# Pain and high-impact pain in community-dwelling older adults in Australia and relation to sociodemographic and health-related factors, including physical disability, psychological distress, and quality of life

## TL;DR

This study finds that high-impact pain is common in older adults in Australia and is strongly linked to lower socioeconomic status, health issues, and reduced quality of life.

## Contribution

The study provides population-based evidence on the prevalence and correlates of general and high-impact pain in older adults.

## Key findings

- High-impact pain affects 13% of older adults and is more common in women, older age groups, and those with lower income or education.
- People with high-impact pain are significantly more likely to experience severe physical limitations and psychological distress.
- High-impact pain is strongly associated with poor quality of life and self-rated health.

## Abstract

Chronic pain is common and debilitating and significantly impacts quality of life (QoL). However, large-scale population-based evidence on general bodily pain, pain sufficient to impact daily life (high-impact pain), and their relation to sociodemographic and health-related outcomes is limited.

Self-administered questionnaire data from the 45 and Up Study (Wave-2, 2012–2015), an Australian population-based cohort study, were used to estimate the prevalence of general and high-impact pain. Modified Poisson regression estimated age- and sex-adjusted prevalence ratios (PRs) quantified their relation to sociodemographic, behavioural, and health characteristics, as well as physical functioning, psychological distress, QoL, and self-rated health.

Overall, the study included n = 142,313 participants. Among them, 31% reported moderate-to-severe bodily pain, and 13% reported high-impact pain. High-impact pain was more common among females (14.3% versus 12.0% in males; PR = 1.24 [1.21–1.28]), older adults (18.8%, PR = 1.73 [1.66–1.79] for age ≥ 80 years; 14.2%, PR = 1.29 [1.26–1.33] for 65–79 years; versus 11.2% for 45–64 years), those least physically active (versus most active), currently smoking (versus never-smoking), obese, or had chronic health conditions. The prevalence of high-impact pain was markedly higher among those with lower education levels, lower household income, physical disability, psychological distress, or low QoL. Similar patterns were observed for bodily pain, although associations were weaker. Consistently, people reporting greater high-impact pain and bodily pain were substantially more likely to experience severe physical functioning limitations, moderate-to-high psychological distress, and poor/fair self-rated health and QoL compared to people without such pain. For example, 47.2% of the 16,825 people with high-impact pain had severe physical limitations versus 4.0% of 30,748 people without impactful pain (PR = 10.35 [9.78–10.95]); among those with high-impact pain, 40.5%, 36.5%, and 26.7%, respectively, had moderate-to-high psychological distress (PR = 4.61 [4.43–4.80]), poor/fair self-rated health (PR = 8.64 [8.16–9.14]), and poor/fair QoL (PR = 8.73 [8.16–9.34]).

Bodily pain sufficient to interfere with daily life affects around one-in-eight older community-dwelling participants. People of lower socioeconomic position and those with health problems, particularly physical disability, are more likely to experience high-impact pain. Among those experiencing high-impact pain, around half have severely reduced physical functioning or high psychological distress, and a quarter report poor/fair QoL.

The online version contains supplementary material available at 10.1186/s12916-026-04642-0.