Widespread musculoskeletal pain and the progression of disability in older disabled women

Background: Widespread musculoskeletal pain is a poorly understood but common problem in older adults. Little is known about the progression of disability related to this condition. Objective: To determine whether widespread musculoskeletal pain increases the risk for worsening disability in older women with disabilities. Design: Prospective cohort study. Setting: The Women's Health and Aging Study. Participants: 1002 community-dwelling women 65 years of age or older with disability. Measurements: Widespread musculoskeletal pain was defined as pain in the upper and lower extremities and axial pain with moderate or severe pain in at least one of the three regions. Worsening disability was defined as progression from no or mild difficulty to severe difficulty or inability to perform activities of daily living (ADLs), walk one-quarter mile, or lift 10 lbs. Results: At baseline, 24% of participants had widespread pain and 25% had no pain or only mild pain in a single site. Women with widespread pain were 2.5 to 3.5 times more likely to have severe difficulty with ADLs, walking, or lifting at baseline compared with women who had no or mild pain. In women without severe difficulty initially, widespread pain nearly doubled the risk for progression to severe difficulty in each of the tasks, after adjustment for age, body mass index, comorbid illness, and other confounders. Conclusion: Widespread musculoskeletal pain is frequent among community-dwelling older women with disability and appears to predict the progression of disability. Efforts to better understand the cause of this pain and its treatment might reduce the overall burden of disability.