Hindawi Publishing Corporation Pain Research and Management Volume 2016, Article ID 7852397, 7 pages http://dx.doi.org/10.1155/2016/7852397

Research Article Prevalence and Correlates of Pain in People Aged 60 Years and above in Singapore: Results from the WiSE Study Pratika Satghare, Siow Ann Chong, Janhavi Vaingankar, Louisa Picco, Edimansyah Abdin, Boon Yiang Chua, and Mythily Subramaniam Research Division, Institute of Mental Health, Singapore 539747 Correspondence should be addressed to Pratika Satghare; pratika [email protected] Received 5 February 2016; Accepted 15 May 2016 Academic Editor: Eldon R. Tunks Copyright © 2016 Pratika Satghare et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Although pain is experienced among people of all ages, there is a need to study its risk factors and impact among older adults. Aims. The study sought to determine the prevalence, sociodemographics, and clinical correlates of pain along with association of pain with disability among older adults in Singapore. Methods. The WiSE study was a comprehensive cross-sectional, single phase, epidemiological survey conducted among the elderly aged 60 years and above and used a nationally representative sample of three main ethnic groups in Singapore: Chinese, Malays, and Indians. The survey administered 10/66 protocol pain questionnaire, sociodemographic questionnaire, health status questionnaire, World Health Organization Disability Assessment Scale (WHODAS 2.0), and Geriatric Mental State (GMS) examination. Results. A total of 2565 respondents completed the study giving a response rate of 65.5%. The prevalence of pain among the elderly aged 60 years and above is 19.5 %. Females, incomplete primary education Indians, and those diagnosed with any chronic health condition were associated with risk of pain and disability. Conclusion. Study findings showed that disability related to pain among the elderly is considerable making it a priority to reduce the morbidity and disability among the elderly with pain.

1. Introduction Pain is a common and a significant problem among many older adults which is often associated with worse health due to greater functional impairment, disability, depression, dementia, impaired sleep, and social isolation [1]. Pain is not an inevitable part of aging but unfortunately is often accepted as a normal part of aging among older adults for which they may be undertreated [2]. Studies have indicated that as many as 50% of older adults who live in the community and 45% to 80% of those in nursing homes suffer from this problem [3]. At any age, pain has significant impact on the life of an individual, but the effect may be greater on older adults as compared to younger adults [4]. Pain prevalence increases with increasing age among older adults [5]. Prior research demonstrated increased pain prevalence with increasing age and highlighted pain as a frequent problem for a large number of older adults [6, 7]. A systematic review suggests a peak or plateau in the prevalence of pain by age 65 and a decline in reported pain in the old-old

(75–84 years), and oldest-old (85+ years) [8]. Older patients often experience pain in multiple sites, compounding painrelated suffering and disability. Pain is one of the most widely cited symptoms underlying disability among older adults and also pain is an outcome of various comorbid illnesses [9, 10]. Hence, the multidimensional impact of pain decreases the ability of older adults to effectively respond to physiologic stressors, ultimately leading to the development of frailty [5]. Cognitive impairment due to dementia, depression, and/or delirium represents a particular challenge to pain management because older adults with these conditions may be unable to verbalize their pain. The prevalence of pain among older adults with dementia varies greatly from 28% to 83% [11]. Another study observed that pain in older men was associated with increased frailty and also indicated that mood may be a more important factor in the association between pain and frailty than physical illnesses [12]. Population aging is occurring in nearly every country of the world [13]. Singapore is a country located in Southeast Asia with a multiethnic population (74.3% are Chinese, 13.3%

2 are Malays, 9.1% are Indians, and 3.3% belong to other ethnic groups) and has one of the world’s fastest aging population. Population of older adults in Singapore has grown dramatically from 2.5% in 1965 to 11% in 2014 [14]. Data on the prevalence of pain and its causative factors among older adults in Singapore is limited. Hence, this study sought to determine the prevalence and impact of pain in a large, nationally representative sample of people aged 60 years and above in Singapore. Specifically, the aims of the current study were to (1) determine the overall prevalence of pain, (2) evaluate the factors associated with pain including sociodemographic correlates and chronic diseases (hypertension, transient ischaemic attack, diabetes mellitus, dementia, and depression), and (3) assess the effect of pain on disability.

