Geriatric Pain Measure: Cross-Cultural Adaptation and Psychometric Properties of the Persian Version of Geriatric Pain Measure (P-GPM) among Elderly Adults

Geriatric Pain Measure: Cross-Cultural Adaptation and Psychometric Properties of the Persian Version of Geriatric Pain Measure (P-GPM) among Elderly Adults | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Geriatric Pain Measure: Cross-Cultural Adaptation and Psychometric Properties of the Persian Version of Geriatric Pain Measure (P-GPM) among Elderly Adults Hadiseh Sattari, Abdolhakim Jorbonyan, Masoud Gharib, Abolfazl Hosseinnataj, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7784231/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Chronic pain is a common issue among older adults that affects not only their physical health but also their psychological well-being and functional abilities. Accurate pain assessment is essential, requiring multidimensional tools adapted to the cultural context of the target population. This study aimed to translate, culturally adapt, and evaluate the psychometric properties of the Persian version of the Geriatric Pain Measure (GPM-24) in Iranian older adults. Methods: This methodological study was conducted in 2025 with a sample of 290 individuals aged 60 years and above living in Sari, Iran. The GPM-24 was translated into Persian and psychometrically tested. Additional tools used included a demographic questionnaire, the McGill Pain Questionnaire (MPQ), the Visual Analogue Scale (VAS), and the Timed Up and Go (TUG) test. Data analysis was performed using SPSS and the lavaan package in R, with significance set at p < 0.05. Results: Participants’ mean(SD) age was 69.45(6.47) years. Face and content validity were confirmed with a content validity ratio (CVR) of 75%. Confirmatory factor analysis supported a five-factor structure of the Persian GPM-24, showing acceptable fit indices (χ²/df=1.10, CFI=0.91, RMSEA=0.07). Significant correlations between GPM scores and MPQ (r=0.64), VAS (r=0.85), and TUG (r=0.39) indicated good convergent validity. Reliability was excellent, with Cronbach’s alpha of 0.84 and intraclass correlation coefficient (ICC) of 0.98. Linear regression revealed that age, education, and gender significantly predicted GPM scores (p < 0.05). Conclusion: The Persian GPM-24 demonstrates good validity and reliability and is a suitable tool for assessing multidimensional pain in Iranian older adults. Geriatric Pain Measure (GPM-24) Aged Pain Measurement Chronic Pain cross-cultural adaptation Psychometrics Figures Figure 1 1. Introduction The aging process is associated with a gradual decline in physical, cognitive, psychological, and social functions, which makes older adults one of the most vulnerable age groups( 1 ). With increasing age, due to reduced physiological reserves and the high prevalence of chronic diseases, the occurrence of chronic pain rises, and older adults become one of the most susceptible groups to chronic pain( 2 ). This issue poses serious challenges to their lives and leads to a decline in quality of life( 3 ). Chronic pain may result from physical injury or the course of a disease and can persist for a long time (months or years)( 4 ). Chronic pain is generally classified into two categories: nociceptive and neuropathic. Nociceptive pain arises from tissue damage or inflammation and is often controlled with conventional analgesics, whereas neuropathic pain originates from injury to the peripheral or central nervous system and usually does not respond well to classic analgesics but can be managed with medications such as antidepressants and anticonvulsants( 5 ). Epidemiological studies estimate the prevalence of chronic pain in the general population to be about 40%, increasing to approximately 50% among older adults worldwide. In Iran, the six-month prevalence of persistent chronic pain in individuals aged 60 to 90 years has been reported at 67%. Statistics also indicate that the prevalence and consequences of chronic pain are influenced not only by age but also by gender, with pain disorders being diagnosed about twice as frequently in women compared to men( 6 ). Among older adults with chronic pain, pain is often experienced in multiple areas of the body, which increases the risk of disability and reduced mobility( 7 ). If not properly managed and treated, chronic pain can lead to suffering, hopelessness, and impaired functioning( 3 ). Furthermore, chronic pain imposes substantial economic burdens on both the individual and society. Evidence shows that people with chronic pain use primary health care services up to five times more than the general population( 8 ). In addition, chronic pain not only affects the individual but also places strain on their caregivers and family( 9 ). It influences cognition, performance, and emotions, leading to various limitations in daily life, such as reduced activity, increased dependency, and impaired physical, psychological, and social well-being( 3 ). The clinical manifestations of chronic pain in older adults are often complex and multifactorial. The presence of factors such as depression, psychosocial concerns, cognitive decline, and poor health complicates its assessment and treatment in this population( 10 ). Moreover, a common misconception is that chronic pain is a natural part of aging and should simply be tolerated rather than treated. Such attitudes contribute to under-recognition and under-treatment of pain in many cases. Evidence also suggests that in many older adults, chronic pain assessment is not performed accurately. Misinterpretation of pain sensations or difficulty using assessment tools may lead to underreporting or nonreporting of pain( 5 ). Unidimensional pain assessment tools usually measure only pain intensity, with the most common being the Visual Analogue Scale (VAS) and the Verbal Numerical Scale (VNS). In contrast, multidimensional instruments such as the McGill Pain Questionnaire (MPQ) and the Brief Pain Inventory (BPI) aim to assess different aspects of pain. However, these tools are challenging for older adults due to their lengthy structure( 11 ). Specifically, the MPQ, with its extensive details, may include sections unnecessary for