A Systematic Review of the Association Between Pain and Instrumental Activities of Daily Living Disability in Community-Dwelling Older Adults
Abstract
1. Introduction
2. Materials and Methods
2.1. Search Strategy
2.2. Eligibility Criteria
2.3. Study Selection
2.4. Data Extraction
2.5. Data Synthesis
2.6. Quality Assessment
3. Results
3.1. Identification of Studies
3.2. Study Characteristics
3.3. Design
3.4. Pain Assessment
3.4.1. Pain Presence Definition
3.4.2. Pain Location
3.4.3. Pain Severity
3.4.4. Pain Frequency/Quality
3.5. IADL Assessment
3.6. Confounders
3.7. Statistical Analysis
3.8. Synthesis of Results
3.8.1. Association Between Pain Location and IADL Disability
3.8.2. Association Between Pain Severity and IADL Disability
3.8.3. Association Between Pain Frequency/Quality and IADL Disability
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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First Author | Year | Location | Design | Sample Size | Female (%) | Mean Age (SD), Range |
---|---|---|---|---|---|---|
Chu J. [35] | 2025 | China | Cross-sectional | 8102 | 49,7 | 68.0, 64–73 |
Balicki P. [36] | 2025 | Poland | Cross-sectional | 2992 | 66.6 | -, 60–106 |
Ord AS. [37] | 2024 | USA | Cross-sectional | 452 | 56.0 | 73.5, 60–89 |
Liu P. [38] | 2024 | USA | Cross-sectional | 5557 | 59.4 | -, ≥65 |
Muhammad T. [39] | 2023 | India | Cross-sectional | 31,464 | 52.5 | -, ≥60 |
Olawumi AL. [40] | 2023 | Nigeria | Cross-sectional | 312 | 59.6 | 67.67 (7.69), 60–74 |
Lu Z. [41] | 2022 | China | Cross-sectional | 7619 | 51.2 | 68.2 (6.3), ≥60 |
Scott D. [42] | 2021 | Australia | Cohort | 1452 | 0 | 76.5 (5.2), ≥70 |
Svensson HK. [43] | 2021 | Sweden | Cross-sectional | 446 | 100 | 70.0 (0), 70 |
Al-Qahtani AM. [44] | 2020 | Saudi Arabia | Cross-sectional | 171 | 0 | 70.6, 60–102 |
Peng X. [45] | 2020 | China | Cross-sectional | 1321 | 63.8 | 71.6 (9.3), ≥60 |
Ćwirlej-Sozańska A. [46] | 2019 | Poland | Cross-sectional | 2207 | 60.0 | 72.1 (7.8), ≥60 |
Carmona-Torres JM. [47] | 2019 | Spain | Cross-sectional | 25,465 | 60.6 | 75.9 (7.4), ≥65 |
Thakral M. [31] | 2019 | USA | Cohort | 398 | - | -, ≥70 |
Makris UE. [48] | 2018 | USA | Cohort | 754 | 64.6 | 78.4(5.3), ≥70 |
Ćwirlej-Sozańska Ab. [49] | 2018 | Poland | Cross-sectional | 426 | 59.9 | 75.6 (2.9), 71–80 |
Connolly D. [28] | 2017 | Ireland | Cross-sectional | 3499 | 52.5 | -, ≥65 |
Liang En W. [50] | 2016 | Singapore | Cross-sectional | 559 | 55.3 | -, ≥60 |
Shega JW. [23] | 2014 | USA | Cross-sectional | 2430 | 52.3 | -, ≥62 |
Yağci N. [51] | 2014 | USA | Cross-sectional | 258 | 49.2 | 72.0 (5.9), 65–100 |
Eggermont LH. [52] | 2014 | USA | Cohort | 634 | 64 | 78.0 (5.0), 64–97 |
Shega JW. [24] | 2010 | Canada | Cross-sectional | 5549 | - | -, ≥65 |
Buchman AS. [53] | 2010 | USA | Cohort | 898 | 74.3 | 79.7, ≥65 |
Shega JW. [54] | 2010 | Canada | Cross-sectional | 5086 | - | -, ≥65 |
Weaver GD. [55] | 2009 | USA | Cross-sectional | 744 | 63 | 82.0 (4.4), 74–100 |
Gureje O. [56] | 2006 | Nigeria | Cross- sectional | 2152 | 47.5 | 75.0 (9.2), ≥65 |
Miu DK. [25] | 2004 | China | Cross-sectional | 749 | 51.4 | 75.2 (6.6), ≥65 |
Mossey JM. [57] | 2000 | USA | Cross-sectional | 228 | 80.7 | -, ≥60 |
Barberger-Gateau P. [58] | 1992 | France | Cross-sectional | 2792 | 60 | -, ≥65 |
First Author | Pain Presence Definition | Pain Location | Pain Severity | Pain Frequency/Quality |
---|---|---|---|---|
Chu J. [35] | Experiencing any pain-related discomfort | Head, neck, shoulder, arm, wrist, fingers, chest, stomach, back, waist, buttocks, leg, knees, ankle, toes, and other specified areas | Without vs. with Without pain vs. pain in the head, upper limb, torso, or lower limb Without pain vs. single-site pain vs. multisite pain | - |
Balicki P. [36] | EQ-5D pain scale: moderate or extreme problems | - | Without vs. with | - |
Ord AS. [37] | Having chronic pain complaints | - | Without vs. with | - |
