| BackgroundChina has already entered a deeply aging society.The trend of "empty nesting" is becoming more and more prominent,and has gradually become an important feature of China’s aging population.Due to the tightening of social resources and lack of emotional support,the vulnerable group of rural empty nesters needs urgent attention.Studies have found that empty nesters have a high incidence of falls,and that falls exacerbate health problems and financial burdens for empty nesters.Evidence suggests that chronic pain is a risk factor for falls and a more common somatic problem in older adults;chronic pain could cause severe psychological distress,and there is also an association between psychological distress and increased risk of falls.Based on this and combined with the fear-avoidance model of pain,it is hypothesized that psychological distress might be a mediating factor between chronic pain and falls.However,the occurrence of falls,chronic pain,and psychological distress among rural empty nesters is unclear,and the longitudinal association between chronic pain and falls and the mediating role of psychological distress between chronic pain and falls need to be further explored.ObjectivesTo understand the status and changes in the occurrence of chronic pain,falls,and psychological distress among rural empty nesters,to explore the longitudinal association between chronic pain and falls among rural empty nesters,and to explore the mediating role of psychological distress in the relationship between chronic pain and falls.MethodsThe data of this study were obtained from the first(T1)and second(T2)follow-up data of the Shandong Rural Elderly Health Cohort(SREHC).According to the inclusion and exclusion criteria of this study,2055 rural empty nesters were included as the study population,and the occurrence of chronic pain,psychological distress,and falls among rural empty nesters were collected through questionnaires.Generalized estimating equations were used to analyze the longitudinal association between chronic pain and falls among rural empty nesters,and generalized structural equation modeling was used to test the mediating effect of psychological distress in the association between chronic pain and falls.ResultsIn the period of T1,347 rural empty nesters had fall once in the past year,with a fall incidence rate of 16.89%,845 with chronic pain,accounting for 41.12%,and 556 at high/very high levels of psychological distress,accounting for 27.06%;in the period of T2,403 rural empty nesters had fall once in the past year,with a fall incidence rate of 19.61%,and 883 with chronic pain,accounting for 42.97%,and 346 at high/very high levels of psychological distress,accounting for 16.84%.From stage T1 to T2,the incidence of falls and chronic pain among rural empty nesters showed an increasing trend,and the incidence of psychological distress,which was at a high/very high level,showed a decreasing trend.After adjusting for control variables,multifactorial generalized estimating equation analysis revealed that empty nesters with chronic pain at T1 were 1.55 times more likely to have fall once at the period of T2 than empty nesters without chronic pain at the period of T1(OR=1.55,P<0.001).Generalized structural equation modeling estimates revealed a statistically significant direct effect of chronic pain on the occurrence of falls among rural empty nesters(direct effect value=0.642,P<0.001),accounting for 79.91%of the total effect,and a statistically significant effect of chronic pain affecting falls through the mediating effect of psychological distress(indirect effect value=0.182,P=0.026),accounting for 22.09%.Conclusions and SuggestionsConclusionsFrom stage T1 to T2,the incidence of falls(16.89%,19.61%)and chronic pain(41.12%,42.97%)among rural empty nesters showed an increasing trend,and the incidence of severe psychological distress(27.06%,16.84%)showed a decreasing trend.Chronic pain was longitudinally associated with falls in rural empty nesters,that is to say,empty nesters with chronic pain at T1 period had a higher risk of falls at T2 period than those without chronic pain;psychological distress mediated the relationship between chronic pain and falls in rural empty nesters,that is to say,chronic pain not only directly increased the risk of falls in rural empty nesters,but also indirectly increases the risk of falls by aggravating psychological distress.SuggestionsImprove the early warning capability of fall risk,strengthen the age-appropriate renovation of the living environment of rural empty nesters;improve the health service for rural empty nesters,focus on the identification and management of chronic pain;multidimensional strengthen of psychological distress intervention for rural empty nesters to alleviate psychological distress of empty nesters. |
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