Transitions in psychosocial phenotypes in older adults with pain

Although pain is prevalent in older adults, there are gaps in the existing literature regarding multivariable psychosocial contributors to pain outcomes. Identifying psychosocial phenotypes, or patterns of psychological and social characteristics, can help predict outcomes; however, further longitudinal analysis is required. This study explores the stability of psychosocial phenotypes longitudinally in older adults with pain, along with the predictors of transitions in phenotypes over time. Using 2018–2022 annual National Health and Aging Trends Study data, 813 older adults consistently reported pain. Psychosocial variables used in the analysis included depression, anxiety, affect, self-realization, resilience, self-efficacy, and social participation. Latent transition analysis was used to identify optimal psychosocial phenotypes and proportions of participants transitioning to different phenotypes longitudinally. Baseline variables (pain characteristics, physical, cognitive) associated with longitudinal transitions in psychosocial phenotypes were determined via logistic regression. Latent transition analysis resulted in three psychosocial phenotypes (Adverse, Favorable, and Intermediate) based on scores on psychosocial variables. Longitudinally, phenotype membership remained generally stable with a trend towards increased psychosocial adversity. Baseline cognition and physical performance were predictors of transitions to less adverse phenotypes longitudinally. In contrast, baseline sleep, physical performance, pain limitations, and self-rating of general health were predictors of transitions to more adverse phenotypes. There is stability in psychosocial well-being longitudinally in older adults with pain and a remarkable ability to rebound despite major stressors. Future research should explore interventions that promote transitions to more favorable psychosocial phenotypes, develop point-of-care clinical insights, and advance precision pain medicine. Perspective: This study analyzed psychosocial phenotypes in older adults with chronic pain using latent transition analysis. It identified stable phenotypes (Adverse, Intermediate, Favorable) and tracked changes over time. Findings highlight the impact of cognitive and physical health on psychosocial well-being, supporting personalized interventions and advancing precision pain medicine in older adults.