Chronic pain and subjective memory problems are dynamic risk factors for functional decline: An ACTIVE longitudinal study

Abstract

Chronic pain is highly prevalent in older adults and is associated with elevated risk for disability and dementia. Subjective memory problems (SMPs) - self-rated memory difficulties - are also common and may serve as early indicators of functional decline. This study examined associations between SMPs and cognitive, physical, and psychosocial functioning among older adults with and without chronic pain. Data were drawn from 2365 participants in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study. Multilevel models assessed the impact of baseline and time-varying SMPs on cognitive performance (memory, reasoning, processing speed), physical function (mobility, grip strength, self-rated physical health), and psychosocial outcomes (depressive symptoms, social functioning). Chronic pain, defined as moderate-to-severe pain using the SF-36 Bodily Pain Scale, was tested as a moderator. At baseline, greater SMPs were associated with poorer cognitive performance (βs: −0.52 to −0.23). SMPs and chronic pain were independently linked to worse physical function, lower social functioning, and more depressive symptoms (βs: −0.94 to −0.34; 0.51 to 1.01). Chronic pain uniquely predicted worse mobility and reduced grip strength. Prospectively, SMPs interacted with chronic pain to predict steeper declines in reasoning and physical function. Concurrent increases in SMPs paralleled further declines in most cognitive, physical, and psychosocial domains. Findings suggest that SMPs are stronger predictors of certain outcomes among older adults with chronic pain. These results highlight the importance of jointly considering subjective memory problems and chronic pain to better identify individuals at heightened risk for accelerated functional decline in later life.