Liu P. [38] | Having bothered pain | Back, hips, knees, feet, hands, wrists, shoulders, neck, arms, legs | Multisite pain (≥2 sites) vs. no multisite pain (≤1 site) | - |
Muhammad T. [39] | Being often troubled by pain | - | Without vs. with | Frequency: never, rarely (1–2 days per week), occasionally (3–4 days per week), frequently (≥5 days per week) |
Olawumi AL. [40] | Having chronic pain | - | Without vs. with | - |
Lu Z. [41] | Having body pain in any, or in back and/or shoulder, or in leg and/or knee pain | Head, back, shoulder, arm, stomach, legs, neck, knees, others | Without vs. with | - |
Scott D. [42] | During the past 4 weeks, having pain interfered with normal work | Body: hands, wrists, elbows, shoulders, face, jaw, neck, hips, knees, ankles, feet, back, other | SF-12 intrusive pain: moderately, quite a bit, extremely | - |
Svensson HK. [43] | Having long-term pain | Back | Without vs. with | - |
Al-Qahtani AM. [44] | Self-rated pain ≥ 1 point | Body | Six-point Likert scale: none, very mild, mild, moderate, severe, very severe | - |
Peng X. [45] | NRS ≥ 1 point | - | NRS: 0 (no pain) to 10 (worst pain imaginable) | - |
Ćwirlej-Sozańska A. [46] | VAS for pain sensation (ICF b280) ≥1 point | - | VAS: 0 (no pain) to 10 (worst pain imaginable) | - |
Carmona-Torres JM. [47] | Having pain in the past 4 weeks | - | Without vs. with | - |
Thakral M. [31] | - | - | - | MBS pain quality instrument: 20 descriptors in 3 groups (cognitive/affective, sensory, neuropathic); same quality (1, 2, or 3 categories) |
Makris UE. [48] | Restricting activity by pain | Back | Without vs. with | - |
Ćwirlej-Sozańska Ab. [49] | VAS for having pain in the last 30 days ≥1 point | - | VAS: 0 (no pain) to 10 (the worst pain imaginable) | - |
Connolly D. [28] | Being often troubled by pain | - | Without vs. with | - |
Liang En W. [50] | Having chronic pain lasting ≥3 months | Generalized, headache, face or tooth or jaw, neck, shoulder or elbow, arm or hand, chest, back, abdominal, hip or thigh, knee or leg, ankle or foot | Without vs. with | - |
Shega JW. [23] | Having moderate or greater pain in the past 4 weeks | 45 locations (specified on human body diagram) | VDS: no pain, slight pain, mild pain, moderate pain, severe pain, extreme pain, the most intense pain imaginable | - |
Yağci N. [51] | Having spinal pain vs. lower extremity pain | Spinal pain (Group I), lower extremity pain (Group II) | VAS: 0 (no pain) to 10 (the worst pain imaginable) | - |
Eggermont LH. [52] | 1.Having single-site or wider spread pain lasting 3 or more months in the previous year and still present in the previous month 2. BPI severity subscale score >0 point 3. BPI interference with daily activities subscale >0 point | 1. Back, chest, shoulder, hand/wrist, hip, knee, foot 2 and 3. - | 1. 14-item questionnaire: no pain, single-site pain, >1 site not meeting criteria for widespread pain, or widespread pain (back or nonanginal chest pain) 2. BPI pain severity: 0 (no pain) to 10 (severe or excruciating pain as bad as imaginable) 3. BPI interference: 0 (not interfere at all) to 10 (complete interference) | - |
Shega JW. [24] | Having very mild or greater noncancer pain in the past 4 weeks | Body | VDS: none, very mild, moderate, severe, very severe | - |
Buchman AS. [53] | Having joint pain on most days for at least one month during the prior year | Joints (back or neck, hands, hips, knees, feet) | Without vs. with | - |
Shega JW. [54] | Having very mild or greater noncancer pain in the past 4 weeks | Body | VDS: none, very mild, moderate, severe, very severe | - |
Weaver GD. [55] | Having very mild or greater bodily pain in the past 4 weeks | Body | SF-36: none, very mild, mild, moderate, severe, very severe | - |
Gureje O. [56] | Having persistent pain with 6 months duration | Back or neck, chest, joint, frequent headaches, general category of persistent pain in any other body parts | Without vs. with | - |