clinical trials, making it time-consuming and difficult to complete( 12 ). To address this, a shortened version of the MPQ was developed( 13 ). Nevertheless, it still requires supervision and familiarity with its terminology( 14 ). Moreover, the American Geriatrics Society emphasizes the importance of using multidimensional instruments for assessing pain in older adults. Therefore, there is a need for tools that provide multidimensional quantification of pain in older adults and are also linguistically and culturally adapted for use in non-English-speaking populations(11). Considering these points, the 24-item Geriatric Pain Measure (GPM-24) is one of the instruments specifically designed for older adults. It is multidimensional, assessing functional and psychological aspects of pain, easy to complete in both clinical and outpatient settings, requires only about five minutes to administer, and has demonstrated strong psychometric validity( 15 ). Accordingly, given the need for a brief and appropriate tool to assess pain in Persian-speaking older adults, and the fact that the Persian version of the GPM-24 has not yet been translated and psychometrically validated in Iran, the present study aimed to translate, culturally adapt, and evaluate the psychometric properties of this instrument among Iranian older adults. 2. Materials and Methods 2.1. Study design This methodological study was conducted in a cross-sectional design in two phases: translation and cultural adaptation, and psychometric evaluation of the instrument. The cross-cultural adaptation process followed the six-step guideline of Beaton et al.( 16 ) to ensure the linguistic and cultural validity of the Persian version. For psychometric evaluation, the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) were applied( 17 , 18 ). 2.2. Sample size and setting The study was carried out from March to June 2025 among individuals aged 60 years and older attending health care centers in Sari, Mazandaran Province, Iran. According to the general rule of thumb for methodological studies, the minimum required sample size is estimated at 10 participants per item of the questionnaire( 19 ). Since the GPM-24 consists of 24 items, the minimum required sample was 240, and with an additional 50 participants to account for possible dropouts, the final sample size was determined to be 290 to enhance the validity of results. Sampling was conducted using a convenience (non-probability) method among older adults attending health centers in Sari, Mazandaran. After obtaining the necessary research approvals, participants were informed about the study objectives, assured of confidentiality, and provided written informed consent (from caregivers if needed). Questionnaires were completed by the participants under the supervision of the researcher. Inclusion criteria were: age ≥ 60 years, ability to communicate and respond to the questionnaire, fluency in Persian, informed consent, and achieving a score of 7 or higher on the Abbreviated Mental Test (AMT)( 20 ). Exclusion criterion was incomplete completion of the questionnaire. 2.3. Data collection measures The following instruments were used in this study: Demographic information form: A checklist collected demographic characteristics including age, gender, marital status, education level, perceived economic status, occupation, Living Status, chronic diseases, and living companions. Abbreviated Mental Test Score (AMTs):This tool consists of 10 questions and is designed to screen for cognitive impairment in older adults. Its validity and reliability have been confirmed in Iranian elderly, with a Cronbach’s alpha of 0.76 and an inter-rater correlation of 0.89, indicating satisfactory validity and reliability. A score of 7 provides 100% sensitivity and 71% specificity( 20 ). Geriatric Pain Measure (GPM-24): The GPM-24 was developed by Ferrell et al. in 2000 to design and evaluate a multidimensional, elderly-specific tool for assessing pain. The questionnaire consists of 24 items, with a total score ranging from 0 to 42; to calculate the final score, the raw score is multiplied by 2.38. A score below 30 indicates mild pain, 30–69 indicates moderate pain, and above 70 indicates severe pain. Factor analysis of the GPM-24 identified five subscales: “withdrawal due to pain” (items 9, 10, 11, 12, 15, 18, 24); “pain intensity” (items 13, 17, 19, 20, 21, 22, 23); “pain while walking” (items 4, 5, 6, 7); “pain with strenuous activities” (items 1, 2, 3); and “pain with other activities” (items 8, 13, 14, 15, 16). All items loaded on at least one factor, with only two items loading on two subscales. Internal consistency was excellent, with a Cronbach’s alpha of 0.94. The average inter-item correlation was 0.41 and the homogeneity ratio was 0.45, confirming strong reliability and validity of the questionnaire in older adults with multiple medical problems( 15 ). Visual Analogue Scale (VAS):This tool consists of a 10 cm line divided into 1 cm intervals and numbered from 1 to 10, where participants are asked to mark their level of pain. Higher numbers indicate greater pain. The VAS has shown good positive correlation with pain intensity and has been used in numerous studies. Its reliability has been reported between 0.60 and 0.77, and validity between 0.76 and 0.84( 21 ). McGill Pain Questionnaire (MPQ): The MPQ contains 20 sets of descriptors assessing different dimensions of pain perception. Items 1–10 measure sensory perception, 11–15 affective perception, item 16 evaluative perception, and items 17–20 miscellaneous pain. If none of the descriptors fit the participant’s pain, a score of zero is given for that set. Subscale scores are calculated by summing the items within each dimension, and the overall score is the total across all items, with higher scores reflecting greater pain perception. In a study on Iranian cancer patients, the Persian version demonstrated a Cronbach’s alpha of 0.85 and subscale reliabilities above 0.80, confirming satisfactory internal consistency( 22 ). Timed Up and Go (TUG) test:This test measures balance and functional mobility in older adults. It records the time needed to rise from a chair, walk three meters, turn, and return to sitting. The mean of three trials is taken as the final score. The TUG has demonstrated strong validity and reliability, with ICC = 0.95 and correlation coefficient = 0.77( 23 ). The optimal cut-off point for older adults has been identified as 9.025 seconds( 24 ). 