Patients With COPD, Severe Pain at an Increased Risk of Falling

Patients with chronic obstructive pulmonary disease (COPD) and severe pain are at an increased predicted probability of falling, according to a study published in the International Journal of Environmental Research and Public Health.

The researchers explained that frailty is common in patients with COPD, as 23% have been classified as frail and 56% as prefrail. They emphasized that falling is a prominent feature of frailty, resulting in patients with COPD being 4 times more likely to fall than healthy patients. Pain is also common among patients with COPD, as they have a 66% prevalence of pain.

Because of this, the researchers created a study to predict the probability of falling among older adults with COPD and their healthy peers, investigating the impact of pain severity on fall incidents and the association between pain and fall severity. The researchers used data from the English Longitudinal Study of Ageing (ELSA) to create their study population, considering their sex, age, wealth, and education level; ELSA investigates aspects of aging and older people in England, collecting data on their physical and mental health, as well as social and financial circumstances, at 2-year intervals.

The study population consisted of those a part of the ELSA cohort who were at least 58 years old at baseline assessment. A total of 18,572 people matching these criteria were initially included, but this number decreased after the researchers removed those missing necessary data points. As a result, the study population consisted of 806 patients with COPD and 3898 healthy patients.

The researchers noted that both groups were similar in age, sex, and body mass index, but they differed in pain level, wealth, education level, and fall occurrences. They explained that 56.1% of the patients with COPD experienced pain, while only 22.4% of the healthy patients did. Also, patients with COPD had lower levels of both education (median of no qualifications in the COPD group vs median of intermediate in the healthy controls) and wealth status (mean of £28,478 in theCOPD group vs £65,097 in thehealthycontrols). Lastly, 33% of those with COPD reported falls compared with 19.5% of healthy patients.

By calculating odds ratios (ORs), researchers discovered a relationship between incident falls and pain severity categories within both the COPD group and the control group. They explained that those with any severity of pain in both groups had a greater risk of falling, increasing with pain severity (mild pain: OR, 1.47 for COPD and 1.40 for healthy controls; moderate pain: OR, 1.68 for COPD and 1.61 for healthy controls; severe pain: OR, 2.39 for COPD and 1.84 for healthy controls).

Additionally, the researchers found that the predicted probabilities of falling for patients with COPD were greater across all pain categories than for healthy controls. The predicted probability for patients with COPD and no pain was 20% (95% CI, 17%-25%), with mild pain was 28% (95% CI, 18%-38%), with moderate pain was 28% (95% CI, 22%-34%), and with severe pain was 39% (95% CI, 30%-47%). In comparison, the predicted probability of falling for healthy controls with no pain was 17% (95% CI, 16%-18%), with mild pain was 22% (95% CI, 18%-27%), with moderate pain was 25% (95% CI, 20%-29%), and with severe pain was 27% (95% CI, 20%-35%).

Overall, the researchers highlighted that those with COPD and severe pain had an almost 40% predicted probability of falling, indicating the potential interaction between COPD and severe pain. Also, the predicted probability of falling for those with COPD and pain was greater than those for both people with COPD and no pain and healthy controls with pain. For both groups, the predicted probability of falling increased as the severity of pain increased, but this was more prevalent for patients with COPD across all pain severities.

The researchers noted various limitations to their study, one being that the researchers could not identify all comorbidities beyond the common ones identified by the main ELSA set. Because of this, some patients within the healthy group may have comorbidities that affected their risk of falls but were not included within the data set.

The researchers noted that future research will aim at understanding potential shared factors between COPD and pain that increase the risk of falling, including multisite pain, pain interference, and psychological impacts.

“Further prospective research is required to determine if the pain is associated with falls in people with COPD, including the identification of those with pain for intervention to prevent the deleterious effects of falling,” the authors concluded.

Reference

Loughran KJ, Tough D, Ryan CG, et al. The association of pain with incident falls in people with chronic obstructive pulmonary disease: evidence from the English Longitudinal Study of Ageing. Int J Environ Res Public Health. 2023;20(13):6236. doi:10.3390/ijerph20136236