Association between Frailty and Pain in Older People at High Risk of Future Hospitalization

Huan-Ji Dong^1*Joakim Yang¹Maria M Johansson²Anneli Peolsson³Marco Barbero⁴Magnus Nord⁵

• ¹Dept. of Health, Medicine and Caring Sciences, and Pain and Rehabilitation clinic, Linköping University, Linköping, Östergötland, Sweden
• ²Dept. of Activity and Health in Linköping and Dept of Health Medicine and Caring Sciences, Linköping University, Linköping, Östergötland, Sweden
• ³Dept. of Health Medicine and Caring Sciences, Unit of Physiotherapy, and Occupational and Environmental Medicine Centre, Dept. of Health Medicine and Caring Sciences, Unit of Clinical Medicine, Linköping University, Linköping, Östergötland, Sweden
• ⁴Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Ticino, Switzerland
• ⁵Dept. of Health, Medicine and Caring Sciences, Linköping University, Sweden; and Primary Health Care Center Valla, Linköping University, Linköping, Östergötland, Sweden

Background: Previous studies have demonstrated an independent association between pain and frailty, but knowledge about this association with different pain characteristics is limited. Objective: This study was embedded in a prospective, pragmatic, matched-control multicenter trial at 19 primary care practices in south-eastern Sweden (ClinicalTrials.gov 170608, ID: NCT03180606), aiming to investigate the association between frailty and pain characteristics among older people (75+) at high risk of hospitalization. Methods: High risk of hospitalization was identified using case-finding algorithm including 32 diagnostic codes of morbidities and healthcare use. Frailty was assessed by a nurse-physician team using Clinical Frailty Scale (N=389). Data on pain aspects, physical and ADL functioning were collected in the self-reported questionnaires. Results: One in three (n=133, 34%) was classified as frail. About 36% (n=142) reported frequent pain (from several times per week to constantly). Slightly over 40% reported pain lasting longer than 3 months (n=163, 41.9%) and/or having regional or widespread pain (n=165, 42.4%). In comparison to non-frail peers, frail participants reported higher pain intensity, more ADL-dependency, less physical active, and more anxiety/depression (p < 0.01). In logistic regression analysis, pain frequency [Odds Ratio (OR) 1.8, 95% confidence interval (CI): 1.2-2.8] was associated with frailty. However, the models with ADL-staircase score (OR 1.4, 95% CI: 1.2-1.6) had a higher explanatory power (Nagelkerke 𝑅𝑅 2 : 0.39) in predicting frailty than those without this aspect (𝑅𝑅 2 : 0.10 and 0.13). Conclusion: In older people at high risk of hospitalization, pain frequency seemed to be related to frailty, whilst ADL dependency demonstrated a stronger association.