Geriatrics

12 pages, 373 KB

Open AccessArticle

Examination of Social Participation in Older Adults Undergoing Frailty Health Checkups Using Deep Learning Models

by Yoshiharu Yokokawa, Keisuke Nakamura, Tomohiro Sasaki, Shinobu Yokouchi and Fumikazu Kimura

Geriatrics 2025, 10(5), 124; https://doi.org/10.3390/geriatrics10050124 - 12 Sep 2025

Background/Objectives: Frailty in older adults limits social participation. We aimed to predict social participation in older individuals undergoing frailty health checkups using three machine learning (ML) models and identify key predictive factors through deep neural network (DNN) analysis. Methods: Overall, 301 [...] Read more.

Background/Objectives: Frailty in older adults limits social participation. We aimed to predict social participation in older individuals undergoing frailty health checkups using three machine learning (ML) models and identify key predictive factors through deep neural network (DNN) analysis. Methods: Overall, 301 older individuals were enrolled; 295 were included in the final analysis. The survey measured 18 attributes, including demographic, physical, cognitive, and social factors. Logistic regression (LR), nonlinear support vector machine (NLSVM), and DNN were used for prediction, with precision, accuracy, sensitivity, specificity, F1 score, and area under the curve (AUC) calculated as evaluation metrics. Results: Among 295 participants, 236 (80%) engaged in social activities, whereas 59 (20%) did not. The three models demonstrated complementary strengths: DNN provided the most balanced performance with superior sensitivity for detecting social participants; NLSVM showed the best overall discriminative ability but with higher false positive rates; and LR achieved the highest precision for correctly identifying participants but missed detecting social participants. AUC values ranged from 0.776 to 0.795 across models, indicating moderate discriminative performance. Contribution analysis revealed information-collection ability as the strongest predictor of social participation, followed by walking speed and number of cohabitants. Conclusions: ML models achieved moderate discriminative performance for predicting social participation among frailty-screened older adults. The DNN provided the most balanced performance. Each model exhibited distinct characteristics suitable for different screening purposes, with information-collection ability emerging as a key factor. The findings suggest that models must be carefully selected based on specific community health screening objectives. Full article

(This article belongs to the Collection Frailty in Older Adults)

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12 pages, 264 KB

Open AccessArticle

Association Between Ultra-Processed Food Consumption Frequency and Frailty: Findings from the InCHIANTI Study of Aging

by Xin Li, Yichen Jin, Stefania Bandinelli, Luigi Ferrucci, Toshiko Tanaka and Sameera A. Talegawkar

Geriatrics 2025, 10(5), 123; https://doi.org/10.3390/geriatrics10050123 - 11 Sep 2025

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Abstract

Background/Objectives: As individuals age, they experience declines in multiple physiological domains, which increases their vulnerability to health challenges and frailty. While adherence to healthy dietary patterns has been shown to protect against frailty, consuming ultra-processed foods (UPFs)—which are high in added sugars and [...] Read more.

Background/Objectives: As individuals age, they experience declines in multiple physiological domains, which increases their vulnerability to health challenges and frailty. While adherence to healthy dietary patterns has been shown to protect against frailty, consuming ultra-processed foods (UPFs)—which are high in added sugars and saturated fat—may contribute to frailty risk. This study investigates the association between UPF consumption and frailty progression among 938 participants aged 65 years and older who were in the InCHIANTI study, Italy. Methods: The patients’ dietary intakes over the past year were assessed using a validated food frequency questionnaire, with items categorized into food groups based on the Nova classification. Frailty was operationalized using a 42-item frailty index (FI). Multivariable linear regression was used to examine the association between the baseline UPF consumption frequency and baseline frailty status, while linear mixed-effects models were used to examine the frailty progression over time. Results: Overall, the participants with the lowest UPF consumption frequency were younger, had more years of education, and had a lower baseline FI. Higher UPF consumption was significantly associated with a greater baseline FI after adjustments for the sociodemographic and health characteristics (β = 0.026, 95% CI = 0.010–0.041, p = 0.001), and this difference persisted over a 16.1-year follow-up period (β = 0.022, 95% CI = 0.006–0.037, p = 0.006). Conclusions: These findings underscore the potential negative health impacts of UPF on frailty prevalence and progression in older adults. Full article

