Objective. Explore the relationships between pain, depression, and functional disability in elderly persons. Design.A cross-sectional, observational study of 228 independently living retirement community residents.Methods. Self-report measures of pain (adaptation of McGill Pain Questionnaire), depression (Geriatric Depression Scale [GDS]) and physical functioning (Physical performance difficulties, activities of daily living [ADL], independent activities of daily living [IADL], and 3-meter walking speed) were employed.Outcome Measures. Physical functioning variables were dichotomized. Individuals in the lowest quartiles of functional performance and of walking speed were contrasted to all others; for ADL and IADL, those needing some help were compared with those independent in activities.Results. Pain and depression levels were strongly related to physical performance; depression levels were related to ADL and walking speed. In multivariate analyses, an interaction effect was observed where the effects of pain were a function of level of depression. Individuals reporting activity-limiting pain and slightly elevated depressive symptom levels, sub-threshold depression, or major depression were significantly more likely (AOR 7.8; 95% CI, 3.07-20.03) than non-depressed persons to be in the lowest quartile of self-reported physical performance.Conclusions. While both pain and depression level affect physical performance, depressive symptoms rather than pain appear the more influential factor. When seeing elderly patients, identifying, evaluating, and treating both pain complaints and depressive symptoms and disorders may reduce functional impairment.Key Words: Pain; Depression; Physical Function; Elderly hronic pain is a major obstacle to a satisfying old age [1]. With the number of persons 65 years of age and older in the United States currently about 35 million and projected to reach more than 64 million by 2030, chronic pain in the elderly is emerging as a significant public health problem of increasing magnitude. In their lifetime, an estimated 80% to 85% of persons age 65 and older will experience a significant health problem that will predispose them to pain [2]. In a recent study of community-dwelling senior citizens living in Western Ontario, Canada, Scudds and Robertson observed self-reported musculoskeletal pain during the past 2 weeks in 72.7% of their sample [3]. Fifteen percent indicated their pain was extremely severe. Higher prevalence rates of severe pain have been reported in the institutionalized elderly. The limited data available suggest that 33% to 61% report severe pain [4,5], 26 to 34% describe pain as occurring constantly or daily [6,7] and up to 47% report

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