Pain and Cognitive Frailty in Chinese Elders: Mediation by Daily Living Activities

BACKGROUND: Pain is highly prevalent among older adults and represents a significant risk factor for cognitive frailty, but the underlying mechanism remains insufficiently understood. OBJECTIVE: To examine the mediating effects of basic, instrumental, and advanced activities of daily living (ADL) in the relationship between pain and cognitive frailty in community-dwelling older adults. METHODS: A cross-sectional survey was conducted among 710 Chinese adults aged 60 and above. Pain was measured using the Revised Faces Pain Scale. Cognitive frailty, defined by the FRAIL scale, subjective cognitive decline, and Short Portable Mental Status Questionnaire, was subclassified into reversible cognitive frailty (RCF) and potentially RCF (PRCF) subtypes. Katz Index for basic ADL, the Lawton Scale for instrumental ADL, and the advanced ADL scale (AADL). Parallel mediation models were tested using logistic regression, Z-test, and bootstrapping, while adjusting for covariates. RESULTS: Pain was significantly associated with both subtypes of cognitive frailty (RCF: OR = 3.75, 95% CI [2.36, 5.97]; PRCF: OR = 7.60, 95% CI [4.10, 14.06]). AADL, rather than basic ADL and instrumental ADL, partially mediated this association for both RCF and PRCF. Both the Z-test and bootstrapping method confirmed the indirect effect (estimate = 0.316, SE = 0.095, 95% CI [0.157, 0.533]). CONCLUSIONS: AADL played a key mediating role in the link between pain and cognitive frailty. Interventions targeting AADL may be crucial for preventing cognitive frailty in older adults experiencing pain.