Chronic Pain and Health-Related Quality of Life in Older Adults with Disability in Canada

1. Examining the Relationship Between Chronic Pain and Health-Related Quality of Life Among Older Canadian Adults with Disability • Kristina Zawaly, B.A., B.Sc. & M.Sc. • University of Manitoba

2. Acknowledgments • Advisor: ShahinShooshtari, Ph.D. University of Manitoba • Committee Members: Nancy Hansen, Ph. D., VerenaMenec, Ph.D. and Ian Clara Ph.D. University of Manitoba • Funding: The University of Manitoba Centre on Aging (2011, Graduate Fellowship) & The University of Manitoba Research Data Centre (2011, Graduate Fellowship) & Research Data Centre (2012, Travel Grant)

3. Background • With the aging of the Canadian population, there will be a significant increase in the number of individuals, who will be aging with/into disability. • Pain related disability is common affecting approximately 27% of the older Canadian population (Ramage-Morin, 2008). • Prevalence of chronic pain increases with age: 55-64 [Males: 15.2%; Females: 19.2% ] 65-74 [Males: 20.6%; Females: 24.8%] 75+ [Males: 28.8%; Females: 38.5%] (Statistics Canada, 2011b) • Previous research clearly shows that chronic pain is associated with reduced health-related quality of life (HRQoL) (Picavet & Hoeymans, 2004; Kim et al., 2005; Lamé, Peters, Vlaeyen, Kleef & Patijn, 2005 ).

4. Study Objectives 1) To estimate the prevalence of chronic pain among older Canadian adults with disability. 2) To examine the relationship between chronic pain and HRQoL among older Canadian adults with disability. 3) To assess if there is a dose-response relationship between chronic pain and HRQoL among older Canadian adults with disability.

5. Research Methods • Study Design: Analysis of cross-sectional data • Data Source: 2006 Participation and Activity Limitations Survey (PALS) - Adult survey • Post-censual survey • Conducted by Statistics Canada • Target population: Canadian adults (15+) and children (<15) with disability living in 10 Canadian provinces and 3 territories. • Purpose: To collect information on the prevalence of various disabilities, support for persons with disabilities, their employment profile, income and participation in society. (Statistics Canada, 2009)

6. Research Methods • Study Sample : Individuals who were at least 55 years of age at the time of the survey who reported “Yes” to having a disability. • Study Population: The number of participants in the study sampleare representing 2,582,500 of all Canadians 55+ who experience disability.

7. Study Measures • Dependent Variables (DV): • To address objective #1: Chronic pain • To address objectives #2 & #3: HRQoL • Independent Variables: • Chronic pain • Sociodemographic characteristics (Age, sex, education, marital status, total household income and social network); • Disability measures (Type of disability, severity of disability, and onset of disability).

8. Data Analysis • Population weights were applied and weighted frequencies were used to describe the target population and their characteristics. • Bivariate analyses (t-test and chi-square test) were used to examine the cross-sectional relationship between study variables and chronic pain as well as HRQoL. • Multiple logistic regression modeling was used to examine the independent effect of chronic pain in relation to HRQoL controlling for the effects of all the other study factors. • Bootstrap weights were applied using SUDAAN software to estimate variance and 95% confidence intervals.

9. Results

10. Descriptive ResultsStudy Population: Canadian Population with Disability Aged 55+, PALS 2006

13. Bivariate ResultsDescription of Study Population by Chronic Pain Study Population: Canadian Population with Disability Aged 55+, PALS 2006

14. Table (1): Chronic Pain by Sociodemographic and Disability Characteristics ***p<0.001, **p<0.01, *p<0.05

15. ***p<0.001, **p<0.01, *p<0.05

17. Bivariate ResultsDescription of Study Population by HRQoL Study Population: Canadian Population with Disability Aged 55+, PALS 2006

18. Table (2): HRQoL by Sociodemographic and Disability Characteristics ***p<0.001, **p<0.01, *p<0.05

19. ***p<0.001, **p<0.01, *p<0.05

21. Multiple Logistic Regression Model Predictors of HRQoL Study Population: Canadian Population with Disability Aged 55+, PALS 2006

22. Table (3): Socio-demographic Predictors of Negative HRQoL ***p<0.001, **p<0.01, *p<0.05

23. ***p<0.001, **p<0.01, *p<0.05

24. ***p<0.001, **p<0.01, *p<0.05

25. ***p<0.001, **p<0.01, *p<0.05

26. Summary of Findings • The oldest old Canadian adults reported less chronic pain than did the youngest old adults (X2=13.51; p=0.0000). • Those affected by chronic pain reported significantly poorer HRQoL compared to those who did not report chronic pain (X2=207.27; p=0.0000). • The age of onset and the type of disability were significantly associated with reported chronic pain.

27. Summary of Findings (Con’t) • Females reported higher levels of chronic pain, but controlling for the effects of all the other factors, they had significantly lower odds of reporting negative HRQoL [AOR=0.69 (95% CI: 0.55-0.88); p=0.0024]. • Those with agility and mobility disability reported high levels of chronic pain and high levels of negative HRQoL than those who reported no mobility or agility disability [AOR=1.85 (95% CI: 1.39-2.47); p=0.0000] and [AOR=2.26 (95% CI: 1.91-3.61); p=0.0000 respectively].

28. Implications of Findings • Practice: The study findings highlight the importance of “proper pain assessment and management” among older adults with disability (both men and women), especially for those with limited communication skills. • Policy: In Canada the collection of information on individuals with disabilities has been discontinued. National level data of longitudinal nature is needed to examine trends over time, and to inform policy and practice. • Research: Further research is needed to examine the impact of chronic pain on HRQoL and other outcomes (e.g., social participation), using longitudinal data. study. Given the observed sex differences in the reported rates of chronic pain and HRQoL, it is important to explore sex differences, when examining chronic pain and HRQoL association.

29. References • Kim, J., Henderson, R. A., Pocock, S. J., Clayton, T., Sculpher, M. J., & Fox, K. A. (2005). Health-related quality of life after interventional or conservative strategy in patients with unstable angina or non-ST-segment elevation myocardial infarction: one-year results of the third Randomized Intervention Trial of unstable Angina (RITA-3). Journal of the American College of Cardiology, 45(2), 221- 228. • Lamé, I. E., Peters, M. L., Vlaeyen, J. W., Kleef, M., & Patijn, J. (2005). Quality of life in chronic pain is more associated with beliefs about pain, than with pain intensity. European Journal of Pain, 9(1), 15-24. • Picavet, H., & Hoeymans, N. (2004). Health related quality of life in multiple musculoskeletal diseases: SF-36 and EQ-5D in the DMC3 study. Annals of the Rheumatic Diseases, 63(3), 723-729. • Ramage-Morin, P. L. (2008). Chronic pain in Canadian seniors. Health Reports (Catalogue number 82-003-X). • Statistics Canada (2011b). Disability in Canada: A 2006 Profile. (Catalogue number HS64-11/2010E-PDF). • Statistics Canada (2009). Participation and Activity Limiation Survey Public Use Microdata file User Guild. (Catalogue number: 89M0023XCB2006). • World Health Organization (WHO). (2001). International Classification of Functioning, Disability and Health: ICF. Geneva, Switzerland.