Miu DK. [25] | Being troubled by pain in the previous 2 weeks | Joints, muscles, bones | Without vs. with | - |
Mossey JM. [57] | Bothering pain with activity limitations in the last two weeks | - | McGill Pain Questionnaire: no pain, pain without activity, pain with activity limitations | - |
Barberger-Gateau P. [58] | Suffering from pain | Joints | Without vs. with | - |
First Author | IADL Assessment | Confounders | Statistical Analysis | Findings |
---|---|---|---|---|
Chu J. [35] | Lawton’s index (no disability vs. disability) | Age, gender, education, depression, comorbidities, self-report health, life satisfaction, physical activity, falls, cognition | Logistic regression | Participants with pain had a higher risk of IADL disability (aOR: 1.91, 95% CI: 1.67–2.19). Participants with pain located in the head and neck (aOR: 1.22, 95% CI: 1.06–1.41), upper limb (aOR: 1.25, 95% CI: 1.08–1.45), torso (aOR: 1.27, 95% CI: 1.10–1.46), and lower limb (aOR: 1.38, 95% CI: 1.20–1.59) had a higher odds of IADL disability. Participants with multisite pain (aOR: 2.13, 95% CI: 1.85–2.45) and single site pain (aOR: 1.35, 95% CI: 1.12–1.64) had progressively higher odds of IADL disability. |
Balicki P. [36] | Lawton’s index (total score ranging from 0 (dependent) to 8 (independent)) | - | Analysis of Variance | Participants with pain had significantly lower scores than those without pain (p < 0.001). |
Ord AS. [37] | A dichotomized IADL self-report questionnaire (total score of items requiring assistance) | Age, gender, education, marital status, number of medical conditions | Hierarchical regression | Participants with chronic pain had higher IADL disability scores (β: 0.86, 95% CI: 0.31–1.41). |
Liu P. [38] | 5-item scale (no disability vs. disability) | Social participation, depressive symptoms, anxiety symptoms | Logistic regression | Participants with multisite musculoskeletal pain had higher odds of IADL disability (aOR: 1.99, 95% CI: 1.69–2.34). |
Muhammad T. [39] | 7-item scale (no difficulty vs. 1 difficulty) | Age, sex, education, marital status, living arrangements, work status, physical activity, self-rated health, chronic diseases, depressive symptoms, cognitive impairment, wealth quintiles, religion, social group, place of residence, regions | Logistic regression | Participants with pain had higher odds of IADL disability (aOR: 1.43, 95% CI: 1.35–1.51). Participants with rare pain (aOR: 1.12, 95% CI: 1.02–1.23), occasional pain (aOR: 1.49, 95% CI: 1.38–1.61), and frequent pain (aOR: 1.67, 95% CI: 1.53–1.82) had progressively higher odds compared to those without pain. |
Olawumi AL. [40] | Lawton’s index (independent vs. dependent) | - | Fisher’s Exact test | No significant association was found for chronic pain. |
Lu Z. [41] | Lawton’s index (no disability vs. at least one disability) | - | Chi-square test | Participants with any pain, back and/or shoulder pain, and leg and/or knee pain had significantly more disability (p < 0.001). |
Scott D. [42] | Rosow-Breslau scale (no disability vs. disability) | Age, BMI, current smoking status, physical activity, number of comorbidities, number of prescription medications, depression symptoms | Logistic regression | At 5-year follow-up, participants with persistent intrusive pain (aOR: 4.63, 95% CI: 2.22–9.65) and incident intrusive pain (aOR: 2.98, 95% CI: 1.81–4.90) had higher odds of IADL disability. |
Svensson HK. [43] | Lawton’s index (total score ranging from 0 (dependent) to 8 (independent)) | - | Mann–Whitney U test | Not significant association was found for long-term back pain. |
Al-Qahtani AM. [44] | 7-item score (ranging: 7 = no impairment to 21 = total impairment) | - | Kruskal–Wallis test | Participants with severe body pain showed significantly worse IADL scores (p < 0.001). |
