Associations of multiple chronic conditions with physical performance and falls among older adults with back pain: A longitudinal, population-based study.

Abstract Objective Determine the association of chronic conditions measured at baseline with physical performance and falls over time among older adults with back pain. We examined both number and type (depression, anxiety, and arthritis) of chronic conditions. Design Retrospective cohort study Setting National Health and Aging Trends Study Participants 2438 community-dwelling Medicare Beneficiaries age ≥65 years with bothersome back pain Interventions None Main Outcome Measures Short Physical Performance Battery (SPPB; range: 0-12, lower indicates worse function) and recurrent falls measured annually over 6 years. Results The sample was mostly female (62%) and 65-74 years old (56%). Multiple chronic conditions were highly prevalent (82%) among those reporting back pain. Adjusted regressions using survey weights with Taylor series linearization method and containing interaction terms for comorbidity and time showed having 2-3 chronic conditions versus 0-1 was associated with lower SPPB scores and differences grew over time [for example 0.61 points lower (95% CI: -0.88, -0.34) and 1.22 points lower (95% CI: -1.76, -0.67) in Rounds 3 and 6, respectively]. Having ≥4 chronic conditions was associated with lower SPPB scores at all timepoints versus 0-1 (point estimate range of -1.72 to -2.31). Arthritis alone, the combination of arthritis with depression, and the triad of arthritis, depression, and anxiety were associated with lower SPPB scores at all time points. Logistic regression models showed presence of 2-3 and ≥4 chronic conditions were associated with increased odds of recurrent falls in any given year (OR=1.91, 95% CI: 1.35, 2.69 and OR=3.92, 95% CI: 2.81, 5.46, respectively). Those with the triad of arthritis, depression, and anxiety had greater odds of recurrent falls versus none or 1 condition. Conclusions Among older adults with back pain, those with multiple chronic conditions, including co-occurrence of arthritis, depression, and anxiety, have greater risk for poor physical functioning and falls over time.