2.4. GPM cross-cultural adaptation Before initiating the translation process, written permission was obtained via email from the original developer of the Polish version of the instrument. The cross-cultural adaptation was carried out according to internationally recognized guidelines (including those of Beaton et al.) to ensure both linguistic accuracy and cultural appropriateness( 16 ). Step 1 : Forward translation: Two translators fluent in both Persian and English and familiar with medical concepts independently translated the questionnaire into Persian. Step 2 : Synthesis: The two forward translations were reviewed by the research team, and through consensus, the preliminary Persian version of the instrument was prepared. Step 3 : Expert review: The preliminary version was then reviewed and confirmed by two independent translators who were not involved in the earlier stages but were proficient in both Persian and English. Step 4 : Linguistic editing: After expert approval, the Persian version underwent linguistic and grammatical editing by a specialist in Persian language and literature. Step 5 : Back-translation: The edited Persian version was translated back into English by a bilingual expert and sent to the original developer of the instrument. Step 6 : Final approval: The developer reviewed the back-translated version and confirmed its equivalence to the original. This structured process ensured that the Persian version of the instrument was not only linguistically accurate but also culturally relevant for the Persian-speaking population. 2.5. Data analysis Descriptive statistics, including mean, standard deviation, median, frequency, and percentage, were used in the analysis. Normality of data distribution was examined using graphical methods and statistical indices, and after confirming the assumption of normality, inferential analyses were performed using parametric tests. Independent t-test (for two groups) and one-way ANOVA (for more than two groups) were applied to compare means. Pearson’s correlation test was used to examine relationships between continuous variables. Multiple linear regression analysis was performed to identify factors associated with the GPM-24 score (chronic pain in older adults) while controlling for confounding variables. All analyses were conducted using SPSS version 22 and the lavaan package in R version 4.1.1 (for confirmatory factor analysis), with the significance level set at p ≤ 0.05. Psychometric evaluations in this study followed COSMIN guidelines( 17 ). Face and content validity were assessed using data from 30 older adults aged 60–90 years and 10 gerontology experts. The content validity ratio (CVR), content validity index (CVI), and impact score were calculated. Construct validity was evaluated through confirmatory factor analysis (CFA), with model fit indices including chi-square/degree of freedom ratio (χ²/df), comparative fit index (CFI), Tucker–Lewis index (TLI), standardized root mean square residual (SRMR), and root mean square error of approximation (RMSEA). Convergent validity was assessed by calculating correlations between the GPM-24 and other measures, including the Visual Analogue Scale (VAS), the McGill Pain Questionnaire (MPQ), and the Timed Up and Go (TUG) test. Reliability was examined using the intraclass correlation coefficient (ICC) for test–retest stability and Cronbach’s alpha for internal consistency. The standard error of measurement (SEM) was also calculated using the formula: SEM = SD × √(1 − ICC). 3. Results 3.1. Descriptive statistics A total of 290 older adults aged 60 years and above were included in the study. The mean (SD) age of participants was 69.45 (6.47) years, ranging from 60 to 91 years. The majority were women (56.6%), married (71%), and reported an average economic status (51.4%). Regarding educational level, the largest group were individuals with primary education (35.9%). Moreover, 66.2% of participants reported having chronic diseases. Additional demographic characteristics are presented in Table 1 . As shown in Table 2 , The mean (SD) score of the GPM was 24.43 (8.78), and the adjusted GPM score was 58.15 (20.91). The mean score of the MPQ was 22.94 (8.83), the mean VAS score was 6.74 (2.26), and the mean TUG score was 12.69 (3.52). 3.2. Data normality Normality was confirmed using the Kolmogorov–Smirnov test, skewness and kurtosis indices, and graphical methods. Therefore, parametric tests were used for inferential analyses. 3.3. Content validity Face validity, as part of content validity, was assessed using impact scores, and all items achieved scores ≥ 1.5, thus retained. In the quantitative content validity assessment, 10 gerontology experts evaluated the CVR and CVI. The overall CVR was 0.75, and the overall CVI was 0.99, both indicating satisfactory content validity of the instrument. Table 1 Demographic Characteristics of Participants Variable Category Frequency Percentage Mean (SD) F /t p-value Gender Male 126 43.4% 21.38 (7.99) 5.39 < 0.001 Female 164 56.6% 26.76 (8.70) Marital Status Single 7 2.4% 22.86 (9.15) 14.76 < 0.001 Married 206 71.0% 22.48 (8.77) Divorced 4 1.4% 30.00 (6.68) Widowed 73 25.2% (6.44)29.77 Education Level Illiterate 91 31.4% 29.93 (4.95) 15.05 < 0.001 Primary 104 35.9% 20.52 (8.88) Secondary 10 3.4% 21.30 (7.66) High School 14 4.8% 26.36 (5.30) Diploma 48 16.6% 23.87 (9.41) University 23 7.9% 21.64 (10.28) Living Companion Alone 44 15.2% 28.70 (8.25) 10.64 < 0.001 With Spouse 161 55.5% 22.94 (9.10) With Children 31 10.7% 29.94 (5.31) With Spouse & Children 45 15.5% 20.77 (7.18) With Caregiver 9 3.1% 29.33 (4.00) Chronic Disease Yes 192 66.2% 25.74 (7.67) 3.58 < 0.001 No 98 33.8% 21.90 (10.23) Living Status Owner 277 95.5% 24.37 (8.90) 0.31 0.57 Tenant 13 4.5% 25.77 (6.29) Perceived Economic Status Weak 106 36.6% 25.98 (8.05) 5.61 0.004 Moderate 149 51.4% 24.30 (8.11) Good 35 12.1% 20.34 (8.11) Occupation Retired 98 33.8% 21.66 (8.67) 7.08 < 0.001 Employee 100 34.4% 