Pain and sleep disturbance were negatively associated with function and community mobility after hospitalization
Background: The inconsistent nature of functional recovery after hospitalization points to gaps in our understanding of its determinants. The goal of this study was to examine associations between post-discharge pain interference and sleep disturbance on function and community mobility following hospitalization for medical illness. Methods: We conducted a cross-sectional analysis of data collected as part of a larger study evaluating a hospital-based mobility program. Participants were aged ≥60 and within one month of discharge from one of eight Veterans Affairs (VA) hospitals between September 2017 and August 2019. Data were collected through telephone surveys. Primary predictors of pain interference and sleep disturbance were measured by PROMIS-4 short forms. Outcomes were function measured by Late-Life Function and Disability Instruments (LLFDI overall function and advanced lower extremity function scores) and community mobility measured by Life Space. For each outcome, separate multiple linear regression models were fit including the key explanatory variables of interest and selected covariates. Results: Participants (n = 618) were mean age 70.6 years, 95% male, 25% Black, and 34% lived alone; overall eight percent reported being discharged to a nursing home, and 15% being readmitted to the hospital. Overall, 39.9% of participants reported moderate/severe pain interference; of these, approximately half also reported at least some degree of sleep disturbance. Moderate/severe sleep disturbance was endorsed by 19%; of these, more than 75% also experienced some degree of pain interference. In adjusted models, pain interference and sleep disturbance were negatively associated with total function, lower extremity function, and community mobility (P-values <0.01). Conclusions: In this sample of recently hospitalized older adults, pain interference and sleep disturbance were independently associated with functional limitations and reduced community mobility. Primary care providers should consider assessing for pain and sleep problems during post-hospitalization visits to support optimal functional recovery.