10 pages, 286 KB

Open AccessSystematic Review

Effects of the Prescription of Physical Exercises Mediated by Mobile Applications on the Health of Older Adults: A Systematic Review

by Débora Vanessa Santos Dias Costa, Evellin Pereira Dourado, Mayara Bocchi Fernandes, Eduardo Vignoto Fernandes and David Michel de Oliveira

Geriatrics 2025, 10(5), 122; https://doi.org/10.3390/geriatrics10050122 - 10 Sep 2025

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Abstract

Background/Objectives: Aging and a sedentary lifestyle aggravate hypokinetic diseases, compromising the functional capacity of older adults. Thus, the prescription of physical exercise (PE) through mobile applications (MA) has emerged as a remote and personalized alternative. However, there are still gaps in the effectiveness [...] Read more.

Background/Objectives: Aging and a sedentary lifestyle aggravate hypokinetic diseases, compromising the functional capacity of older adults. Thus, the prescription of physical exercise (PE) through mobile applications (MA) has emerged as a remote and personalized alternative. However, there are still gaps in the effectiveness of prescribing physical exercise via mobile apps for older people. This study aimed to analyze the effects of prescribing PE through MAs on the health of older adults. Materials and Methods: This systematic review included studies with older people (≥60 years) that used MAs to prescribe PE, published between 2014 and 2024, in Portuguese or English. The search strategy used the descriptors “older adults,” “physical exercise,” “mobile applications,” and “health,” combined with Boolean operators. The screening followed previously defined eligibility criteria regarding population, intervention, outcomes, and study design. Two independent reviewers extracted data, mediated by a third party in case of disagreement; they screened and extracted data from the PubMed and VHL/Medline databases from 2004 to 2024. Risk of bias was assessed according to levels of evidence, and the results were categorized. Results: Of the 2298 publications initially identified, 7 studies were eligible for this review, totaling 748 participants, predominantly female. The studies included prospective and observational clinical trials with older people suffering from Parkinson’s disease, cardiovascular disease, sarcopenia, and breast cancer. The findings showed favorable effects on adherence to the program (6 studies; n = 654), an increase in PE (5 studies; n = 502), and improvements in functional capacity (4 studies; n = 389), perceived quality of life (5 studies; n = 481), and muscle strength (3 studies; n = 298). Conclusions: The prescription of MA-mediated PE showed positive effects on the health of older people, indicating its viability as a complementary strategy in clinical practice or public health. Full article

(This article belongs to the Topic Exercise and Human Aging: Physiological and Psychological Functions)

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13 pages, 834 KB

Open AccessArticle

Sleep Disturbances and Dementia in the UK South Asian Community: A Qualitative Study to Inform Future Adaptation of the DREAMS-START Intervention

by Penny Rapaport, Malvika Muralidhar, Sarah Amador, Naaheed Mukadam, Ankita Bhojwani, Charles Beeson and Gill Livingston

Geriatrics 2025, 10(5), 121; https://doi.org/10.3390/geriatrics10050121 - 8 Sep 2025

Viewed by 394

Abstract

Background/Objectives: Little is known about experiences of sleep disturbance in dementia amongst South Asian families, the UK’s biggest minority ethnic group. We aimed to explore their experiences of these alongside translation and preliminary cultural adaptation of an existing effective multicomponent intervention, DREAMS-START. [...] Read more.

Background/Objectives: Little is known about experiences of sleep disturbance in dementia amongst South Asian families, the UK’s biggest minority ethnic group. We aimed to explore their experiences of these alongside translation and preliminary cultural adaptation of an existing effective multicomponent intervention, DREAMS-START. Methods: We interviewed family carers of people living with dementia who had participated in the DREAMS-START (n = 7) trial or other dementia studies (n = 4), conducting reflective thematic analysis. We translated DREAMS-START into Hindi and consulted with Hindi speakers with experience in dementia care, revising iteratively. Results: We identified two overarching themes: (i) the experience of dementia-related sleep disturbance in South Asian families, including the impact of multigenerational living, cultural expectations and practices, and existing relationships; and (ii) considerations for culturally adapting DREAMS-START, including language barriers, linguistic and other changes to peripheral elements to increase engagement and relevance, and culturally competent facilitation of the intervention. Conclusions: Consideration of multigenerational family structures, within-member dynamics, culturally appropriate activities and lack of access to support are important during consultation and intervention. It was thought that cultural adaptation of the intervention in language and facilitator cultural competence, including consideration of the schedule of prayer, would increase relevance and thus community access. We will use this preliminary work to inform future cultural adaptation and testing of the intervention with the intention to widen access for UK-based South Asian families. Full article

