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The relationship of pain and cognitive impairment with social vulnerability--an analysis of the Canadian Study of Health and Aging.

Shega JW, Andrew M, Hemmerich J, Cagney KA, Ersek M, Weiner DK, Dale W. The relationship of pain and cognitive impairment with social vulnerability--an analysis of the Canadian Study of Health and Aging. Pain medicine (Malden, Mass.). 2012 Feb 1; 13(2):190-7.

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OBJECTIVE: The objective of this study was to delineate the relationship between noncancer pain and cognitive impairment with social vulnerability. DESIGN: The study was designed as a cross-sectional analysis of the Canadian Study of Health and Aging, 1996 wave. SETTING: Community-dwelling older adults in Canada. SUBJECTS: 3,776 study participants. OUTCOME MEASURES: Pain was categorized as no or very mild pain vs moderate or severe pain. Cognitive impairment was dichotomized from the Modified Mini-Mental State Examination (0-100) to no ( > 77) or impairment (77 or < ). Social vulnerability (outcome) was operationalized as the accumulation of 39 possible self-report variables related to social circumstance, scores range from 0 to 1, where higher scores indicate greater vulnerability. Additional covariates included demographics, depressed mood, comorbidity, and functional impairment. Bivariate and multivariate relationships between pain and cognitive impairment with social vulnerability were assessed using t-tests and linear regression, respectively. RESULTS: Of 5,703 respondents, 1,927 were missing a component of the social vulnerability index and of these nine were missing a pain response, leaving 3,767 (66.1%) of the original sample. A total of 2,435 (64.6%) reported no/mild pain and 3,435 (91.2%) were cognitively intact. The mean (standard deviation) social vulnerability index was 9.97 (3.62) with scores ranging from 1.12 to 26.85. Moderate or severe pain 0.44 (95% confidence interval [CI] 0.21, 0.66, P < 0.01) and cognitive impairment 0.49 (95% CI 0.13, 0.86, P < 0.01) were independently associated with social vulnerability, but the interaction term was not statistically significant, 0.40 (95% CI -0.32,1.14, P = 0.27). CONCLUSION: Pain and cognitive impairment are independently associated with social vulnerability. Improvements in pain management might mitigate social vulnerability in a growing number of older adults with either or both conditions.

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