Pain as a Risk Factor for Disability or Death

ObjectivesTo determine whether pain predicts future activity of daily living (ADL) disability or death in individuals aged 60 and older.DesignProspective cohort study.SettingThe 1998 to 2008 Health and Retirement Study (HRS), a nationally representative study of older community-living individuals.ParticipantsTwelve thousand six hundred thirty-one participants in the 1998 HRS aged 60 and older who did not need help in any ADL.MeasurementsParticipants reporting that they had moderate or severe pain most of the time were defined as having significant pain. The primary outcome was time to development of ADL disability or death over 10yrs, assessed at five successive 2-year intervals. ADL disability was defined as needing help performing any ADL: bathing, dressing, transferring, toileting, eating, or walking across a room. A discrete hazards survival model was used to examine the relationship between pain and incident disability over each 2-year interval using only participants who started the interval with no ADL disability. Several potential confounders were adjusted for at the start of each interval: demographic factors, seven chronic health conditions, and functional limitations (ADL difficulty and difficulty with five measures of mobility).ResultsAt baseline, 2,283 (18%) participants had significant pain. Participants with pain were more likely (all P&nbsp