title: The effects of pain and depression on physical functioning in elderly residents of a continuing care retirement community.
abstract: OBJECTIVE. Explore the relationships between pain, depression, and functional disability in elderly persons.
  
  
  METHODS
  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.
  
  
  METHODS
  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 level 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.
authors.affiliation: Center for Epidemiology and Biostatistics, School of Public Health, MCP Hahnemann University, Philadelphia, Pennsylvania 19102-1192, USA. jana.mossey@drexel.edu
authors.forename: J M
authors.initials: JM
authors.lastname: Mossey
authors.forename: R M
authors.initials: RM
authors.lastname: Gallagher
authors.forename: F
authors.initials: F
authors.lastname: Tirumalasetti