Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Suzanne G. Leveille

Second Advisor

Ling Shi

Third Advisor

Tongjian You


Falls are a threat to the health of the older population and impair their functional independence in everyday life. Chronic pain is a risk factor contributing to mobility impairment and falls. This study aims to examine the association of chronic pain with 1) risk of injurious falls, and 2) circumstances of falls in community-dwelling older adults. This study used a prospective cohort study design and secondary data analysis. The MOBILIZE Boston Study (MBS) recruited 765 community-dwelling older adults aged 70 years and older in Boston area. Chronic pain characteristics including global pain severity, pain interference, and pain distribution were measured using Brief Pain Inventory (BPI) pain severity subscale, BPI pain interference subscale, and the joint pain questionnaire in the baseline home interview, respectively. Participants were followed up for up to 4.3 years for monthly pain ratings and fall data collection using monthly fall calendars, followed by a fall follow-up phone interview about the circumstances and outcomes of falls. Negative binomial models and logistic regression models examined the association between chronic pain and long-term and short-term risk of injurious falls, respectively. Logistic regression models examined the association between monthly pain ratings and circumstances of falls in the following month.

Participants in the highest third of pain interference score and multisite pain had an approximately 50% greater risk of injurious falls in up to 4.3 years of follow up. Moderate to very severe pain in any given month was associated with a greater risk of injurious falls in the subsequent month compared to those without pain. Participants with moderate to very severe pain in a given month were more likely to report an indoor fall, a fall while walking, standing, or getting onto or out of a chair, sofa, bed, or toilet compared to those without pain. They were more likely to report causes of falls as health problems or feeling dizzy or faint. Health care providers in the community need to provide tailored fall prevention programs for older adults with different health conditions and environmental hazards. Study findings shed light on the pain-fall relationship among community-dwelling older adults.


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