The effects of pain and depression on physical functioning in elderly residents of a continuing care retirement community

Objective. Explore the relationships between pain, depression, and functional disability in elderly persons. Design. A cross-sectional, observational study of 228 independently living retirement community residents. Methods. Self-report measures of pain (adaptation of McGill Pain Questionnaire), depression (Geriatric Depression Scale [GDS]) and physical functioning (Physical performance difficulties, activities of daily living [ADL],independent activities of daily living [IADL], and 3-meter walking speed) were employed. Outcome Measures. Physical functioning variables were dichotomized. Individuals in the lowest quartiles of functional performance and of walking speed were contrasted to all others; for ADL and IADL, those needing some help were compared with those independent in activities. Results. Pain and depression levels were strongly related to physical performance; depression levels were related to ADL and walking speed. In multivariate analyses, an interaction effect was observed where the effects of pain were a function of lever of depression. Individuals reporting activity-limiting pain and slightly elevated depressive symptom levels, sub-threshold depression, or major depression were significantly more likely (AOR 7.8; 95% CI, 3.07-20.03) than non-depressed persons to be in the lowest quartile of self-reported physical performance. Conclusions. While both pain and depression level affect physical performance, depressive symptoms rather than pain appear the more influential factor. When seeing elderly patients, identifying, evaluating; and treating both pain complaints and depressive symptoms and disorders may reduce functional impairment.