Association Between Pain Distribution and Limitations in Basic and Instrumental Activities of Daily Living: A Cross-Sectional Study Based on the Survey of Health, Aging and Retirement in Europe on the Influence of Biopsychosocial Variables and Lifest

Pain is a common condition among older adults and a key factor influencing daily functioning. This cross-sectional study examined how pain presence and distribution (no pain, localized pain [LP], and widespread pain [WP]) are related to limitations in Basic and Instrumental Activities of Daily Living (BADLs and IADLs). Data were drawn from the Survey of Health, Aging, and Retirement in Europe (SHARE) Wave 9, including 68,839 participants aged 50 or older. A clear gradient of functional limitation was observed: Individuals with WP reported the highest number of limitations, followed by those with LP, while those with no pain showed minimal impairment. These associations remained significant after adjusting for age, sex, cognitive status, physical health, and psychosocial factors, with adjusted prevalence ratios (aPRs) for WP of 1.77 for BADLs and 1.22 for IADLs (p < 0.001). Notably, depression, perceived loneliness, long-term illness, physical inactivity, and mobility limitations were especially relevant among participants with WP. The findings suggest the clinical value of assessing and implementing interventions not only in the presence but also in the extent of pain to better identify individuals at greater risk of losing independence in daily life.