23.67 (8.22) Self-employed 43 14.8% 22.14 (7.46) Unemployed 7 2.4% 28.43 (9.32) Housewife 132 45.5% 27.08 (8.55) Table 2 Descriptive statistics of quantitative variables Variables Mean (SD) Observed Range Age 69.45 (6.47) 60–91 P-GPM score 24.43 (8.78) 2–41 Adjusted GPM score 58.15 (20.91) 4.76–97.58 McGill Pain score 22.94 (8.83) 3–46 Visual Analogue Scale (VAS) 6.74 (2.26) 1–10 TUG test 12.69 (3.52) 8–30 3.4. Construct validity (confirmatory factor analysis) Results of the confirmatory factor analysis indicated that the model fit indices were within acceptable ranges. The chi-square to degrees of freedom ratio (χ²/df) was 1.10, suggesting a good model fit. The comparative fit index (CFI = 0.917) and Tucker–Lewis index (TLI = 0.905) also showed favorable values. The RMSEA was 0.073, which was within the acceptable range. Although the SRMR was reported as 0.11, slightly higher than the optimal cutoff (0.08), the overall model fit was considered satisfactory based on the other indices (Table 3 ). The five-factor structure of the GPM-24 was confirmed by CFA. As shown in Fig. 1 , each of the five factors (F1–F5) loaded on a distinct set of items, and all factor loadings were greater than 0.40, indicating meaningful contributions of all items in explaining the main construct of chronic pain in older adults. 3.5. Construct validity (convergent validity) To evaluate convergent validity, Pearson correlation coefficients between the GPM and other instruments were calculated (Table 4 ). The results showed significant positive correlations between the GPM and the MPQ, VAS, and TUG (p < 0.01), indicating that the GPM demonstrated satisfactory convergent validity with other measures relevant to older adults’ pain status. 3.6. Reliability Internal consistency of the questionnaire was assessed using Cronbach’s alpha, which was 0.84, reflecting good internal consistency among the items. Test–retest reliability was examined with a two-week interval in a subsample of 30 participants. The intraclass correlation coefficient (ICC) between the two administrations was 0.98 (95% CI: 0.95–0.990, p < 0.05), confirming excellent stability and reproducibility of the instrument. Table 3 Goodness-of-fit indices for the measured model of the P-GPM Model Chi2/df CFI TLI RMSEA SRMR Recommended value 1 ≤ Chi2/df ≤ 5 > 0.80 > 0.90 < 0.08 < 0.08 P-GPM 1.108 0.917 0.905 0.073 0.114 Table 4 A correlation matrix of the study’s main variables Scale GPM MPQ TUG VAS P-GPM 1 - - - MPQ 0.64 ** 1 - - TUG 0.39 ** 0.33 ** 1 - VAS 0.85 ** 0.66 ** 0.42 ** 1 Correlation is significant at p < 0.001**, P-GPM: Persian-Geriatric Pain Measure. MPQ: McGill Pain Questionnaire, TUG: Timed Up and Go, VAS: Visual Analogue Scale 3.7. Measurement error The standard error of measurement (SEM) was found to be 1.24. A lower SEM indicates greater measurement precision. The observed value reflects the average range of error around each individual’s observed score. 3.8. Assessment of score distribution (floor and ceiling effects) Floor and ceiling effects are considered present when more than 15% of respondents achieve the lowest or highest possible score, respectively. The presence of such effects suggests that extreme response categories are not adequately captured by the instrument. In the present study, descriptive findings (frequency/percentage) indicated that only 1% of participants achieved the lowest possible score and 1% the highest score, suggesting the absence of significant floor or ceiling effects in the Persian GPM. 3.9. Multiple linear regression Results of the multiple linear regression analysis showed that gender, education level, occupation, perceived economic status, presence of chronic disease, and age were significant predictors of GPM-24 scores. Women had higher scores than men (B = 5.58, p < 0.001), indicating greater pain in this group. Among education levels, only participants with primary education had lower scores compared to illiterate participants (B = − 4.32, p 0.05). Regarding occupation, employees (B = 6.14, p = 0.011) and self-employed individuals (B = 3.59, p = 0.07) reported higher pain scores than retirees, while other occupational groups did not differ significantly (p > 0.05). Participants reporting better economic status had lower GPM scores (B = − 7.18, p < 0.001), indicating less pain. Presence of chronic disease was associated with higher scores and greater pain (B = 5.59, p < 0.001), while those without chronic conditions reported less pain. Age also showed a significant positive relationship with GPM scores (B = 0.45, p < 0.001), such that with each additional year of age, the GPM score increased by an average of 0.45 points. Other variables, including marital status, living companions, and housing conditions, showed no significant associations with the reference groups (p > 0.05). Detailed coefficients and related statistics are presented in Table 5 . Table 5 Results of Multiple Linear Regression Analysis Variables(reference) B Standard Error Sig Gender (Male) Female 5.58 1.54 < 0.001 Marital Status (Single) Married 4.98 4.27 0.243 Divorced 6.21 4.28 0.147 Widowed 3.04 2.85 0.286 Education Level (Illiterate) Primary school -4.32 1.17 < 0.001 Middle school -2.20 2.35 0.349 High school 1.56 2.09 0.454 Diploma 0.96 1.45 0.506 Academic degree -0.51 2.00 0.801 Occupation (Retired) Homemaker 2.77 1.63 0.088 Unemployed 3.56 2.77 0.199 Self-employed 3.59 1.33 0.007 Employee 6.14 2.42 0.011 Living Arrangement (Alone) Caregiver -0.60 2.57 0.815 Spouse and children -3.70 3.53 0.295 Children -1.13 1.65 0.492 Spouse -3.04 3.39 0.369 Housing Status (Owner) Tenant -0.88 1.94 0.651 Perceived Economic Status (poor) Average -0.98 0.91 0.281 Good -7.18 1.52 < 0.001 Chronic Disease (Yes) No -5.59 0.87 < 0.001 Age (years) 0.45 0.08 < 0.001 4. Discussion The aim of the present study was to translate, culturally adapt, and evaluate the psychometric properties of the Persian version of the GPM-24. This cross-sectional study was conducted among 290 Iranian older adults. Although numerous studies have been conducted on pain assessment in older adults using various tools, few have examined the psychometric properties of the GPM-24. Therefore, direct comparisons of the present findings