2. Methods The WiSE survey was a comprehensive single phase survey conducted across Singapore with older adults aged 60 years and above. The study adopted the 10/66 Dementia Research Group protocols [15] to establish the prevalence of dementia in Singapore’s elderly resident population. A cross-sectional epidemiological survey was conducted with 2565 participants who were randomly selected from a national database with information on all Singapore residents aged 60 years and above. The database consisted of administrative data (i.e., name, identification card number, ethnicity, gender, and address) of all the citizens and permanent residents in Singapore, which was updated on a regular basis. A probability sample was randomly selected using a disproportionate stratified sampling design according to ethnicity (Chinese (38.5%), Malay (30.1%), Indian (30.1%), and others (1.4%)) and age groups (60–74, 75–84, and 85 years and above) [16]. Residents in the older age group and also those belonging to Malay and Indian ethnic groups were oversampled in order to improve reliability of estimates for subgroup analysis by achieving sufficient sample size. Older adults residing in day care centres, nursing homes, and institutions were included in the study. 10/66 questionnaires were available in English, Chinese, and Tamil while the research team translated the instruments into Malay. The questionnaires were also transcribed into three major dialects, Hokkien, Cantonese, and Teochew, and choice of administered language was based on the participant’s preferences. An informant selected for each participant was a “person who knew the older person best” and those informants were most commonly coresidents, family members, or caregivers of the participant [17]. Written informed consent was obtained from all participants; in the event that the respondent was unable to understand or give consent, consent was obtained from a legally acceptable representative. Trained interviewers administered the adapted 10/66 questionnaires through face to face interviews to 2565 respondents and their informants. All the respondents received the full assessment, lasting approximately 2-3 hours. A Computer Assisted Personal Interviewing (CAPI) mode was used for real-time data collection in the field. This study yielded a response rate of 65.6%. The study was approved by institutional ethics review boards, National Healthcare Group Domain Specific Review Board (DSRB) and the SingHealth

Pain Research and Management Centralised Institutional Review Board (CIRB). Detailed information of the study has been provided in earlier paper [16]. 2.1. Measurements and Assessments. The measurements and assessments are as follows: (i) Pain Questionnaire (10/66 Research Protocol, Participant Version) [15]. During the interview, participants were asked three questions to assess frequency of pain, severity of pain, and restriction in activity due to pain. The participants were asked, “In the past month, how often has any health condition caused you pain?” and the response options available were “never,” “23 times in the past month,” “about once a week,” “2-3 days a week,” and “every day.” After excluding the “Never” option, for the purpose of analysis, other options were collapsed, recoded, and categorized into the following: (1) “More than once a month” including “2-3 times in the past month” and “about once a week” and (2) “more than once a week” including “2-3 days a week” and “every day.” With regard to pain severity, the question asked was, How would you rate severity of the pain in the last month? Would you say it is, “Mild pain”, “Moderate pain”, “Severe pain”, “Very severe pain”, “Unbearable pain”? Except “Mild pain” and “Moderate pain,” remaining responses, “Severe pain,” “Very severe pain,” and “Unbearable pain,” were categorized into “Severe pain” for the purpose of analysis. Restriction in doing daily activities due to pain was assessed by “When the pain is at its worst, how much does it restrict the things that you do?” The response options available were “Not at all,” “Not very much,” “Moderately,” and “Very much.” These responses were categorised as follows: (1) “Not at all” was recoded as “Never,” (2) “Not very much” and “Moderately” were collapsed into “Mild to Moderate,” and (3) “Very much” was recoded as “Severe.” (ii) Geriatric Mental State Automated Geriatric Examination for Computer Assisted Taxonomy (GMSAGECAT) [18]. It is a semistructured questionnaire which applies a computer algorithm to identify nine diagnoses including organicity (probable dementia), across 5 levels of psychopathology from 0 (noncase) to 5 (severe case). (iii) World Health Organization Disability Assessment Scale (WHODAS 2.0). WHODAS 2.0 was established as an international and cross-cultural method to assess severity of disability in patients [19]. WHODAS was developed by the International Classification of Functioning, Disability, and Health (ICF) to identify symptoms of disorders that hindered every day living. Disability levels measured by this assessment have good test-retest reliability with validation in 16 languages in 14 countries. WHODAS measures functioning based on six domains: cognition, mobility, selfcare, getting along, life activities, and participations. Items were measured and computed using a specific

Pain Research and Management

3 Table 1: Sociodemographic correlates of pain.

Variables Age group 60–74 75–84 85+ Gender Males Females Ethnicity Chinese Indians Malay Others Marital status Married/cohabiting Divorced/separated Never married Widowed Education Completed tertiary education None Completed primary education Some, but did not complete primary education Completed secondary education Employment Paid work (part-time and fulltime) Homemaker Retired Unemployed ∗

𝑁 (participants who reported pain) 560

% 19.49

Odds ratio∗

95% CI

𝑝 value

331 151 78

18.2 23.8 25.9

Ref 1.3 1.3

(0.9, 1.9) (0.8, 2.9)

0.126 0.286

183 377

15.2 23.0

Ref 1.8

(1.2, 2.7)

0.003

163 222 162 13

17.9 30.9 23.0 39.0

Ref 2.4 1.4 3.4

(1.8, 3.0) (1.0, 1.9) (1.6, 7.5)

Prevalence and Correlates of Pain in People Aged 60 Years and above in Singapore: Results from the WiSE Study.

Background. Although pain is experienced among people of all ages, there is a need to study its risk factors and impact among older adults. Aims. The ...
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