TRAIT EXPECTANCIES AND PAIN-RELATED OUTCOMES IN OLDER ADULTS

Older adults with persistent pain experience reduced physical functioning, increased
disability, and higher rates of depression. Previous research suggests that different types of
positive and negative expectancies (e.g., optimism and hopelessness) may be associated with the
severity of these pain-related outcomes. Moreover, different types of expectancies may interact
with perceived control to predict these outcomes. However, it is unclear whether different types
of expectancies are uniquely predictive of changes in pain-related outcomes over time in older
adults and whether perceived control moderates these relationships. The primary aims of the
current study were to 1) examine how the shared and unique aspects of optimism and
hopelessness differentially predict changes in pain-related outcomes (i.e., pain severity, pain
interference, disability, and depressive symptoms) in older adults experiencing persistent pain
over a 10-year and 2-year timeframe and 2) examine whether perceptions of control over one’s
health moderate these relationships. The present study sampled older adults with persistent pain
who participated in a nationally representative, longitudinal study (i.e., The Health and
Retirement Study) at three timepoints across a 10-year period. First, confirmatory factor analyses
(CFA) were conducted to determine appropriate modeling of expectancy variables. Second,
mixed latent and measured variable path analyses were created to examine the unique
relationships between expectancy variables and changes in pain-related outcomes over both a 10-
year and 2-year period. Finally, mixed latent and measured variable path analyses and PROCESS
were used to test perceived control as moderator of the relationships between expectancy
variables and changes in pain-related outcomes over time. CFA results suggested that measures
of optimism and hopelessness were best understood in terms of their valence, as positive (i.e.,
optimism) or negative (i.e., pessimism and hopelessness) expectations. Results from path
analyses suggested that only negative, not positive, expectancies were significantly associated
with worsening pain severity, pain interference, disability, and depressive symptoms across both
10-year and 2-year periods. Moderation analyses demonstrated inconsistent results and
difficulties with replication. However, post-hoc path analyses found that perceptions of control
over one’s health independently predicted some changes in pain-related outcomes over time,
even when controlling for expectancies. Altogether, the current findings expand our knowledge
of the associations between expectancies and pain by suggesting that negative expectancies are
predictive of changes in mental and physical pain-related outcomes across years of time. The
current study also suggests that positive and negative expectancies may be related, but distinct
factors in older adults with persistent pain and that health-related perceived control may be
predictive of changes in pain over time. The current discussion reviews these extensions of our
current knowledge in greater detail, discusses the potential mechanisms driving these
relationships through a theoretical lens, and identifies the implications of this work.