Date of Award

8-2023

Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Sun Kim

Second Advisor

Suzanne G. Leveille

Third Advisor

Qian Song

Abstract

More than half of older adults in the United States (US) experience pain which is associated with disability, falls, physical frailty, and depression posing a risk to their functional independence with daily activities. As the older population continues to grow, it is crucial to understand holistic ways to prevent and mitigate pain. Little is known about the longitudinal influence of social participation (SP) and physical activity (PA) on pain outcomes among community dwelling US older adults. Guided by the Biopsychosocial Model of Chronic Pain for older adults (Miaskowski et al., 2020), the primary aim of this study was to understand the association between cross-sectional relationships and longitudinal patterns of SP, PA, and pain outcomes (presence of pain and number of pain sites) from 2011-2021 among community dwelling US adults aged 65 or older via three publications. This 3-part manuscript study is a secondary data analysis of the National Health and Aging Trends Study (NHATS).

The first study assessed cross-sectional associations among SP/PA and pain outcomes and whether SP and/or PA decrease the risk for developing new or worsening pain over a 10-year period via a survival analysis by logistic regression. This study demonstrated that more SP was cross-sectionally associated with pain outcomes but might not be protective for developing new or worsening pain. Additionally, PA was cross-sectionally associated with pain outcomes, and importantly may be protective for developing new or worsening pain.

The second manuscript assessed longitudinal associations of SP, PA and number of pain sites over a 10-year period via growth curve modeling using mixed-effects negative binomial regressions. This study also assessed whether the relationships between SP, PA and number of pain sites were moderated by demographic (age, race, gender) and health characteristics (BMI and central obesity) and whether the relationships varied according to demographic and health characteristics. This study demonstrated that SP and PA were consistently inversely associated with number of pain sites over a 10-year period. No moderation effects were noted, and the stratified analysis revealed that the association between SP/PA and number of pain sites remained consistent across certain racial/ethnic groups, and all genders, age groups and health characteristics. These consistent associations across demographic strata and BMI/ central obesity strata emphasizes the need for adequate assessment of SP/PA among all older adults experiencing pain.

In a natural experiment, the third manuscript assessed trends of SP/PA before and during the pandemic, and whether the years of the pandemic were associated with the prevalence of bothersome pain and number of pain sites among community dwelling older adults. This study demonstrated that SP significantly decreased during the pandemic compared to pre pandemic years, while involvement in walking increased and vigorous activity decreased. Pain outcomes varied according to two phases of the pandemic (years 2020 and 2021) where the prevalence of bothersome pain did not significantly change; yet the mean number of reported pain sites slightly increased in 2020 compared to 2018. By 2021, the mean number of pain sites was lower than pre-pandemic years. We observed a coincident temporal trend between decreased SP and higher mean number of pain sites in 2020. Patterns of PA did not track with pain experience during both pandemic years compared to pre-pandemic years.

Taken together, this dissertation highlights that SP and PA can influence pain experience. Further research should prospectively study SP and PA in relation to pain among US older adults. Overall, these results support future policy implications and a rational for investment in equitable access to SP and PA among community dwelling older adults to help mitigate their pain experience.

Comments

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