with other studies were limited. In this study, the severity of pain among participants, based on the GPM-24 scores, was assessed at a moderate level. This finding is consistent with the Portuguese version, in which the mean overall scores across three stages were also reported at a moderate level( 11 ). This can be explained by physiological decline during aging and the high prevalence of chronic diseases in this age group—factors that contribute to the onset and persistence of chronic pain in older adults( 3 ). Regarding pain classification, 14.5% of participants had mild pain, 49% moderate pain, and 36.3% severe pain. This pattern differs significantly from a Turkish study that used the Turkish GPM in 244 outpatients in an internal medicine clinic, reporting 48.8% mild, 43% moderate, and 8.2% severe pain( 25 ). Similarly, in the original study by Ferrell et al., the distribution was 48% mild, 42% moderate, and 10% severe( 15 ). These comparisons suggest that in the Iranian population, the proportion of older adults with severe pain is considerably higher. Evidence indicates that current health services in Iran may not adequately meet the needs of older adults for pain management( 26 ), which may account for the higher severity of pain observed. 4.1. Cross-cultural adaptation and psychometric properties of the GPM This study followed the standardized Beaton guidelines (2000) for translation and cross-cultural adaptation to ensure that the Persian version of the GPM-24 was not only linguistically accurate but also culturally appropriate( 16 ). Given that the GPM-24 was originally developed within a predefined theoretical framework including five dimensions (“withdrawal due to pain,” “pain intensity,” “pain while walking,” “pain with strenuous activities,” and “pain with other activities”), confirmatory factor analysis (CFA) was used instead of exploratory factor analysis (EFA) to test the fit of this five-factor model in Iranian older adults. The findings confirmed that the five-factor structure of the instrument demonstrated acceptable and adequate fit in this population, consistent with the results of Clough-Gorr et al. in three European countries( 27 ). In this study, the internal consistency of the GPM-24, measured by Cronbach’s alpha, was 0.84, indicating good internal consistency among Iranian older adults. In the original study by Ferrell et al., Cronbach’s alpha was 0.94, indicating excellent reliability( 15 ). Similarly, studies in Turkey (0.85)( 25 ), South Korea (0.92)( 28 ), and Poland (0.89)( 29 ) reported alpha values within satisfactory ranges. In contrast, the Portuguese version yielded a lower alpha (0.73), which, although less than other studies, was still acceptable( 11 ). Variations in Cronbach’s alpha across studies may be attributable to sample characteristics and data collection conditions. Cultural differences in the perception and reporting of pain experiences may also influence item intercorrelations and, consequently, reliability indices. In the present study, the test–retest correlation coefficient (ICC) after a two-week interval was 0.98, indicating excellent stability of the instrument. This was substantially higher than the Korean version, where a moderate temporal stability (r = 0.643) was reported after 2–4 weeks. Differences between findings may be due to variations in retest intervals as well as population characteristics. To complement reliability evaluation, the standard error of measurement (SEM) was also calculated, providing a more direct estimate of score precision. Considering the scale range, the relatively low SEM found in this study indicates that the GPM-24 is capable of distinguishing between different levels of pain severity among older adults with acceptable precision. This enhances confidence in its application for both clinical and research purposes. 4.2. Factors affecting pain in Older Adults The study revealed that gender, education, occupation, perceived economic status, presence of chronic disease, and age significantly influenced GPM-24 scores. Women had higher scores than men, indicating greater pain severity. This finding aligns with the results of Cicekci et al. in Turkey, where women consistently reported higher pain scores across different severity levels( 30 ). This similarity may reflect the influence of biological (e.g., hormonal differences), psychological, and social factors on women’s pain experiences compared to men. Older adults reporting better economic status had lower GPM-24 scores and less pain. This is consistent with the Turkish study, which also found that lower income was associated with higher pain intensity and poorer quality of life( 30 ). This relationship may be explained by the role of economic status in access to health care and the ability to manage pain effectively. In this study, only those with primary education reported lower pain scores compared to illiterate participants, while other education levels showed no significant differences. This contrasts with findings from Turkey, where higher education levels were generally associated with lower pain( 31 ). Such differences may arise from cultural, socioeconomic, or health care accessibility differences between the two populations. Furthermore, employed participants (employees and self-employed) reported higher pain scores compared to retirees, whereas in the study by Dursun et al. in Turkey, housewives reported the highest scores( 25 ). These discrepancies may reflect differences in cultural and social conditions across settings. The presence of chronic disease was associated with higher GPM scores and greater pain, consistent with findings from Poland, where chronic pain was significantly linked to functional limitations( 32 ). Similarly, older age was significantly associated with greater pain severity. In Poland, pain intensity was notably higher in adults over 85 years( 32 ). Overall, aging is characterized by physiological decline, reduced functional capacity, and increased prevalence of chronic diseases, all of which may exacerbate pain in later life. 4.3. Limitations This study has several limitations. First, it was conducted only in health centers in Sari, which may limit the generalizability of findings to older adults in other regions. Second, the self-reported nature of the questionnaire increases the likelihood of recall bias and social desirability bias. Finally, inter-rater reliability was not assessed, preventing conclusions regarding the consistency of results when administered by different evaluators. 