Persistence and Remission of Musculoskeletal Pain in Community-Dwelling Older Adults: Results from the Cardiovascular Health Study
Stephen M. Thielke, MD, MSPH Heather Whitson, MD, MHS Paula Diehr, PhD Ann O’Hare, MD, MA Patricia M. Kearney, PhD Sarwat I. Chaudhry, MD Neil A. Zakai, MD, MSc Dae Kim, MD, MPH Nishant Sekaran, MD Joanna E. M. Sale, PhD Alice M. Arnold, PhD Paulo Chaves, MD, PhD Anne Newman, MD, MPH
OBJECTIVE: To characterize longitudinal patterns of musculoskeletal pain in a community sample of older adults over a 6-year period and to identify factors associated with persistence of pain.
DESIGN: Secondary analysis of the Cardiovascular Health Study.
SETTING: Community-based cohort drawn from four U.S. counties.
PARTICIPANTS: Five thousand ninety-three men and women aged 65 and older.
MEASUREMENTS: Over a 6-year period, pain was assessed each year using a single question about the presence of pain in any bones or joints during the last year. If affirmative, participants were queried about pain in seven locations (hands, shoulders, neck, back, hips, knees, feet). Participants were categorized according to the percentage of time that pain was present and according to the intermittent or chronic pattern of pain. Factors associated with persistent pain during five remaining years of the study were identified.
RESULTS: Over 6 years, 32% of participants reported pain for three or more consecutive years, and 32% reported pain intermittently. Of those who reported pain the first year, 54% were pain free at least once during the follow-up period. Most of the pain at specific body locations was intermittent. Factors associated with remission of pain over 5 years included older age, male sex, better self-rated health, not being obese, taking fewer medications, and having fewer depressive symptoms. Approximately half of those with pain reported fewer pain locations the following year.
CONCLUSIONS: Musculoskeletal pain in older adults, despite high prevalence, is often intermittent. The findings refute the notion that pain is an inevitable, unremitting, or progressive consequence of aging. J Am Geriatr Soc. 2012;60(8):1393-1400.
Self-Help Treatment for Insomnia Symptoms Associated With Chronic Conditions in Older Adults: A Randomized Controlled Trial
Kevin Morgan, PhD Pamela Gregory, MSc Maureen Tomeny, D Clin Psy Beverly M. David, PhD Claire Gascoigne, MSc
OBJECTIVES: To evaluate the effectiveness of a self-help cognitive behavioral intervention in improving sleep quality in older adults reporting insomnia symptoms associated with chronic disease.
DESIGN: A pragmatic two-arm randomized controlled trial comparing supported self-help with treatment as usual (TAU).
SETTING: Primary care.
PARTICIPANTS: One hundred ninety-three self-referred individuals aged 55 to 87 with long-term conditions and chronic insomnia symptoms (as defined according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition).
INTERVENTION: Self-help participants received six consecutive booklets, at weekly intervals, providing structured advice on important components of cognitive behavioral therapy for insomnia (CBT-I, including self-monitoring, sleep restriction, stimulus control procedures, and cognitive strategies), plus access to a telephone helpline. Control group participants received a single sheet of advice detailing standard sleep hygiene measures.
MEASUREMENTS: The primary outcome was sleep quality, measured by the Pittsburgh Sleep Quality Index (PSQI). Secondary outcomes were the Insomnia Severity Index (ISI), the subjective sleep efficiency index, and the Fatigue Severity Scale.
RESULTS: In the self-help group, sleep outcomes showed significant improvements after treatment (PSQI, P< .001; ISI, P< .001; sleep efficiency, P< .001) and at 3-month (PSQI, P=.002; ISI, P=.006; sleep efficiency, P=.001) and 6-month (PSQI, P=.003; ISI, P=.003; sleep efficiency, P=.001) follow-up. Effect sizes were moderate (range of adjusted Cohen d=0.51–0.75). Treatment had no effect on levels of daytime fatigue. Most treated participants (73%) said they would recommend the self-help program to others.
CONCLUSION: Self-help CBT-I offers a practical first-line response to individual reporting insomnia symptoms associated with chronic disease in primary care settings. In these individuals, symptoms of daytime fatigue may be more closely associated with disease processes than with sleep quality. J Am Geriatr Soc. 2012;60(10):1803-1810.
Serum Albumin in Relation to Change in Muscle Mass, Muscle Strength, and Muscle Power in Older Men
Caryn K. Snyder, MPH Jodi A. Lapidus, PhD Peggy M. Cawthon, PhD, MPH Thuy-Tien L. Dam, MD Lynn Y. Sakai, PhD Lynn M. Marshall, ScD
OBJECTIVES: To investigate the relationship between serum albumin and change in muscle mass, grip strength, and leg power.
DESIGN: Prospective cohort.
SETTING: Six U.S. academic medical centers.
PARTICIPANTS: Community-dwelling men aged 65 and older participating in the Osteoporotic Fractures in Men (MrOS) Study.
MEASUREMENTS: Serum albumin was measured at baseline in 5,534 participants. Baseline serum albumin was examined in relation to change in appendicular skeletal muscle (ASM) mass, grip strength, and leg power after 2 and 4.6 years. Two-year change in serum albumin was examined with respect to simultaneous change in these outcomes in 1,267 participants.
RESULTS: Baseline serum albumin <40 g/L was not associated with 2- or 4.6-year change in ASM mass, grip strength, or leg power before or after adjustment for confounders. There was no association between serum albumin change and change in grip strength. A statistically significant trend was observed between serum albumin change and change in ASM mass, but there was substantial overlap across confidence intervals (CIs). Participants with a marked decrease (>3 g/L) and mild decrease (1–2 g/L) in serum albumin over 2 years exhibited a modest change of −8.9 W (95% CI= −25.6 to −7.8 W) and −6.3 W (95% C= −21.2 to −8.5 W) of leg power, respectively (P for trend=.02), compared with those with no decrease in albumin concentration.
CONCLUSION: Serum albumin demonstrated modest and inconsistent trends with loss of muscle mass and function. Low serum albumin within the normal range is not a risk factor for this process in elderly men. J Am Geriatr Soc. 2012;60(9):1663-1672.