Kırılgan Bireylerde Ağrı Şiddeti ve Süresinin Günlük Yaşam Aktiviteleri Üzerine Etkisi

Öz

Amaç: Bu çalışmada, acil servise başvuran 65 yaş ve üzeri bireylerde kırılganlık düzeyine göre ağrı şiddeti ve süresinin günlük yaşam aktiviteleri ve fonksiyonel bağımsızlık üzerindeki etkisinin değerlendirilmesi amaçlandı. Gereç ve Yöntem: Bu tanımlayıcı-kesitsel anket çalışması, Kütahya Şehir Hastanesi Acil Servisi’ne başvuran 65 yaş ve üzeri 222 katılımcı ile gerçekleştirildi. Katılımcıların kırılganlık düzeyi FRAIL ölçeği ile non-frail, pre-frail ve frail olarak sınıflandırıldı. Ağrı şiddeti; istirahat, aktivite ve gece dönemleri için Görsel Analog Ölçeği (VAS) ile değerlendirildi. Temel günlük yaşam aktiviteleri Katz Günlük Yaşam Aktiviteleri Ölçeği (KATZ-ADL) ile, enstrümantal günlük yaşam aktiviteleri ise Lawton–Brody Enstrümantal Günlük Yaşam Aktiviteleri Ölçeği (IADL) ile ölçüldü. Gruplar arası karşılaştırmalarda uygun parametrik ve nonparametrik istatistiksel testler kullanıldı. Bulgular: Pre-frail ve frail gruplarda günlük ağrı görülme oranı, non-frail gruba kıyasla anlamlı derecede daha yüksekti (p<0,001). Ağrı süresi pre-frail ve frail gruplarda non-frail gruba göre daha uzun saptanırken (p=0,020), pre-frail ve frail gruplar arasında ağrı süresi açısından anlamlı fark izlenmedi. Ağrı şiddeti istirahat, aktivite ve gece dönemlerinde frail grupta en yüksek, non-frail grupta en düşük düzeydeydi (tüm karşılaştırmalar için p<0,001). Fonksiyonel değerlendirmede KATZ-ADL ve IADL skorlarının kırılganlık düzeyi arttıkça anlamlı biçimde azaldığı ve frail grupta fonksiyonel bağımlılığın belirgin olduğu saptandı (p<0,001). Sonuç: Acil servise başvuran yaşlı bireylerde kırılganlık düzeyinin artması, ağrı yükünde artış ve günlük yaşam aktivitelerinde belirgin azalma ile ilişkilidir. Özellikle pre-frail evrede saptanan bulgular, bu dönemin erken tanı ve müdahale açısından kritik bir fırsat sunduğunu göstermektedir. Ağrı ve kırılganlığın birlikte değerlendirilmesi, acil servis pratiğinde fonksiyonel kaybın erken öngörülmesine katkı sağlayabilir.

Anahtar Kelimeler

• Kırılganlık
• ağrı
• günlük yaşam aktiviteleri

The Effect of Pain Intensity and Duration on Activities of Daily Living in Frail Older Adults

Öz

Aim: This study aimed to evaluate the association of pain intensity and pain duration with activities of daily living and functional independence according to frailty level among adults aged ≥65 years presenting to the emergency department. Material and Methods: This cross-sectional study included 222 participants aged ≥65 years presenting to the emergency department of Kütahya City Hospital. Frailty was assessed using the FRAIL scale, and participants were categorized as non-frail, pre-frail, or frail. Pain intensity was measured using the Visual Analog Scale (VAS) at rest, during activity, and at night. Basic activities of daily living were assessed using the Katz Activities of Daily Living (Katz-ADL) scale, and instrumental activities were assessed using the Lawton–Brody Instrumental Activities of Daily Living (IADL) scale. Group comparisons were performed using appropriate parametric or non-parametric tests. Results: The prevalence of daily pain was significantly higher in the pre-frail and frail groups than in the non-frail group (p<0.001). Pain duration was longer in the pre-frail and frail groups than in non-frail individuals (p=0.020), while no significant difference was observed between the pre-frail and frail groups. Pain intensity at rest, during activity, and at night was highest in the frail group and lowest in the non-frail group (all p<0.001). Katz-ADL and IADL scores progressively declined with increasing frailty severity, with markedly greater functional dependence in frail participants (p<0.001). Conclusion: Among older adults presenting to the emergency department, higher frailty levels are associated with increased pain burden and reduced functional independence. The pre-frail stage may represent a critical window for early identification and intervention. Integrating pain and frailty assessment into routine emergency department evaluation may support early recognition of high-risk patients and strategies to prevent functional decline.

Anahtar Kelimeler

• Frailty
• pain
• activities of daily living

Kaynakça

1. 1. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-56.
2. 2. Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14(6):392-7.
3. 3. Salvi F, Morichi V, Grilli A, Giorgi R, De Tommaso G, Dessì-Fulgheri P. The elderly in the emergency department: a critical review of problems and solutions. Intern Emerg Med. 2007;2(4):292-301.
4. 4. Carpenter CR, Shelton E, Fowler S, Suffoletto B, Platts-Mills TF, Rothman RE, et al. Risk factors and screening instruments to predict adverse outcomes for undifferentiated older emergency department patients: a systematic review and meta-analysis. Acad Emerg Med. 2015;22(1):1-21.
5. 5. Herr K, Coyne PJ, McCaffery M, Manworren R, Merkel S. Pain assessment in the patient unable to self-report: position statement with clinical practice recommendations. Pain Manag Nurs. 2011;12(4):230-50.
6. 6. Patel KV, Guralnik JM, Dansie EJ, Turk DC. Prevalence and impact of pain among older adults in the United States: findings from the 2011 National Health and Aging Trends Study. Pain. 2013;154(12):2649-57.
7. 7. Reid MC, Eccleston C, Pillemer K. Management of chronic pain in older adults. BMJ. 2015;350:h532.
8. 8. Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012;16(7):601-8.

9. 9. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA. 1963;185:914-9.
10. 10. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3):179-86.
11. 11. Hadjistavropoulos T, Herr K, Turk DC, Fine PG, Dworkin RH, Helme R, et al. An interdisciplinary expert consensus statement on assessment of pain in older persons. Clin J Pain. 2007;23(1 Suppl):S1-S43.
12. 12. Shega JW, Dale W, Andrew M, Paice J, Rockwood K, Weiner DK. Persistent pain and frailty: a case for homeostenosis. J Am Geriatr Soc. 2012;60(1):113-7.
13. 13. Eggermont LH, Leveille SG, Shi L, Kiely DK, Shmerling RH, Jones RN, et al. Pain characteristics associated with the onset of disability in older adults: the maintenance of balance, independent living, intellect, and zest in the Elderly Boston Study. J Am Geriatr Soc. 2014;62(6):1007-16.
14. 14. Leveille SG, Bean J, Ngo L, McMullen W, Guralnik JM. The pathway from musculoskeletal pain to mobility difficulty in older disabled women. Pain. 2007;128(1-2):69-77.
15. 15. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489-95.
16. 16. Gill TM, Gahbauer EA, Han L, Allore HG. Trajectories of disability in the last year of life. N Engl J Med. 2010;362(13):1173-80.
17. 17. Cesari M, Landi F, Vellas B, Bernabei R, Marzetti E. Sarcopenia and physical frailty: two sides of the same coin. Front Aging Neurosci. 2014;6:192.
18. 18. Dent E, Kowal P, Hoogendijk EO. Frailty measurement in research and clinical practice: a review. Eur J Intern Med. 2016;31:3-10.
19. 19. Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. Lancet. 2019;394(10206):1365-75.