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

To investigate the association between pain distribution patterns, particularly lower extremity involvement and multisite pain, and fall risk among older adults in Korea.

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.

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.

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.