(This article belongs to the Section Geriatric Psychiatry and Psychology)

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12 pages, 394 KB

Open AccessArticle

Cognitive Function and Subjective Well-Being in Japanese Community-Dwelling Older Adults: A Cross-Sectional Study

by Baoxing Li, Tianshu Chu, Ziming Gong, Le Tian and Hiro Kishimoto

Geriatrics 2025, 10(5), 120; https://doi.org/10.3390/geriatrics10050120 - 6 Sep 2025

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Abstract

Background: The relationship between mild cognitive impairment (MCI) and subjective well-being remains poorly understood. We examined associations between cognitive function and well-being domains in community-dwelling older Japanese adults with and without MCI. Subjects and Methods: A cross-sectional analysis of 710 community-dwelling [...] Read more.

Background: The relationship between mild cognitive impairment (MCI) and subjective well-being remains poorly understood. We examined associations between cognitive function and well-being domains in community-dwelling older Japanese adults with and without MCI. Subjects and Methods: A cross-sectional analysis of 710 community-dwelling Japanese adults aged 65–75 years was carried out. Well-being was measured using the Philadelphia Geriatric Center Morale Scale (PGCMS score ≥ 13 indicates high well-being), comprising agitation, attitude toward aging, and lonely dissatisfaction subscales. MCI was defined as a Montreal Cognitive Assessment (MoCA) score of 18–25. Multivariable logistic regression examined potential associations between socio-demographic and health factors. Results: Among the participants (mean age 70.0 ± 2.5 years, 49% women), 423 (59.6%) had MCI. The MCI status was not associated with overall well-being (OR 1.06, 95% CI: 0.72–1.57, p = 0.77). However, within the MCI group, each 1-point increase in the MoCA score was associated with lower agitation (OR 1.21, 95% CI: 1.04–1.41) but higher lonely dissatisfaction (OR 0.83, 95% CI: 0.70–0.98, p = 0.02). No associations were observed in the non-MCI group. Conclusions: Cognitive function shows domain-specific rather than global associations with well-being in individuals with MCI. Full article

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14 pages, 1834 KB

Open AccessArticle

Floor-to-Stand Transfers in Older Adults: Insights into Strategies and Lower Extremity Demands

by Lyndsay Stutzenberger and Tyler Whited

Geriatrics 2025, 10(5), 119; https://doi.org/10.3390/geriatrics10050119 - 6 Sep 2025

Viewed by 284

Abstract

Background/Objectives: Getting up from the floor is an important functional skill for independence in older adults but is not often assessed clinically. The purpose of this study was to investigate how floor-to-stand transfer (FTS) ability is related to self-report measures and five-time sit-to-stand [...] Read more.

Background/Objectives: Getting up from the floor is an important functional skill for independence in older adults but is not often assessed clinically. The purpose of this study was to investigate how floor-to-stand transfer (FTS) ability is related to self-report measures and five-time sit-to-stand (5XSTS) performance, as well as compare peak joint angles during common FTS strategies and lower extremity demands between the 5XSTS and a commonly instructed FTS strategy. Methods: Thirty-four community-dwelling older adults completed self-report measures and performed the 5XSTS, a FTS in a self-selected manner, and an instructed FTS strategy. Biomechanical analysis of the lower extremities was used to determine peak joint angles, moments, and powers during study tasks. Correlation analyses were used to determine associations between FTS time and self-report scores, 5XSTS time, and lower extremity demands during the 5XSTS. One-way analysis of variance (ANOVA) and Kruskal–Wallis tests were used to determine the differences in self-report measures, 5XSTS performance, and FTS time between self-selected FTS strategies. Lower extremity demands between the 5XSTS and the instructed FTS strategy were compared with Wilcoxon Signed-Rank tests. Results: Self-report measures were not associated with FTS time or different between FTS strategies. Knee flexion was greater in the roll-over compared to the quadruped strategy (p < 0.001). Ankle and hip demands were greater during the instructed FTS, and knee demands were greater during the 5XSTS (p < 0.001) when comparing the tasks. Conclusions: The study findings may improve clinical decision-making related to FTS assessment and interventions in older adults. Prescribing exercises with greater hip and ankle demand than the 5XSTS may help maximize FTS ability. Full article

