Association between chronic shoulder pain and executive function in community-dwelling older adults

Hio Teng LEONG, Chung Yee Cecilia HO, Yeuk Lam FUNG, Kwan Nga FU, Hau Kuen SHAM, Yan Yung Emily KWOK, Ho Ching MAN
Purpose:

The aims of this study are: 1) to examine the cognitive function (i.e., executive function) of community-dwelling older adults with chronic shoulder pain and compare them with age and sex matched healthy controls; and 2) to determine the associations of cognitive function with pain intensity, pain-related disability and psychological factors. 

Methods:

This is a cross-sectional study. Adults aged above 65 years with or without chronic shoulder pain were recruited in local elderly community centers. We assessed executive function using the Trial Making Test; the self-perceived pain using the pain sub-score of the Shoulder Pain and Disability Index (SPADI); pain-related disability using total score of the SPADI; psychological status (depression, anxiety and stress) using Depression, Anxiety and Stress Scales (DASS); and pain beliefs using Pain Catastrophizing Scale.

Results:

A total of 64  older adults (41 with chronic shoulder pain and 23 healthy, mean age = 77.5 years) participated in this study.  Our results showed older adults with chronic shoulder pain demonstrated significant longer time to complete the Trail Making Test (Part A) when compared to healthy controls (76.9±30.8 seconds vs. 60.5±26.14 seconds, p=0.034).  Pearson correlation analysis showed significant positive correlations between the time to complete the Trail Making Test (Part A) with self-perceived pain (r=0.377, p=0.002), depression (r=0.310, p=0.013), anxiety (r=0.289, p=0.021) and pain catastrophizing (r=0.262, p=0.038), respectively. 

Conclusion(s):

Community-dwelling older adults with chronic shoulder pain demonstrated poorer executive function when compared to healthy participants.  Poorer executive function was associated with greater self-perceived pain and higher levels of depression, anxiety and pain catastrophizing.

Implications:

Findings from this study provide evidence on the relationship between chronic shoulder pain and cognitive impairment in older adults. It is essential to raise awareness about shoulder health in older adults in Hong Kong. Healthcare providers can develop ways to implement preventive strategies and manage shoulder pain, and prevent or delay the progression of cognitive decline or dementia in older adults with chronic shoulder pain and warrants further investigation.

Funding acknowledgements:
This study is supported by Start-up Fund from the Hong Kong Polytechnic University.
Keywords:
chronic shoulder pain
executive function
community-dwelling older adults
Primary topic:
Musculoskeletal: upper limb
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
Institutional Review Board, The Hong Kong Polytechnic University
Provide the ethics approval number:
HSEARS20230403005
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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