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What factors mediate the inter-relationship between frailty and pain in cognitively and functionally sound older adults? A prospective longitudinal ageing cohort study in Taiwan
  1. Jing-Hui Chiou1,2,
  2. Li-Kuo Liu1,3,
  3. Wei-Ju Lee2,3,4,
  4. Li-Ning Peng1,2,3,
  5. Liang-Kung Chen1,2,3
  1. 1 Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
  2. 2 Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan
  3. 3 Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan
  4. 4 Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Taipei, Taiwan
  1. Correspondence to Dr Liang-Kung Chen; lkchen2{at}


Objectives The main aim was to investigate the complex inter-relationship between frailty and pain, and the mediating roles of cognitive function, morbidity and mood in this nexus.

Design A cross-sectional analysis.

Setting A prospective community-dwelling population-based cohort.

Participants 1682 adults age ≥50 years without evident cognitive or functional impairment, or history of cancer.

Primary and secondary outcome measures The mediating effect of depression, cognitive function and comorbidity on the nexus between pain and frailty among older and middle-aged adults.

Results The pain score among older subjects (≥65 years), increased with the degree of frailty (robust=0.96±0.82; pre-frail=1.13±0.86; frail=1.63±1.02; P<0.001); multivariate analysis gave the same result, while moderate pain was associated with frailty in older subjects (OR=3.00, 95% CI 1.30 to 6.60). Conversely, pain and frailty among middle-aged subjects (aged 50–64 years) did not appear to be significantly related; in mediation analysis, pain exerted an indirect effect on frailty via depression (indirect effect=0.03, 95% CI 0.01 to 0.07), while neither cognitive function nor comorbidity had any significant effect in mediating the relationship between pain and frailty.

Conclusion In cognitively and functionally sound community-dwelling adults aged ≥50 years, moderate pain was related to frailty in those older than 65 years, but not younger ones. Besides the direct influence of pain on frailty, depression partially mediated the pain–frailty nexus. The mechanism by which depression influences pain and frailty requires further investigation.

  • frailty
  • moderator
  • older adults
  • pain

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  • Contributors All the authors revised and approved the contents of the submitted article. C-JH, L-WJ, P-LN and C-LK created the idea of the manuscript. C-JH and L-LK conducted statistical analysis of data. C-JH, L-LK and L-WJ wrote the manuscript. All the authors made substantial contributions to interpretation of data and carried out a critical revision of the manuscript for important intellectual content.

  • Funding The research was funded by Ministry of Science and Technology, Taiwan (MOST 104-2633-B-400-001 and MOST 105-3011-B-010-001).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The National Yang Ming University Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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