5. Conclusion Given the high prevalence of chronic pain in older adults and its extensive physical, psychological, social, and economic consequences, access to accurate and culturally adapted assessment tools is essential. The findings of this study demonstrated that the Persian version of the GPM-24 possesses satisfactory validity and reliability and can be considered a valid and reliable tool for multidimensional pain assessment in Iranian older adults. This instrument not only captures pain intensity but also its psychological and functional dimensions, making it suitable for populations with multiple medical conditions. Declarations Acknowledgements The authors would like to acknowledge the Mazandaran University of Medical Sciences for their support. We also express our sincere gratitude to the older adults and healthcare centers in Sari County for their valuable cooperation in this research. The data for this study were extracted from the Master’s thesis of Hadiseh Sattari, Department of Geriatric Health, School of Health, Mazandaran University of Medical Sciences. Authors’ contributions H.S. and Sh.P., together with A.J. and G.P., conceptualized and designed the study and were responsible for manuscript editing. H.S. and Sh.P., along with S.S.K. and A.J., contributed to the literature review, data collection, and drafting of the final manuscript. A.Hn. and M.Gh. carried out the statistical analyses and assisted in manuscript revision. All authors read and approved the final manuscript. Funding The authors declare that no financial support was received for the research, authorship, or publication of this article. Data availability The dataset generated and analyzed during the current study is available from the corresponding author upon reasonable request. The data are not publicly available due to privacy and ethical restrictions. Declarations Ethics approval and consent to participate This study adhered to the principles outlined in the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethical approval was obtained from the Research Ethics Committee of Mazandaran University of Medical Sciences (Code: IR.MAZUMS.REC.1403.463). Written informed consent was obtained from all participants, who were also assured of anonymity, confidentiality, and their right to withdraw from the study at any stage without consequences. Clinical trial number not applicable. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Author details [1] , 2 Department of Geriatric Health, School of Health, Mazandaran University of Medical Sciences, Sari, Iran l 3 Orthopedic Research Center, Department of Rehabilitation, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran l 4 Department of Biostatistics, School of Health, Mazandaran University of Medical Sciences, Sari, Iran l 5 Department of Health Education and Promotion, School of Health, Mazandaran University of Medical Sciences, Sari, Iran l 6 Department of Internal and Environmental Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland l 7 Department of Nursing, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran Correspondence: Shahab Papi, Assistant Professor of Gerontology, Department of Nursing, School of Nursing and Midwifery, Lorestan University of Medical Sciences. E-mail: [email protected] | Tel: +98 9160549640 References Nooripour R, Ghanbari N, Hosseinian S, Ronzani TM, Hussain AJ, Ilanloo H, et al. Validation of the Spiritual Well-being Scale (SWBS) and its role in Predicting Hope among Iranian Elderly. Ageing Int. 2023;48(2):593–611. Kaye AD, Baluch AR, Kaye RJ, Niaz RS, Kaye AJ, Liu H, et al. Geriatric pain management, pharmacological and nonpharmacological considerations. Psychol Neurosci. 2014;7:15–26. Shirazi M, Manoochehri H, Zagheri Tafreshi M, Zayeri F, Alipour V. The association between chronic pain acceptance, life style and restriction related chronic pain in the elderly. Avicenna J Nurs Midwifery Care. 2016;24(3):148–58. Hadi Toroghi H, Masoudi S. The effectiveness of acceptance and commitment therapy on the reduction of perceived stress in the elderly afflicted by chronic pain. Aging Psychol. 2019;5(1):1–11. Shirazi M, Manoochehri H, Zagheri Tafreshi M, Zayeri F, Alipour V. Prevalence of chronic pain and its characteristics among elderly people in Ahvaz city: A cross sectional study. J Geriatric Nurs. 2015;2(1):62–78. Kolagari S, Sabzi Z, Boroujerdi M, Hesari E. Study of life pattern with chronic pain in the elderly referred to Mirdamad Comprehensive Aging Center in Gorgan and its relationship with some demographic factors. Nurs Dev Health J. 2021;11(2):44–53. Eggermont LH, Leveille SG, Shi L, Kiely DK, Shmerling RH, Jones RN, et al. Pain characteristics associated with the onset of disability in older adults: the maintenance of balance, independent living, intellect, and zest in the Elderly Boston Study. J Am Geriatr Soc. 2014;62(6):1007–16. Shirazi M, Manoochehri H, Zagheri Tafreshi M, Zayeri F, Alipour V. Testing of comprehensive chronic pain management model in older people. Anesthesiology Pain. 2016;7(1):49–62. Behrouz S, Kooshyar H, Mazlom R, Aghebati N, Asgharipour N, Behnam H. The Effect of Laughter Therapy on Severity and Sites of Pain Among the Elderly. Armaghane Danesh. 2019;24(5):730–45. Kaye AD, Baluch A, Scott JT. Pain management in the elderly population: a review. Ochsner J. 2010;10(3):179–87. Motta TSd, Gambaro RC, Santos FC. Pain measurement in the elderly: evaluation of psychometric properties of the Geriatric Pain Measure–Portuguese version. Revista Dor. 2015;16(2):136–41. Adelmanesh F, Arvantaj A, Rashki H, Ketabchi S, Montazeri A, Raissi G. Results from the translation and adaptation of the Iranian Short-Form McGill Pain Questionnaire (I-SF-MPQ): preliminary evidence of its reliability, construct validity and sensitivity in an Iranian pain population. Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology. 