What was already known?

Frailty is a common syndrome that becomes more common with increasing age, with an overall prevalence estimate of 10.7% in community-dwelling older adults. There is no generally accepted definition of frailty; one frequently used definition is a state of increased vulnerability to stressors, resulting from a cumulative loss of physiological reserve. Those suffering from frailty have been found to have an increased risk of hospitalisation and falls.

Factors linked with the development and progression of frailty include; smoking, high alcohol consumption, depression, obesity and the presence of chronic diseases such as cardiovascular disease and diabetes. Chronic widespread pain (CWP), a prominent symptom of fibromyalgia, affects up to 11% of adult men and women. It is linked with adverse health outcomes including an increased mortality risk. Risk factors for CWP include psychological distress, poor sleep, low levels of physical activity and being overweight.

What we did?

We hypothesised that CWP, by acting as a stressor, would be associated with an increased risk of developing frailty. Previous cross-sectional studies have shown evidence of a link between pain and frailty, but they have been unable to determine the direction of the observed associations (i.e. which is cause and which effect). The aim of this analysis was to determine whether the occurrence of CWP predisposes middle-aged and older men to the development of, or worsening of, frailty.

What was discovered?

2,736 community-dwelling men aged 4079 took part in the European Male Ageing Study and provided data for this analysis at baseline and again 4 years later.

1. How many participants had CWP?
   218 (8.3%) men reported CWP at baseline. They had experienced pain for a minimum of 3 months in both the left and right sides of the body, above and below the waist, and in the spinal area.
2. How many participants developed frailty?
   A new Frailty Index was developed and used to measure frailty. 112 men (4.3%) who were not frail at baseline developed frailty during an average of 4.3 years follow-up. Men who developed frailty for the first time during follow-up were older, had lower physical activity levels, were more likely to be depressed, had a higher BMI and were more likely to report experiencing CWP at baseline.
3. Was there an association between pain and frailty?
   Men with CWP were more than 5 times as likely to develop frailty for the first time during follow-up as men who did not have CWP at baseline.

After taking into consideration other known risk factors for frailty (such as depression, physical activity, smoking status), the association between CWP and the development of frailty remained significant. CWP was also an independent predictor of worsening of the frailty score during follow-up.

Why is this important?

CWP is associated with both development of, and worsening of, frailty in middle-aged and older European men, largely independent of health and lifestyle factors. Our findings suggest potential opportunities for targeted interventions to reduce the occurrence of frailty, but also highlight that clinicians need to be attentive to the pain status of older people.

Publications

(Wade K et al.(2015). Chronic widespread pain is associated with worsening frailty in European men. Age Ageing, [Epub ahead of print], eScholarID:275603 | DOI:10.1093/ageing/afv170 )

Related