{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T10:57:27Z","timestamp":1789556247667,"version":"build-2803163510"},"reference-count":29,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2013,3,21]],"date-time":"2013-03-21T00:00:00Z","timestamp":1363824000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"University of California at San Francisco Multidisciplinary Clinical Research Center"},{"DOI":"10.13039\/100000069","name":"National Institute of Arthritis and Musculoskeletal Diseases","doi-asserted-by":"crossref","award":["P60AR053308"],"award-info":[{"award-number":["P60AR053308"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Midcareer Research and Mentoring Award"},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"crossref","award":["P60AR053308"],"award-info":[{"award-number":["P60AR053308"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2013,4]]},"abstract":"\n Objectives<\/jats:title>\n \n To determine whether pain predicts future activity of daily living (\n ADL<\/jats:styled-content>\n ) disability or death in individuals aged 60 and older.\n <\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Prospective cohort study.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n \n The 1998 to 2008\n H<\/jats:styled-content>\n ealth and\n R<\/jats:styled-content>\n etirement\n S<\/jats:styled-content>\n tudy (\n HRS<\/jats:styled-content>\n ), a nationally representative study of older community\u2010living individuals.\n <\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n \n Twelve thousand six hundred thirty\u2010one participants in the 1998\n HRS<\/jats:styled-content>\n aged 60 and older who did not need help in any\n ADL<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Measurements<\/jats:title>\n \n Participants reporting that they had moderate or severe pain most of the time were defined as having significant pain. The primary outcome was time to development of\n ADL<\/jats:styled-content>\n disability or death over 10\u00a0yrs, assessed at five successive 2\u2010year intervals.\n ADL<\/jats:styled-content>\n disability was defined as needing help performing any\n ADL<\/jats:styled-content>\n : bathing, dressing, transferring, toileting, eating, or walking across a room. A discrete hazards survival model was used to examine the relationship between pain and incident disability over each 2\u2010year interval using only participants who started the interval with no\n ADL<\/jats:styled-content>\n disability. Several potential confounders were adjusted for at the start of each interval: demographic factors, seven chronic health conditions, and functional limitations (\n ADL<\/jats:styled-content>\n difficulty and difficulty with five measures of mobility).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n At baseline, 2,283 (18%) participants had significant pain. Participants with pain were more likely (all\n P\u00a0<\/jats:italic>\n <\n \u00a0<\/jats:italic>\n .001) to be female (65% vs 54%), have\n ADL<\/jats:styled-content>\n difficulty (e.g., transferring 12% vs 2%, toileting 11% vs 2%), have difficulty walking several blocks (60% vs 21%), and have difficulty climbing one flight of stairs (40% vs 12%). Over 10\u00a0years, participants with pain were more likely to develop\n ADL<\/jats:styled-content>\n disability or death (58% vs 43%, unadjusted hazard ratio (\n HR<\/jats:styled-content>\n )\u00a0=\u00a01.67, 95% confidence interval\u00a0(\n CI<\/jats:styled-content>\n )\u00a0=\u00a01.57\u20131.79), although after adjustment for confounders, participants with pain were not at greater risk for\n ADL<\/jats:styled-content>\n disability or death (\n HR\u00a0<\/jats:styled-content>\n =\u00a00.98, 95%\n CI<\/jats:styled-content>\n \u00a0=\u00a00.91\u20131.07). Adjustment for functional status almost entirely explained the difference between the unadjusted and adjusted results.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Although there are strong cross\u2010sectional relationships between pain and functional limitations, individuals with pain are not at higher risk of subsequent disability or death after accounting for functional limitations. Like many geriatric syndromes, pain and disability may represent interrelated phenomena that occur simultaneously and require unified treatment paradigms.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/jgs.12172","type":"journal-article","created":{"date-parts":[[2013,3,23]],"date-time":"2013-03-23T01:42:54Z","timestamp":1364002974000},"page":"583-589","source":"Crossref","is-referenced-by-count":81,"title":["Pain as a Risk Factor for Disability or Death"],"prefix":"10.1111","volume":"61","author":[{"given":"James S.","family":"Andrews","sequence":"first","affiliation":[{"name":"School of Medicine Division of Geriatrics University of California at San Francisco San Francisco Veterans Affairs Medical Center San Francisco California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irena Stijacic","family":"Cenzer","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Geriatrics University of California at San Francisco San Francisco Veterans Affairs Medical Center San Francisco California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Yelin","sequence":"additional","affiliation":[{"name":"Division of Rheumatology Division of Geriatrics University of California at San Francisco San Francisco Veterans Affairs Medical Center San Francisco California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth E.","family":"Covinsky","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Geriatrics University of California at San Francisco San Francisco Veterans Affairs Medical Center San Francisco 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