Synergistic effect of pain and deficits in ADL towards general practitioner visits

Abstract

Background: Pain and activities of daily living (ADLs) deficits are common problems among elderly people who visit general practitioners (GPs).

Objective: To examine whether the probability of visiting a GP is related to deficits in ADLs and pain, and whether these factors act synergistically towards GP visits.

Methods: A total of 3097 subjects aged ≥65 years from the Austrian Health Interview Survey formed the cohort. Visiting the GP in the last 4 weeks, chronic pain (CP; pain for at least 3 months) and deficits in ADLs across 11 dimensions were reported. Binary logistic regression models were applied and were stepwise controlled for possible confounders. Based on odds ratios (OR), the synergy index (SI), population attributable fraction (PAF) and relative excess risk due to interaction (RERI) were calculated.

Results: Overall, 61.0% visited their GP; 51.2% were affected by ADL deficits and 42.2% by CP. In subjects with ADL deficits, the OR for GP consultation was 1.32 (95% confidence interval [CI] 1.11-1.56) and in subjects with CP, 1.93 (95% CI 1.63-2.27) in the fully adjusted model. The OR for those affected by both was 2.56 (95% CI 2.08-3.15); SI was 1.82 (95% CI 1.04-3.18), PAF was 0.27 (95% CI 0.08-0.47) and RERI was 0.70 (95% CI 0.13-1.27).

Conclusion: There is a strong synergistic effect of CP and deficits in ADL in patients ≥65 years on visiting the GP. Prevention, screening, treatment and rehabilitation in this population should focus on both CP and ADL deficits.

Keywords: Deficits in activities of daily living; GP; pain; primary health care; synergy index..