Peng X. [45] | Lawton’s index (no disability vs. any disability) | Age, gender, marital status, education, exercise, BMI | Logistic regression | Participants with some degree of pain had higher odds of IADL disability (aOR: 2.97, 95% CI: 2.31–3.83). |
Ćwirlej-Sozańska A. [46] | Lawton’s index (no difficulties vs. ≥1 difficulty) | Age, number of chronic diseases, physical activity, presence of barriers and obstacles, social contacts, good relations with relatives | Logistic regression | Each 1-point increase on the VAS was associated with higher odds of disability (aOR: 1.27, 95% CI: 1.22–1.33). |
Carmona-Torres JM. [47] | Lawton’s index (no difficulty vs. ≥1 difficulty) | Age, gender, educational level, restriction of habitual activity, bedridden status | Logistic regression | Participants with pain in the past 4 weeks had higher odds of disability (aOR:2.8, 95% CI: 2.53–3.09). |
Thakral M. [31] | Lawton’s index (none vs. a little/some vs. a lot/unable) | Age, gender, education, race, Physical Activity Score for the Elderly, BMI, MMSE, lung and heart disease, diabetes mellitus, and baseline IADL difficulty, pain distribution, pain severity | Poisson regression | At 18 months follow-up, individuals with two (RR: 2.59, 95% CI: 1.10–6.09) or three (RR: 2.69, 95% CI: 1.34–7.79) persistent pain qualities had higher risk than those with one. |
Makris UE. [48] | 3-item scale (able vs. unable to complete task) | Age, female sex, non-white race, living alone status, less than high school education, depressive symptoms, overweight, physical frailty, cognitive impairment, ≥2 chronic conditions, hip weakness | Cox proportional hazards model | At 144 months follow-up, participants with restrictive back pain had higher hazard of disability (aHR: 2.33, 95% CI: 2.08–2.61). |
Ćwirlej-Sozańska Ab. [49] | Lawton’s index (without limitation vs. ≥1 hard limitation) | Age, education, fall, adaptation of the interior, using assistive devices, physical activity, number of diseases, QOL | Logistic regression | Each 1-point increase on the VAS was associated with 21% higher odds of disability (aOR: 1.21, 95% CI: 1.06–1.36). |
Connolly D. [28] | Lawton’s index (no difficulty vs. difficulty) | Gender, age, marital status, medical insurance, living status, education, employment status, loneliness, social connectedness score, time spent sitting, BMI, the presence of a chronic condition, fall in past year, smoking status, vision, hearing, number of medications, quality of life, depression, worry levels, self-rated memory, cognition, self-rated health and physical activity | Logistic regression | No significant association was found for participants troubled by pain. |
Liang En W. [50] | Lawton’s index (independent vs. deficient) | Age, sex, marital status, ethnicity, education, employment, income, diabetes, hypertension, hyperlipidemia, BMI, fall, visual impairment, hearing impairment, cognition, depression, comorbidity, living arrangements, household, social support | Logistic regression | Participants with chronic pain had lower odds of IADL independence (aOR: 0.42, 95% CI: 0.20–0.90). |
Shega JW. [23] | 6-item scale (score range: 0 to 6) | - | Wald test | Participants with moderate or greater pain had significantly higher IADL scores than those with none to mild pain. (p < 0.001). |
Yağci N. [51] | Lawton’s index (score range: 0 = dependent to 24 = independent) | - | t-test | The spinal pain group had lower scores than lower extremity pain group (p < 0.05). |