(This article belongs to the Topic Exercise and Human Aging: Physiological and Psychological Functions)

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12 pages, 259 KB

Open AccessArticle

Multifactorial Risk Assessment of Falls in Thai Community-Dwelling Older Adults: Findings from a Geriatric Cohort Study

by Natthaphon Ubonsutvanich, Aisawan Petchlorlian, Bhorn-Ake Manasvanich, Rapas Samalapa, Thanyaporn Hengpongthorn, Jirapa Champaiboon, Kaewkanda Lekmanee, Seangarun Surawong and Kearkiat Praditpornsilpa

Geriatrics 2025, 10(5), 118; https://doi.org/10.3390/geriatrics10050118 - 3 Sep 2025

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Abstract

Background/Objectives: Falls are a major public health concern among older adults, often resulting in injury, mortality, and loss of independence. Understanding fall-related risk factors is essential for developing effective prevention strategies. This study examined the multifactorial risk assessment of falls among Thai [...] Read more.

Background/Objectives: Falls are a major public health concern among older adults, often resulting in injury, mortality, and loss of independence. Understanding fall-related risk factors is essential for developing effective prevention strategies. This study examined the multifactorial risk assessment of falls among Thai community-dwelling older adults, aiming to identify and prioritize modifiable risk factors for targeted interventions in the Thai context. Methods: A cross-sectional study was conducted among 5694 adults aged ≥60 years who attended a comprehensive geriatric clinic in Bangkok, Thailand, between March 2019 and December 2023. All participants underwent a comprehensive geriatric assessment and fall history screening. Logistic regression analysis was performed to identify independent predictors of falls and recurrent falls. Results: Among the 5694 participants, 17.7% reported at least one fall in the past year, and 4.1% experienced recurrent falls. Independent risk factors for falls included female sex (OR = 1.74), unsteadiness (OR = 1.54), fear of falling (OR = 1.22), sedative drug use (OR = 1.38), and low gait speed (<1 m/s; OR = 1.70). Recurrent falls were additionally associated with urinary incontinence (OR = 1.78). Most falls occurred outdoors (58.5%), primarily due to environmental hazards such as slippery floors and uneven surfaces. The Clinical Test of Sensory Integration of Balance (CTSIB) showed no difference between fallers and non-fallers, except under the eyes-open on firm surface condition, where recurrent fallers exhibited significantly greater postural sway (p = 0.048). Conclusions: In community-dwelling Thai older adults with robust or pre-frail status, the three key questions for fall risk screening appear to be the most effective tool. Modifiable risk factors strongly associated with fallers and recurrent fallers include sedative use, urinary incontinence, and unsteadiness. Accordingly, medication review, urinary incontinence screening, and balance assessment may help prevent falls. The CTSIB may have only limited value in differentiating fall risk between fallers and non-fallers in this population. Full article

(This article belongs to the Special Issue Healthy Ageing and Lifestyle Medicine: Current Knowledge and Future Direction)

17 pages, 1540 KB

Open AccessArticle

The Cognitive and Mood-Related Costs of Loneliness: Why Marital Status Matters in Old Age

by Maristella Belfiori, Francesco Salis, Benedetta Puxeddu and Antonella Mandas

Geriatrics 2025, 10(5), 117; https://doi.org/10.3390/geriatrics10050117 - 26 Aug 2025

Viewed by 544

Abstract

Background: The 21st century is characterized by a significant and ongoing rise in the aging population across Europe. In this context, marital status may act as a relevant social factor influencing health trajectories in later life. This study explores the association between marital [...] Read more.

