# Association between chronic pain severity, falls, frailty and perceived health in older adults at risk of falls

## TL;DR

Chronic pain in older adults is linked to more falls, frailty, and worse health, suggesting pain assessment should be part of fall risk evaluations.

## Contribution

This study identifies chronic pain severity as a novel predictor of falls and frailty in older adults at risk of falling.

## Key findings

- Moderate or higher chronic pain increases odds of future falls and frailty in older adults.
- Pain severity correlates with slower gait, worse physical performance, and lower perceived health.
- Incorporating pain assessment into fall risk evaluations may improve prevention strategies.

## Abstract

Chronic pain, defined as pain persisting for ≥ 3 months, is associated with frailty, falls, and reduced quality of life. Falls remain a major cause of morbidity and mortality in older adults, yet the value of integrating pain severity into falls risk assessment is underexplored. This study examined associations between chronic pain severity and subsequent falls, frailty, physical performance, and perceived health in older adults at risk of falls.

In this cross-sectional study, baseline data from 143 community-dwelling adults aged ≥ 60 years at risk of falls were analysed. Participants were recruited from community and primary care centres in Singapore. Pain severity was assessed using the Wong–Baker Faces Pain Rating Scale (0–10) and classified as no pain, mild pain (< 3), or at least moderate pain (≥ 3). Data on demographics, frailty, sarcopenia (SARC-F ≥ 2), nutrition, cognition, fear of falling, and perceived health (EuroQol Visual Analogue Scale [EQ-VAS] and EuroQoL 5-Dimensions [EQ-5D]) were collected. Physical performance tests included handgrip strength, gait speed, 5-times sit-to-stand, and Timed-Up-and-Go (TUG). Logistic and linear regression models examined associations between pain severity and outcomes, adjusting for demographic and clinical covariates.

Chronic pain was prevalent in 37.1%. Compared with no pain, at least moderate pain was associated with higher odds of future falls (adjusted odds ratio (aOR) 3.54, 95% CI 1.53–8.19), moderate/high falls risk (aOR 4.78, 95% CI 1.65–10.77), frailty (aOR 4.17, 95% CI 1.42–8.26), sarcopenia (aOR 4.99, 95% CI 1.63–7.28), slower gait speed (aOR 3.87, 95% CI 1.18–8.67), longer TUG (aOR 4.52, 95% CI 1.36–10.01), and poor physical performance (aOR 12.50, 95% CI 3.94–17.17). Pain severity was associated with EQ-VAS (β = − 4.07, 95% CI − 7.67 to − 1.47) and EQ-5D index (β = − 0.11, 95% CI − 0.15 to − 0.07).

Higher chronic pain severity was associated with future falls, frailty, poor physical performance and lower perceived health in at-risk older adults. Incorporating pain severity assessment into falls risk stratification could support earlier, targeted interventions to prevent injurious falls. Longitudinal studies are needed to determine the causal impact of pain management on falls, frailty, and quality of life.

Chronic pain in older adults is significantly associated with an increased risk of future falls, frailty, poor physical performance, and lower perceived health, highlighting the importance of evaluating chronic pain in fall risk assessments and vice versa. Implementing targeted prevention measures for individuals with chronic pain can potentially mitigate the risk of falls and improve overall health outcomes in this population.