults. Regular pain assessment and appropriate management may help maintain ADL in this population.
探讨60岁及以上社区居住老年人慢性疼痛与日常生活活动能力（ADL）下降之间的纵向关联。
在这项采用叙述性综合的前瞻性纵向研究系统评价中，于2025年2月3日使用自由文本词和医学主题词（MeSH）在PubMed和Embase上进行了全面的文献检索。纳入至少在两个时间点定量评估ADL且至少一次评估疼痛的纵向研究。排除干预性研究、定性研究和非英文出版物。由多名独立评审员根据纳入标准筛选标题、摘要和全文。使用观察性队列研究和横断面研究的研究质量评估工具评估纳入研究的方法学质量。
七项研究（9786名参与者）符合纳入标准。这些前瞻性队列研究表明，慢性肌肉骨骼疼痛，尤其是膝盖或背部疼痛，与基本ADL、工具性ADL、下肢身体功能和行动能力残疾的下降有关。大多数研究基于频率、严重程度或对功能的影响来评估疼痛，而一项研究使用疼痛部位的数量。报告的效应大小各不相同，ADL下降的调整优势比范围为1.31至2.38，风险比范围为1.49至3.47。由于评估疼痛和ADL所使用的测量方法存在异质性，因此无法进行荟萃分析。
本综述表明，慢性疼痛与社区居住老年人的ADL下降有关。定期疼痛评估和适当管理可能有助于维持该人群的ADL。