2011;3(1):27. Keshavarz M, Dadgari A, MIRI F. Evaluation of short form mcgill pain questionnaire in nuliparouse women who referred to fatemiye hospital. Knowl Health. 2007;2(2):35–8. John AA, Rossettie S, Rafael J, Cox CT, Ducic I, Mackay BJ. Clinical assessment of pain and sensory function in peripheral nerve injury and recovery: a systematic review of literature. Archives Plast Surg. 2022;49(03):427–39. Ferrell BA, Stein WM, Beck JC. The Geriatric Pain Measure: validity, reliability and factor analysis. J Am Geriatr Soc. 2000;48(12):1669–73. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000;25(24):3186–91. Mokkink LB, Terwee CB, Knol DL, Stratford PW, Alonso J, Patrick DL, et al. The COSMIN checklist for evaluating the methodological quality of studies on measurement properties: a clarification of its content. BMC Med Res Methodol. 2010;10(1):22. Mokkink LB, Prinsen CA, Bouter LM, Vet HCd, Terwee CB. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and how to select an outcome measurement instrument. Braz J Phys Ther. 2016;20(2):105–13. Singh K, Junnarkar M, Kaur J. Measures of Positive Psychology: Development and Validation. New Delhi: Springer Nature DOI.2016;10:978–81. Nazari S, Sharifi F, Gashtili N. The Relationship between Aging Perception with Stress. Anxiety and Depression in the Elderly Members of the Tehrans Social Security Retirees in. 2020:78–88. Kalani Z, Nasiriani K, Maraghi MM. The effect of Benson's relaxation technique on postoperative pain after total knee replacement infielder hospitalized patients in selected hospitals of kashan. Iran J Rehabil Res Nurs. 2019;5(4):1–8. Khosravi M, Sadighi S, Moradi S, Zendehdel K. Persian-McGill pain questionnaire; translation, adaptation and reliability in cancer patients: a brief report. Tehran Univ Med J. 2013;71(1). Ebrahimpoor M, Lajavardi L, Fallah S, Taghizade G. Sensitivity and specificity of Timed Up and Go test, Functional Reach test, Bend Reach test and step test in functional balance measuring of patients with chronic Cerebrovascular Accident. J Mod Rehabilitation. 2016;9(6):86–95. Aslankhani MA, Farsi A, Fathirezaie Z, Zamani Sani SH, Aghdasi MT. Validity and reliability of the timed up and go and the anterior functional reach tests in evaluating fall risk in the elderly. Iran J Ageing. 2015;10(1):16–25. Dursun G, Bektas H. Cultural validation and reliability of the Turkish version of the geriatric pain measure in the elderly. Pain Pract. 2017;17(4):505–13. Nazaripanah NS, Nadrian H, Bahrevar V, Lotfalinezhad E, Hashemiparast M. Barriers to participation in Iran’s Integrated Geriatric Care Program: A qualitative study. PLoS ONE. 2025;20(2):e0315034. Clough-Gorr KM, Blozik E, Gillmann G, Beck JC, Ferrell BA, Anders J, et al. The self-administered 24-item geriatric pain measure (GPM-24-SA): psychometric properties in three European populations of community-dwelling older adults. Pain Med. 2008;9(6):695–709. Park J, Cho B, Paek Y, Kwon H, Yoo S. Development of a pain assessment tool for the older adults in Korea: the validity and reliability of a Korean version of the geriatric pain measure (GPM-K). Arch Gerontol Geriatr. 2009;49(2):199–203. Puto G, Repka I, Brzyski P. Pain measurement in the older people: evaluation of the psychometric properties of the Geriatric Pain Measure (GPM-24)–Polish version. BMC Geriatr. 2021;21(1):560. Cicekci E, Ozisler Z, Ozel S, Unsal-Delialioglu S, Ozisler C. The factors of musculoskeletal pain in geriatric patients and the relationship between pain and quality of life. Int J Clin Med. 2017;8(8):504–13. ÖZDEMIR N, ŞAHIN ŞK, THE EFFECT OF DEATH ANXIETY, ON PERCEIVED PAIN LEVELS IN ELDERLY PATIENTS. Turkish J Geriatrics/Türk Geriatri Dergisi. 2020;23(2). Puto G, Repka I, Muszalik M. Factors correlating with functional capacity in older people with chronic pain. Int J Environ Res Public Health. 2023;20(3):2748. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7784231","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":549782838,"identity":"8c32b37f-7b84-4cc9-8413-c2df576aecd7","order_by":0,"name":"Hadiseh Sattari","email":"","orcid":"","institution":"Mazandaran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Hadiseh","middleName":"","lastName":"Sattari","suffix":""},{"id":549782840,"identity":"5fcd335e-2d83-4603-83c6-569f7883ac8e","order_by":1,"name":"Abdolhakim Jorbonyan","email":"","orcid":"","institution":"Mazandaran University of Medical 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07:01:07","extension":"xml","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":117138,"visible":true,"origin":"","legend":"","description":"","filename":"ba12413b8ab74b40aa7d8454ca1f869c1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7784231/v1/1ecd6923bc111228a0018f2f.xml"},{"id":96792085,"identity":"066a8b30-1bfd-47bc-a344-f9e902caf9a2","added_by":"auto","created_at":"2025-11-26 07:01:08","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":125144,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7784231/v1/61124cddb231a25b74986fae.html"},{"id":96792088,"identity":"1be16ba1-ee74-4e23-9730-cdc8058fe168","added_by":"auto","created_at":"2025-11-26 07:01:09","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":402860,"visible":true,"origin":"","legend":"\u003cp\u003eThe measurement model of the P-GPM\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7784231/v1/b87480a765e350f1336e4562.png"},{"id":108478890,"identity":"09c1ba57-c899-4d1d-94cd-4e426fe0d720","added_by":"auto","created_at":"2026-05-05 07:26:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":803484,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7784231/v1/fcad7038-8184-4e07-9663-0c168b1156e0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Geriatric Pain Measure: Cross-Cultural Adaptation and Psychometric Properties of the Persian Version of Geriatric Pain Measure (P-GPM) among Elderly Adults","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThe aging process is associated with a gradual decline in physical, cognitive, psychological, and social functions, which makes older adults one of the most vulnerable age groups(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). With increasing age, due to reduced physiological reserves and the high prevalence of