Faculty of Graduate Studies
Thesis Defense of Kristina Zawaly
Examining the Relationship between Chronic Pain and Health Related Quality of Life Among Older Canadian Adults with Disability
Chronic pain is a common health issue that is found to be associated with poor quality of life among older Canadians. Despite the vast literature on chronic pain and health-related quality of life (HRQoL), little literature exists on the effect of chronic pain on HRQoL among older Canadian adults with disability. Thus, the extent by which chronic pain affects HRQoL of older Canadians with disability is not well understood.
Study Objectives: This study was conducted to: 1) estimate prevalence of chronic pain among older Canadian adults with disability, 2) examine the relationship between chronic pain and HRQoL, 3) assess if there is a dose-response relationship between chronic pain and HRQoL.
Methods: This study was a secondary analysis of cross-sectional data from the 2006 Participation and Activity Limitation Survey (PALS). The main objective of PALS was to develop a comprehensive database of Canadians with disabilities. The survey target population consisted of those individuals living in private dwellings in the ten Canadian provinces and three territories, who reported an activity limitation in the Canadian Census. For the purpose of this study, those who were 55 years of age or older at the time of the survey were selected. In this study, chronic pain was measured using a derived variable, which is based on individual responses to the pain related screening questions in the survey. The single item self-rated health question in the survey was used to measure HRQoL. Weighted data was used to examine the relationship between chronic pain and HRQoL using multivariate logistic regression modeling, controlling for the effects of potential covariates. To fully account for the survey sampling design, the bootstrap weights were applied.
Results: An estimated 68% of older Canadians adults with disability reported having chronic pain (45% less severe and 23% more severe). There was a statistically significant association between chronic pain and HRQoL. Multivariate regression analyses confirmed a significant independent effect of chronic pain on self-reported HRQoL. Those who reported severe chronic pain had 3.34 times greater odds of reporting negative HRQoL, relative to those who reported no chronic pain. Older Canadians with disability who reported having less severe chronic pain had 1.39 times greater odds of reporting negative HRQoL, relative to those who reported no chronic pain. It was also found that those individuals with agility disability and mobility disability had greater odds of reporting negative HRQoL when all other potential factors were controlled for in the multivariate analysis [AOR=1.85 (95% CI=1.39, 2.47) and [AOR=2.62 (95% CI=1.91, 3.61) respectively].
Conclusion: Chronic pain is a significant health issue for older Canadian adults with disability, which negatively affects their HRQoL. Our results highlight the importance of pain assessment and management for older adults with disabilities in general and in particular among those with limited communication abilities.