'Living within your limits': activity restriction in older people experiencing chronic pain

Background: although maintaining activity is key to successful pain management, and important to health and wellbeing, it is known that older people in pain frequently alter or reduce activity levels. A 'fear-avoidance' model is often used to explain avoidance of activity in the face of pain. However, this model is not intended to take account of the wider context in which activity changes take place, nor older people's own explanations for their behaviour.Objective: to investigate the reasons why older people in the community adjust their activity levels when living with chronic pain.Methods: thirty-one people aged between 67 and 92 were purposively sampled from respondents to a community-based cross-sectional survey. All participants had reported long-term pain and were interviewed about this. Data were collected and analysed using a qualitative constructivist grounded theory approach.Findings: explanations for deliberative reduction or ceasing of activities reflected a desire to prevent pain exacerbation, thereby avoiding medical intervention. It also reflected a desire to safeguard autonomy in the face of pain in older age. Restrictions were often rationalised as normal in older age, although co-existing accounts of perseverance and frustration with limitation were also evident.Conclusions: a rational desire to avoid pain exacerbation and medical intervention motivated restrictions to activity. However, deliberative limitation of activity has the potential to compromise autonomy by increasing social isolation and de-conditioning. Supporting older people with pain to be active requires sensitivity to the function of activity restriction, especially as a means of preventing deterioration.

背景：尽管保持活动对成功的疼痛管理至关重要，且对健康和幸福很重要，但众所周知，患有疼痛的老年人经常改变或降低活动水平。“恐惧 - 回避”模型常被用于解释在疼痛情况下对活动的回避。然而，该模型无意考虑活动发生变化的更广泛背景，也未考虑老年人对自身行为的解释。 目的：调查社区中患有慢性疼痛的老年人调整活动水平的原因。 方法：从一项基于社区的横断面调查的受访者中有意抽取了31名年龄在67岁至92岁之间的人。所有参与者都报告有长期疼痛，并就此接受了访谈。采用定性的建构主义扎根理论方法收集和分析数据。 结果：对有意减少或停止活动的解释反映了一种防止疼痛加剧的愿望，从而避免医疗干预。这也反映了老年人在面对疼痛时维护自主性的愿望。限制在老年时期常常被合理化为正常现象，尽管同时也存在坚持和对限制感到沮丧的情况。 结论：避免疼痛加剧和医疗干预的合理愿望促使对活动进行限制。然而，有意限制活动有可能因增加社会隔离和身体机能下降而损害自主性。支持患有疼痛的老年人保持活动需要敏锐地察觉到活动限制的作用，特别是作为一种防止身体状况恶化的手段。