Chronic pain and decline in activities of daily living among community-dwelling older adults: a systematic review of longitudinal studies.

Abstract

Purpose: To investigate the longitudinal association between chronic pain and decline in activity of daily living (ADL) among community-dwelling older adults aged ≥ 60 years.

Methods: In this systematic review of prospective longitudinal studies with narrative synthesis, a comprehensive literature search was conducted using PubMed and Embase using free-text words and MeSH terms on February 3, 2025. Longitudinal studies that quantitatively assessed ADL at two or more time points and pain at least once were included. Interventional studies, qualitative research, and non-English publications were excluded. Titles, abstracts, and full texts were screened by multiple independent reviewers based on the eligibility criteria. The included studies' methodological quality was evaluated using the Study Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

Results: Seven studies (9,786 participants) met the inclusion criteria. These prospective cohort studies suggest that chronic musculoskeletal pain, particularly knee or back pain, is associated with declines in basic ADL, instrumental ADL, lower extremity physical function, and mobility disability. Most studies evaluated pain based on frequency, severity, or impact on function, whereas one study used the number of pain sites. The reported effect sizes varied, with adjusted odds ratios for ADL decline ranging from 1.31 to 2.38 and hazard ratios from 1.49 to 3.47. Meta-analysis was not feasible because of the heterogeneity in the measures used to assess pain and ADL.

Conclusions: This review indicates that chronic pain is associated with ADL decline in community-dwelling older adults. Regular pain assessment and appropriate management may help maintain ADL in this population.