Relationship between chronic pain , depressive symptoms, and functional disability in community-dwelling older adults: mediating role of frailty

Objective: To evaluate the direct and indirect effects of chronic pain, depressive symptoms, frailty components, and functional disability through a pathway analysis approach in a sample of community-dwelling older adults. Methods: Data of 419 participants were cross-sectionally evaluated for the presence of depressive symptoms (Geriatric Depression Scale [15 items]), physical frailty components (phenotype criteria), chronic pain, and limitations in performing instrumental activities of daily living (functional disability scale by Lawton and Brody). Structural equation modeling via path analysis was used to explore the direct and indirect effects among these four variables. Statistical significance was set at p<0.05. Results: Of the total participants, 69.8% were women and 59.3% had low education (1-4 years); the mean age was 80.3 +/- 4.6 years. Chronic pain and depressive symptoms were directly related and were associated to frailty. The number of frailty components and depressive symptoms were directly associated with functional disability. Frailty had an indirect effect on the association between chronic pain, depressive symptoms, and functional disabilities. Conclusion: The pathway from chronic pain and depressive symptoms to functional disability is potentially mediated by the number of frailty components.