Pain and the Risk for Falls in Community-Dwelling Older Adults: Systematic Review and Meta-Analysis

Objective: To conduct a systematic review and meta-analysis to establish the association between pain and falls in community-dwelling older adults. Data Sources: Electronic databases from inception until March 1, 2013, including Cochrane Library, CINAHL, EBSCO, EMBASE, PubMed, and PsyclNFO. Study Selection: Two reviewers independently conducted the searches and completed methodological assessment of all included studies. Studies were included that (1) focused on adults older than 60 years; (2) recorded falls over 6 or more months; and (3) identified a group with and without pain. Studies were excluded that included (1) participants with dementia or a neurologic condition (eg, stroke); (2) participants whose pain was caused by a previous fall; or (3) individuals with surgery/fractures in the past 6 months. Data Extraction: One author extracted all data, and this was independently validated by another author. Data Synthesis: A total of 1334 articles were screened, and 21 studies met the eligibility criteria. Over 12 months, 50.5% of older adults with pain reported 1 or more falls compared with 25.7% of controls (P <.001). A global meta-analysis with 14 studies (n=17,926) demonstrated that pain was associated with an increased odds of falling (odds ratio [OR] =1.56; 95% confidence interval [CI], 1.36-1.79; I-2=53%). A subgroup meta-analysis incorporating studies that monitored falls prospectively established that the odds of falling were significantly higher in those with pain (n=4674; OR= 1.71; 95% CI, 1.48-1.98; I-2=0%). Foot pain was strongly associated with falls (n=691; OR= 2.38; 95% CI, 1.62-3.48; I-2=8%) as was chronic pain (n= 5367; OR =1.80; 95% CI, 1.56-2.09; I-2= 0%). Conclusions: Community-dwelling older adults with pain were more likely to have fallen in the past 12 months and to fall again in the future. Foot and chronic pain were particularly strong risk factors for falls, and clinicians should routinely inquire about these when completing falls risk assessments. Archives of Physical Medicine and Rehabilitation 2014;95:175-87 (c) 2014 by the American Congress of Rehabilitation Medicine