Eggermont LH. [52] | 3-item scale (no difficulty vs. difficulty or inability) | Age, sex, race, education, BMI, cognitive function, comorbid conditions, level of physical activity, daily analgesic use, and number of psychotherapeutic medications | Poisson regression | At the 18 months follow-up: Multisite pain (aRR: 2.14, 95% CI: 1.37–3.34) or widespread pain (aRR: 2.69, 95% CI: 1.61–4.50) compared to those with no pain were associated with higher risk. 3rd quartile of pain severity (aRR: 1.89, 95% CI: 1.16–3.08) had higher risk vs. 1st quartile. 2nd (aRR: 2.19, 95% CI: 1.24–3.86), 3rd (aRR: 2.22, 95% CI: 1.43–3.45), and 4th (aRR: 2.56, 95% CI: 1.55–4.22) quartile had higher risk vs. 1st quartile. Persistent multisite pain (aRR: 2.72, 95% CI: 1.86–3.97) was associated with higher risk over time. Pain in the back (aRR: 2.51, 95% CI: 1.59–3.94), hand/wrist (aRR: 2.89, 95% CI: 1.84–4.54), hip (aRR: 2.94, 95% CI: 1.79–4.85), knee (aRR: 2.04, 95% CI: 1.23–3.37), and feet (aRR: 2.20, 95% CI: 1.27–3.82) was associated with higher risk. |
Shega JW. [24] | OARS (no help needed vs. any help needed) | Age, gender, race, education, depressed mood, co-morbidity (summary count), self-rated health | Logistic regression | Participants with moderate or greater noncancer pain had higher odds of disability both among cognitively impaired participants (aOR: 1.74, 95% CI: 1.15–2.62) and cognitively intact participants (aOR: 1.40, 95% CI: 1.20–1.63). |
Buchman AS. [53] | OARS (no help needed vs. help needed or inability) | Age, sex, education, BMI. physical activity, cognition, depressive symptoms, vascular diseases, vascular risk factors | Cox proportional hazards model | At 5.6-year follow-up, each additional painful sites was associated with increased hazard (aHR: 1.10, 95% CI: 1.01–1.20). |
Shega JW. [54] | OARS summary score (range: 0 = no help needed to 10 = impairment) | Age, gender, education, depression, comorbidity index, cognitive impairment | Linear regression | Participants with moderate or greater noncancer pain had higher disability scores (β: 0.17, 95% CI: 0.07–0.26). |
Weaver GD. [55] | 10-item scale (scores range: 0 = no limitations to 10 = limitations in all activities) | Age, gender, education, marital status, comorbidity index, BMI, cognitive status, depressive symptoms, SPPB, frailty status | Negative Binomial regression | Participants with pain severity had greater IADL limitations (β: 0.23, p < 0.01). |
Gureje O. [56] | 7-item scale (no impairment vs. impairment) | Age, sex | Logistic regression | Participants with chronic pain had higher odds of IADL disability (aOR: 4.2, 95% CI: 2.81–6.42). |
Miu DK. [25] | Lawton’s index (total score) | Depressive symptomatology, age, and sleep quality | Logistic regression | No significant association was found for pain. |
Mossey JM. [57] | Lawton’s index (independent vs. help needed with 1–2 activities vs. >2 activities) | Age, gender, self-rated health, number of medical conditions | Logistic regression | No significant association was found for pain. |
Barberger-Gateau P. [58] | Lawton’s index (not dependent vs. dependent) | Age, sex, education, place of residence, dyspnea, visual impairment, hearing impairment, MMS, depression | Logistic regression | No significant association was found for joint pain. |
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Mizutani, Y.; Ukawa, S. A Systematic Review of the Association Between Pain and Instrumental Activities of Daily Living Disability in Community-Dwelling Older Adults. Geriatrics 2025, 10, 113. https://doi.org/10.3390/geriatrics10050113
Mizutani Y, Ukawa S. A Systematic Review of the Association Between Pain and Instrumental Activities of Daily Living Disability in Community-Dwelling Older Adults. Geriatrics. 2025; 10(5):113. https://doi.org/10.3390/geriatrics10050113
Chicago/Turabian StyleMizutani, Yukiko, and Shigekazu Ukawa. 2025. "A Systematic Review of the Association Between Pain and Instrumental Activities of Daily Living Disability in Community-Dwelling Older Adults" Geriatrics 10, no. 5: 113. https://doi.org/10.3390/geriatrics10050113
APA StyleMizutani, Y., & Ukawa, S. (2025). A Systematic Review of the Association Between Pain and Instrumental Activities of Daily Living Disability in Community-Dwelling Older Adults. Geriatrics, 10(5), 113. https://doi.org/10.3390/geriatrics10050113