Not All Pain Is Equal: Lower Extremity Pain and Longitudinal Fall Risk in Older Adults

OBJECTIVES: To investigate the association between pain distribution patterns, particularly lower extremity involvement and multisite pain, and fall risk among older adults in Korea. METHODS: This was a secondary analysis of the Korean Longitudinal Study of Aging (KLoSA). We included participants aged 65 years or older who had experienced no fall during the 2 years prior to baseline. Pain status was assessed at the survey wave preceding a reported fall to capture pre-existing pain. Pain was classified according to its anatomical distribution and cumulative severity. Primary outcome was the incidence of the first fall event during follow-up. Cox proportional hazards models incorporating time-varying pain exposures were used to estimate hazard ratios (HRs) for the first reported fall over up to 16 years of follow-up. RESULTS: A total of 3199 participants (mean age, 72.52 years) were followed for up to 16 years, during which 445 (14%) experienced a fall. Compared to participants without pain, those with lower extremity pain had significantly higher fall risk (isolated lower extremity: HR = 1.38, 95% CI 1.01-1.90; multisite with lower extremity involvement: HR = 1.39, 95% CI 1.04-1.84). Higher lower extremity composite pain scores were associated with greater risk (HR = 1.47, 95% CI 1.10-1.97). Pain at non-lower extremity sites was not significantly associated with falls. CONCLUSION: Self-reported current lower extremity pain was associated with a higher hazard of subsequently reported falls among community-dwelling older adults. Further studies are needed to determine whether pain location improves fall-risk prediction and whether interventions targeting lower extremity pain can reduce falls.