Pain In Married Couples In Later Life: Predictors of Pain Intensity and Associated Outcomes

Background and Purpose: Pain is estimated to affect more Americans—roughly 76.5 million—than diabetes, heart disease, stroke, and cancer combined (APF, 2007). Pain is a major public health issue, costing the US over $100 billion annually. Pain is also implicated in the onset of disability and emotional distress. Estimates suggest that 30-90% of community-dwelling midlife and older adults have pain. Age is also a risk factor for painful diseases (e.g., arthritis). Given that 55-70% of aging adults are married, pain often occurs in the context of marriage. Most of what we know about couples and pain comes from research in clinical settings (e.g., chronic pain patients). Little is known about pain in aging couples living in the community. And, although prevalence data suggests that both spouses can suffer from pain in aging couples, these couples have not been studied. Using a large sample of aging couples in which both spouses have pain, this study aims to: (1) Identify background and health-related characteristics associated with pain intensity; (2) Evaluate if the pain intensity rating of one spouse independently predicts the pain intensity of his/her partner; and (3) Examine the relationships between pain intensity and several health and healthcare outcomes. Methods: This is a secondary analysis of data from the 1998 wave of the Health and Retirement Study (HRS), a panel study of US adults over age 50. Although not designed as a study of couples, HRS recruited ~93% of the spouses of respondents. The 1998 interview was completed by both spouses in 5,400 couples. The present sample is 423 married couples in which both spouses reported being “often troubled with pain.” Because HRS is a nationally-representative sample of community-dwelling adults, these couples are more diverse than clinical samples. Multinomial logistic regression was used to identify the characteristics associated with pain intensity levels (mild, moderate, severe). Models were run separately for husbands and wives because (1) pain intensity differed by gender, and (2) the contribution of the spouse's pain intensity could be assessed directly. Relationships between pain intensity and health and healthcare outcomes were examined using bivariate analyses (e.g., ANOVA, Kruskal-Wallis). Results: 51% of husbands and 57% of wives reported moderate, and 16% and 22% reported severe pain. Multinomial analyses identified several significant predictors of pain intensity. Some were shared—e.g., those with arthritis had increased odds of severe pain (OR=2.66 husbands/2.60 wives). Others were more specific. Notably, the odds of severe pain increased if one's spouse reported severe pain (e.g., OR=2.73 husbands). For outcomes: Higher pain intensity was associated with more physical, ADL, and IADL limitations, and lower self-rated health (p<.05). Those with severe pain also had more doctor visits and hospitalizations (p<.05). Severe pain was also associated with greater depressive symptoms. Conclusions and Implications: Findings can inform clinical practice with couples facing pain in later life, as well as advocacy efforts on their behalf. Knowledge of characteristics associated with pain intensity can guide assessment and interventions. The links between pain intensity and poor health and healthcare use can guide policy recommendations.