The Combined Effects of Chronic Pain and Different Types of Isolation on the Incidence of Disability in Community-Dwelling Older Adults: Prospective Cohort Study

OBJECTIVES: Social isolation is a critical public health issue that increases pain sensitivity and exacerbates chronic pain, leading to further social limitations. However, the risk of disability when these factors overlap remains unclear. This study hypothesized that the coexistence of social isolation and chronic pain would elevate disability incidence among community-dwelling older adults. DESIGN: A prospective cohort study. SETTINGS AND PARTICIPANTS: This study included 4709 community-dwelling older adults (73.8 ± 5.4 years of age, male: n = 2053) without baseline disability. METHODS: Chronic pain, isolation due to lack of social support, and isolation due to lack of social participation were assessed at baseline. Disability incidence was examined during a 24-month follow-up. RESULTS: In the adjusted Cox proportional hazards model, participants experiencing both chronic pain and isolation due to lack of social support provision had a significantly higher risk of disability incidence than those without chronic pain or isolation [hazard ratio (HR), 2.69; 95% CI, 1.78-4.05; P < .001]. Similarly, participants experiencing both chronic pain and isolation due to lack of social participation had a significantly higher risk of disability incidence than those without chronic pain or isolation (HR, 2.97; 95% CI, 2.00-4.40; P < .001). In addition, chronic pain and isolation due to lack of social participation had an additive effect after adjustment (relative excess risk due to interaction, 0.68; 95% CI, 0.00-1.36). CONCLUSION AND IMPLICATIONS: The overlap of chronic pain and isolation due to lack of social participation had an additive effect on disability incidence over 24 months. These findings highlight the importance of preventing the combination of chronic pain and social isolation to mitigate disability risk.