Objective

To determine the association of chronic conditions measured at baseline with physical performance and falls over time among older adults with back pain. We examined both number and type (depression, anxiety, arthritis) of chronic conditions.

Design

Retrospective cohort study.

Setting

National Health and Aging Trends Study.

Participants

A total of 2438 community-dwelling Medicare beneficiaries aged ≥65 years with bothersome back pain (N=2438). The sample was mostly female (62%; 95% confidence interval [CI], 59%-64%) and aged 65-74 years (56%; 95% CI, 53%-58%).

Interventions

Not applicable.

Main Outcome Measures

Short Physical Performance Battery (SPPB) (range, 0-12, lower indicates worse function) and recurrent falls measured annually over 6 years.

Results

Multiple chronic conditions were highly prevalent (82%; 95% CI, 79%-84%) among those reporting back pain. Adjusted regressions using survey weights with Taylor series linearization method and containing interaction terms for comorbidity and time showed having 2-3 chronic conditions vs 0-1 was associated with lower SPPB scores, and differences grew over time (for example 0.61 points lower [95% CI, −0.88 to −0.34] and 1.22 points lower [95% CI, −1.76 to −0.67] in rounds 3 and 6, respectively). Having ≥4 chronic conditions was associated with lower SPPB scores at all time points vs 0-1 (point estimate range, −1.72 to −2.31). Arthritis alone; the combination of arthritis with depression; and the triad of arthritis, depression, and anxiety were associated with lower SPPB scores at all time points. Logistic regression models showed presence of 2-3 and ≥4 chronic conditions was associated with increased odds of recurrent falls in any given year (odds ratio, 1.91; 95% CI, 1.35-2.69 and odds ratio, 3.92; 95% CI, 2.81-5.46, respectively). Those with the triad of arthritis, depression, and anxiety had greater odds of recurrent falls vs none or 1 condition.

Conclusions

Among older adults with back pain, those with multiple chronic conditions, including co-occurrence of arthritis, depression, and anxiety, have greater risk for poor physical functioning and falls over time.

中文翻译：

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患有背痛的老年人中多种慢性疾病与身体机能和跌倒的关联：一项基于人群的纵向研究

客观的

确定基线测量的慢性病与背痛老年人的身体表现和随时间下降的关系。我们检查了慢性病的数量和类型（抑郁、焦虑、关节炎）。

设计

回顾性队列研究。

环境

国家健康和老龄化趋势研究。

参与者

共有 2438 名居住在社区的医疗保险受益人年龄≥65 岁，患有令人烦恼的背痛（N=2438）。样本主要是女性（62%；95% CI，59%-64%）和年龄在 65-74 岁之间（56%；95% CI，53%-58%）。

干预措施

不适用。

主要观察指标

Short Physical Performance Battery (SPPB)（范围，0-12，较低表示功能较差）和反复跌倒，每年测量 6 年。

结果

在那些报告背痛的人中，多种慢性病非常普遍（82%；95% CI，79%-84%）。使用泰勒级数线性化方法的调查权重并包含合并症和时间的交互项的调整回归表明，患有 2-3 种慢性病与 0-1 种慢性病与较低的 SPPB 评分相关，并且差异随着时间的推移而增加（例如，降低 0.61 点 [95%在第 3 轮和第 6 轮中，CI，-0.88 至 -0.34] 和 1.22 点分别降低 [95% CI，-1.76 至 -0.67]）。与 0-1 相比，有 ≥4 种慢性病与较低的 SPPB 分数相关（点估计范围，-1.72 至 -2.31）。单独的关节炎; 关节炎与抑郁症的结合；在所有时间点，关节炎、抑郁和焦虑三联征与较低的 SPPB 评分相关。Logistic 回归模型显示，在任何给定年份，存在 2-3 种和 ≥4 种慢性病与复发性跌倒的几率增加相关（优势比，1.91；95% CI，1.35-2.69 和优势比，3.92；95% CI，2.81 -5.46，分别）。患有关节炎、抑郁和焦虑三联征的人复发性跌倒的几率高于没有或只有一种情况。

结论

在患有背痛的老年人中，患有多种慢性病的人，包括同时患有关节炎、抑郁症和焦虑症的人，随着时间的推移身体机能不佳和跌倒的风险更大。