Background: The 21st century is characterized by a significant and ongoing rise in the aging population across Europe. In this context, marital status may act as a relevant social factor influencing health trajectories in later life. This study explores the association between marital status and various health-related outcomes in community-dwelling older adults. Methods: We enrolled 1201 patients ≥ 65 years (median age: 81, interquartile range (IQR): 76–84) attending the Geriatric Outpatient Service at the University Hospital of Cagliari. Each participant underwent a Comprehensive Geriatric Assessment (CGA). Results: Married individuals were significantly less likely to report depressive symptoms (Risk Ratio (RR) = 0.82; 95% Confidence Interval (CI): 0.73 to 0.92; p = 0.0004) and had a 1.26-point reduction in Geriatric Depression Scale (GDS) scores (β = –1.26; 95% CI: −2.03 to −0.50; p = 0.0013). Separate/Single participants exhibited significantly higher Mini-Mental State Examination (MMSE) scores (β = 1.60; 95% CI: 0.19 to 3.01; p = 0.0262). In contrast, Widowed individuals showed significantly poorer cognitive performance (RR = 1.12; 95% CI: 1.02 to 1.23; p = 0.0204), with lower MMSE scores (β = −1.10; 95% CI: −2.08 to 0.12; p = 0.0279). They also had a higher likelihood of depressive symptoms (RR = 1.16; 95% CI: 1.04 to 1.30; p = 0.0072) and a 1.19-point increase in GDS scores (β = 1.19; 95% CI: 0.38 to 1.99; p = 0.0039). Conclusions: Although observational design precludes causal inference, our findings highlight the significance of marital status as a social factor associated with cognitive function and mood in older adults. Integrating this dimension into the CGA may enhance its ability to capture social vulnerabilities in later life. Full article

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12 pages, 247 KB

Open AccessArticle

Frailty and Oral Health: Associations with Candidiasis, Prosthesis Use, and Hyposalivation

by Renata Centanaro-Vera, Fuad Huamán-Garaicoa, Sofia Cuadrado-Rios, Marcelo Armijos, Ludwig Álvarez-Córdova and Karla Cruz-Moreira

Geriatrics 2025, 10(5), 116; https://doi.org/10.3390/geriatrics10050116 - 26 Aug 2025

Viewed by 408

Abstract

Background/Objectives: Frailty syndrome favors the deterioration of health; therefore, identifying associated factors is essential for establishing preventive measures. Oral candidiasis is a factor that may be related to the onset of frailty. Our objective was to evaluate the association between frailty and [...] Read more.

Background/Objectives: Frailty syndrome favors the deterioration of health; therefore, identifying associated factors is essential for establishing preventive measures. Oral candidiasis is a factor that may be related to the onset of frailty. Our objective was to evaluate the association between frailty and oral candidiasis in institutionalized participants. Methods: We conducted a cross-sectional study involving 589 institutionalized individuals aged 65 years or older. A diagnosis of candidiasis was established clinically and with a microbiological study (potassium hydroxide (KOH) test and culture for candidiasis). Assessments of salivary flow and the use of dental prostheses were also performed. Frailty was classified according to Fried’s phenotype criteria. Results: Frailty and prefrailty were found in 28.9% and 66.7% of the participants, respectively. Oral candidiasis was diagnosed in 39.05% of cases and was more frequent among individuals with dental prostheses (49.13%) and hyposalivation (47.54%). Conclusions: Our findings suggest that frailty in institutionalized older adults is associated with the presence of subprosthetic stomatitis associated with candidiasis and hyposalivation, indicating the need for integrated oral health strategies in geriatric care. Full article

15 pages, 1044 KB

Open AccessArticle

A Comparison of Higher-Level Functional Capacity Between Older Adults with and Without Type 2 Diabetes Mellitus: A Cross-Sectional Study Using Propensity Score Matching

by Takuro Shoji, Kenta Kogure, Nagisa Toda, Mariko Hakoshima, Hisayuki Katsuyama, Hidekatsu Yanai, Satoshi Tokunaga, Korin Tateoka, Taishi Tsuji and Tomohiro Okura

Geriatrics 2025, 10(5), 115; https://doi.org/10.3390/geriatrics10050115 - 26 Aug 2025

Viewed by 354

Abstract

Background/Objectives: In Japan, the number of older patients with diabetes mellitus (DM) is rapidly increasing; however, the impact of DM on higher-level functional capacity in this population is unclear. In this study, we aimed to clarify the characteristics of higher functional capacity [...] Read more.

