Objective:

To examine whether fear of falling (FOF) is associated with differences in pain prevalence, location, and management strategies among older adults using data from the National Health and Aging Trends Study (NHATS).

Background:

Falls in older adults substantially impact mobility, independence, and quality of life. Fear of falling affects nearly half of older adults worldwide, including those without a prior fall history. Pain, reported by an estimated 18.7 million U.S. older adults, also contributes to reduced activity and increased healthcare utilization. While pain is a known risk for falls, the relationship between pain location and FOF remains less explored.

Design/Methods:

This cross-sectional analysis used Round 13 (2023) NHATS data, an annual survey of Medicare beneficiaries aged 65 and older. Data on FOF, 12 pain locations, and pain management (n = 8,597) was analyzed using R’s survey package with weights to adjust for sampling design. The survey-weighted sample represented 37.6 million U.S. older adults (SE = ±226,815).

Results:

Using survey-adjusted chi-square tests, participants with FOF reported higher pain prevalence across all locations, most commonly in the back, knee, and leg (p<0.001). Logistic-regression models adjusted for age and gender found FOF independently associated with increased odds of pain in all locations (ORs 1.65–2.43). Specifically, FOF was linked to 1.75x higher odds of back pain (95% CI 1.58–1.95) and 2.02x higher odds of hip pain (CI 1.85–2.22). Participants with FOF also reported greater daily painkiller use (p<0.001).

Conclusions:

Findings support biopsychosocial models linking pain, reduced mobility, and FOF and indicate a need for targeted pain assessment during FOF screenings. Increased prevalence of back, knee, and leg pain, along with demographic differences, could inform fall prevention programs integrating pain management. These tailored treatments may produce beneficial multifactorial outcomes for vulnerable geriatric populations.