Date

April 2010

Document Type

Dissertation

Degree Name

Ph.D.

Institution

Oregon Health & Science University

Abstract

Objectives: The purpose of this study was to explore factors associated with increased risk of disability in older adults living with fibromyalgia (FM) along with factors that protect or enhance physical function and promote health in the presence of FM. The study addressed the following specific aims: 1. Explore levels and correlates of pain, self-reported physical function and resilience in community-dwelling older adults living with FM. Descriptive aims had no hypothesis. 2. Examine theorized demographic and health-related predictors of self-reported physical function in community dwelling older adults living with FM. It was hypothesized that age, education, income, tangible social support, comorbidity, depressive symptoms, BMI, and physical activity predicted self-reported physical function. 3. Examine resilience as a moderator of the relationship between pain and self-reported physical function in community-dwelling older adults living with FM. It was hypothesized that high levels of resilience moderated (weakened) the relationship between pain level and physical function when controlling for significant predictors of self-reported physical function. Methods: A descriptive correlational, cross-sectional design was used to explore and analyze relationships between demographic variables (age, education, income, tangible social support) and health-related measures (comorbidity, depressive symptoms, BMI, physical activity, FM impact, pain, resilience, and self-reported physical function) in a convenience sample of community-dwelling older adults diagnosed with FM (N = 224,Mage = 62.1 yrs, SD = 6.75). Data was collected via one-time mailed questionnaire. Results: Participants in this convenience sample were predominantly female, Caucasian, married, well-educated, had moderate levels of tangible social support. Nearly three fourths (74%) reported household incomes >$20,000/year. Three fourths of the sample was classified as overweight or obese and the average level of physical activity was low. Over three fourths of the participants reported pain as moderate or severe and, on average, reported moderate limitations in physical function. Despite impaired physical function and moderate to severe levels of pain, the level of resilience was moderately high in this sample. Advanced age, low levels of depressive symptoms, low pain ratings, high levels of physical function, and low overall FM impact were significant and clinically important correlates of high levels of resilience. Significant and clinically important correlates of pain included physical function, depressive symptoms, and overall FM impact. Almost one third of the variance in physical function scores (30%) was accounted for by six of the eight theorized predictors; however, tangible social support and comorbidity did not uniquely contribute to the variance in physical function. Pain and resilience accounted for an additional 15% and 3%, respectively, to account for a total of 48% of the variation in physical function scores. The level of resilience did not moderate the relationship between pain and physical function as hypothesized; resilience contributed uniquely to the variance in physical function. Conclusions: Older adults with FM had moderately high levels of resilience despite moderate to severe levels of pain and impaired physical function. Resilience may help to explain why some older adults with FM report less impact than do younger persons with FM. Resilience did not moderate the impact of pain on physical function; resilience and pain were both independent predictors of physical function in older adults with FM. Older adults with FM who are at most risk for poor physical function are those with limited resilience and high pain. The results of this study will hopefully inspire further research of interventions designed to reduce the risk of disability and promote health and quality of life in a growing number of older adults living with persistent and painful conditions like FM.

Identifier

doi:10.6083/M49Z92VQ

School

School of Nursing

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