Background/Objectives: In Japan, the number of older patients with diabetes mellitus (DM) is rapidly increasing; however, the impact of DM on higher-level functional capacity in this population is unclear. In this study, we aimed to clarify the characteristics of higher functional capacity in older patients with type 2 diabetes mellitus (T2DM). Methods: The participants included outpatients with T2DM receiving care at a general hospital and community-dwelling older adults without DM (both groups aged ≥ 65 years) in Japan. The Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) and the Japan Science and Technology Agency Index of Competence (JST-IC) were used to evaluate higher-level functional capacity. We compared the higher-level functional capacities of the two groups after propensity score matching to ensure homogeneity in background factors. Results: After propensity score matching, 131 individuals each from a group of older patients with T2DM and a group of community-dwelling older adults without DM were included (mean age: 76.6 ± 5.6 and 76.1 ± 5.4 years, respectively; male sex: 54.2% and 52.7%, respectively). The older patients with T2DM had higher average instrumental activities of daily living scores (4.8 vs. 4.6; p < 0.01) and lower average intellectual activity scores (3.4 vs. 3.8; p < 0.01) on the TMIG-IC, average JST-IC scores (10.3 vs. 11.6; p < 0.01), and average social engagement scores (1.0 vs. 2.2; p < 0.01) compared to the community-dwelling older adults without DM. Conclusions: Older outpatients with T2DM demonstrated poorer intellectual activity and social engagement than community-dwelling older adults without DM. Therefore, it may be necessary to focus on preventive interventions to support higher-level functional capacities in this population. Full article

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17 pages, 237 KB

Open AccessArticle

The Consequences of Habitual Rumination, Expressive Suppression, and Perceived Stress on Mental and Physical Health Among Older Adults

by Eyal Gringart, Rodrigo Becerra and Andrea Smith

Geriatrics 2025, 10(5), 114; https://doi.org/10.3390/geriatrics10050114 - 25 Aug 2025

Viewed by 547

Abstract

Background/Objectives: The current study aimed to investigate whether habitual rumination, suppression, and perceived stress predict poor mental and physical health as well as well-being in a group of older adults (aged 50 to 80 years) from a non-clinical community sample. Methods: The current [...] Read more.

Background/Objectives: The current study aimed to investigate whether habitual rumination, suppression, and perceived stress predict poor mental and physical health as well as well-being in a group of older adults (aged 50 to 80 years) from a non-clinical community sample. Methods: The current study comprised a cross-sectional survey design with online self-report measures. It was predicted that higher levels of rumination, suppression, and perceived stress would predict lower levels of general health as well as well-being, and heightened levels of depression and anxiety. Results: Findings from the study indicated that both rumination and perceived stress significantly predicted heightened anxiety, heightened depression, and decreased physical health as well as well-being. Conclusions: These results replicate and extend past research on rumination. However, diverging from past research, suppression was not a significant predictor, or correlate, of stress, anxiety, or of general health and well-being; though, suppression did weakly but significantly predict depression. Full article

(This article belongs to the Section Geriatric Psychiatry and Psychology)

16 pages, 711 KB

Open AccessSystematic Review

A Systematic Review of the Association Between Pain and Instrumental Activities of Daily Living Disability in Community-Dwelling Older Adults

by Yukiko Mizutani and Shigekazu Ukawa

Geriatrics 2025, 10(5), 113; https://doi.org/10.3390/geriatrics10050113 - 23 Aug 2025

Viewed by 489

Abstract

Introduction: Pain is highly prevalent among community-dwelling older adults and can undermine their ability to perform Instrumental Activities of Daily Living (IADL), which are essential for independent living. This systematic review aimed to summarize existing research to clarify the relationship between pain and [...] Read more.

Introduction: Pain is highly prevalent among community-dwelling older adults and can undermine their ability to perform Instrumental Activities of Daily Living (IADL), which are essential for independent living. This systematic review aimed to summarize existing research to clarify the relationship between pain and IADL disability in community-dwelling older adults. Methods: We conducted a search of PubMed on 27 July 2025. Eligible studies met the following criteria: (1) assessed the association between pain and IADL disability; (2) included community-dwelling older adults aged 60 and older; and (3) were published in English. Results: Of the 400 records screened, 29 studies met the inclusion criteria. Of these, 23 studies (18 cross-sectional and 5 cohort studies) reported a significant association between pain and IADL disability, while 6 cross-sectional studies did not. Pain was assessed using diverse instruments across varying recall periods and thresholds, and IADL disability was measured using multiple scales. Such methodological heterogeneity precluded quantitative synthesis. Conclusions: In community-dwelling older adults, pain consistently predicts IADL disability across designs and settings. However, the lack of standardized, multidimensional measures and incomplete adjustment for treatment, multimorbidity, and polypharmacy limits precise effect estimation. Future research should adopt harmonized assessment tools, control comprehensively for relevant confounders, and perform meta-analyses where data permit to clarify pain’s true impact on functional independence. Full article

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