Investigating multisite pain as a predictor of self-reported falls and falls requiring health care use in an older population: A prospective cohort study

Older people are continuing to fall despite fall prevention guidelines targeting known falls' risk factors. Multisite pain is a potential novel falls' risk factor requiring further exploration. This study hypothesises that: (1) an increasing number of pain sites and widespread pain predicts self-reported falls and falls recorded in primary and secondary healthcare records; (2) those relationships are independent of known falls' risk factors and putative confounders. This prospective cohort study linked data from self-completed questionnaires, primary care electronic health records, secondary care admission statistics and national mortality data. Between 2002-2005, self-completion questionnaires were mailed to community-dwelling individuals aged 50 years and older registered with one of eight general practices in North Staffordshire, UK(n = 26,129) yielding 18,497 respondents. 11,375 respondents entered the study; 4386 completed six year follow-up. Self-reported falls were extracted from three and six year follow-up questionnaires. Falls requiring healthcare were extracted from routinely collected primary and secondary healthcare data. Increasing number of pain sites increased odds of future 3 year (odds ratio 1.12 (95% confidence interval: 1.01-1.24)) and 6 year self-reported fall (odds ratio 1.02 (1.00-1.03)) and increased hazard of future fall requiring primary healthcare (hazard ratio 1.01 (1.00-1.03)). The presence of widespread pain increased odds of future 3 year (odds ratio 1.27 (0.92-1.75)) and 6 year fall (odds ratio 1.43(1.06-1.95)) and increased hazard of future fall requiring primary healthcare (hazard ratio 1.27(0.98-1.65)). Multisite pain was not associated with future fall requiring secondary care admission. Multisite pain must be included as a falls' risk factor in guidelines to ensure clinicians identify their older patients at risk of falls and employ timely implementation of current falls prevention strategies.