The Relationship Between Pain, Mobility, and Physical Function for Hospitalized Older Veterans

Background: Older Veterans have increased risk for chronic pain, mobility disorders, and impaired physical function. While older adults often reduce activity to minimize pain, the ability to mobilize and function is essential for managing pain and maintaining quality of life. Despite benefits of inpatient mobility interventions, low mobility remains common during hospitalization. Few studies have explored participant experiences with mobility interventions and pain measures that account for mobility and physical function. This dissertation explored two aims: 1) To understand the experience of assisted mobilization for hospitalized older Veterans and 2) To examine whether mobility- and physical function-adjusted pain measures are more closely associated with important health outcomes for Veterans than unadjusted pain measures. Methods: This study was an exploratory mixed methods secondary analysis of STRIDE (assiSTed eaRly mobIlity for hospitalizeD older vEterans) program data. Post-intervention semi-structured interviews (n=35) were qualitatively analyzed using a content analysis approach. STRIDE participant surveys (n=960) were examined using general linear models (GLMs). Pain was measured by the PROMIS-29 pain intensity and pain interference sub-scales. Mobility was measured by the Life Space-Assessment. Physical function was measured by the Late Life Function and Disability Instrument (LL-FDI). Results: Nine themes were identified from interviews: adapting to aging losses, spectrum of fatigue, the identity continuum, walking prescription, communication barrier, availability of resources, environmental influence, motivation to ambulate, and situational anxiety. Participants described inherent and messaged anxiety about falling and how hospital staff were often unavailable when they desired to walk. Associations between pain and important health outcomes of sleep disturbance and depression were examined. When modeled separately, pain intensity and pain interference each remained positively significantly associated with important health outcomes (p<.0001) when adjusting for mobility and physical function. When modeled together and adjusted for mobility and physical function, pain intensity remained positively significantly associated with important health outcomes, but pain interference only remained positively significantly associated with depression (p=.005). Adjusted relationships were attenuated. Conclusion: This study provides additional understanding of barriers to mobility during hospitalization for older Veterans and offers additional support for the importance of adjusting for mobility and physical function when assessing pain.