Physical strength and mental health mediate the association between pain and falls (recurrent and/or injurious) among community-dwelling older adults in Singapore

Abstract

Objective: This study aims to understand if poor physical strength and depression mediate the association between pain and recurrent and/or injurious falls in a community of older adults. Methods: Data was obtained from a nationally representative longitudinal cohort study conducted in Singapore, PHASE (Wave I and II), which collected information from community-dwelling older adults above 60 years old. A hurdle negative binomial regression and binomial logistic regression were used to assess the association between pain and recurrent falls, and pain and injurious falls respectively. A subsequent mediation analysis was conducted. Results: Almost half of the participants (N = 1144, 39.7%) reported having either mild, moderate, or severe pain at baseline, 166 (5.4%) participants experienced injurious falls and 144 (4.7%) participants experienced recurrent falls at Wave II. After adjusting for covariates, the presence of pain significantly influenced recurrent (OR 2.8; 95% CI: 1.8, 4.4) and injurious falls (OR: 1.8; 95% CI: 1.3, 2.5). Mediation analyses demonstrated that poor physical strength and depression had a significant mediation effect between all pain characteristics on recurrent falls. Poor physical strength partially mediates the effects of pain and injurious falls as well. However, the mediating effect of poor physical strength and depression was not observed between other pain characteristics and injurious falls. Conclusions: The findings highlighted differences in the underlying mechanisms between pain characteristics affecting recurrent and injurious falls. These insights will be useful for identifying patients most at risk for recurrent or injurious falls, and for tailoring future community-based fall intervention programmes.