chronic diseases, the occurrence of chronic pain rises, and older adults become one of the most susceptible groups to chronic pain(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). This issue poses serious challenges to their lives and leads to a decline in quality of life(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eChronic pain may result from physical injury or the course of a disease and can persist for a long time (months or years)(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Chronic pain is generally classified into two categories: nociceptive and neuropathic. Nociceptive pain arises from tissue damage or inflammation and is often controlled with conventional analgesics, whereas neuropathic pain originates from injury to the peripheral or central nervous system and usually does not respond well to classic analgesics but can be managed with medications such as antidepressants and anticonvulsants(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eEpidemiological studies estimate the prevalence of chronic pain in the general population to be about 40%, increasing to approximately 50% among older adults worldwide. In Iran, the six-month prevalence of persistent chronic pain in individuals aged 60 to 90 years has been reported at 67%. Statistics also indicate that the prevalence and consequences of chronic pain are influenced not only by age but also by gender, with pain disorders being diagnosed about twice as frequently in women compared to men(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAmong older adults with chronic pain, pain is often experienced in multiple areas of the body, which increases the risk of disability and reduced mobility(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). If not properly managed and treated, chronic pain can lead to suffering, hopelessness, and impaired functioning(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Furthermore, chronic pain imposes substantial economic burdens on both the individual and society. Evidence shows that people with chronic pain use primary health care services up to five times more than the general population(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In addition, chronic pain not only affects the individual but also places strain on their caregivers and family(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). It influences cognition, performance, and emotions, leading to various limitations in daily life, such as reduced activity, increased dependency, and impaired physical, psychological, and social well-being(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe clinical manifestations of chronic pain in older adults are often complex and multifactorial. The presence of factors such as depression, psychosocial concerns, cognitive decline, and poor health complicates its assessment and treatment in this population(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Moreover, a common misconception is that chronic pain is a natural part of aging and should simply be tolerated rather than treated. Such attitudes contribute to under-recognition and under-treatment of pain in many cases. Evidence also suggests that in many older adults, chronic pain assessment is not performed accurately. Misinterpretation of pain sensations or difficulty using assessment tools may lead to underreporting or nonreporting of pain(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eUnidimensional pain assessment tools usually measure only pain intensity, with the most common being the Visual Analogue Scale (VAS) and the Verbal Numerical Scale (VNS). In contrast, multidimensional instruments such as the McGill Pain Questionnaire (MPQ) and the Brief Pain Inventory (BPI) aim to assess different aspects of pain. However, these tools are challenging for older adults due to their lengthy structure(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Specifically, the MPQ, with its extensive details, may include sections unnecessary for clinical trials, making it time-consuming and difficult to complete(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). To address this, a shortened version of the MPQ was developed(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Nevertheless, it still requires supervision and familiarity with its terminology(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Moreover, the American Geriatrics Society emphasizes the importance of using multidimensional instruments for assessing pain in older adults. Therefore, there is a need for tools that provide multidimensional quantification of pain in older adults and are also linguistically and culturally adapted for use in non-English-speaking populations(11).\u003c/p\u003e\u003cp\u003eConsidering these points, the 24-item Geriatric Pain Measure (GPM-24) is one of the instruments specifically designed for older adults. It is multidimensional, assessing functional and psychological aspects of pain, easy to complete in both clinical and outpatient settings, requires only about five minutes to administer, and has demonstrated strong psychometric validity(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Accordingly, given the need for a brief and appropriate tool to assess pain in Persian-speaking older adults, and the fact that the Persian version of the GPM-24 has not yet been translated and psychometrically validated in Iran, the present study aimed to translate, culturally adapt, and evaluate the psychometric properties of this instrument among Iranian older adults.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1. Study design\u003c/h2\u003e\u003cp\u003eThis methodological study was conducted in a cross-sectional design in two phases: translation and cultural adaptation, and psychometric evaluation of the instrument. The cross-cultural adaptation process followed the six-step guideline of Beaton et al.(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) to ensure the linguistic and cultural validity of the Persian version. For psychometric evaluation, the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) were applied(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2. Sample size and setting\u003c/h2\u003e\u003cp\u003eThe study was carried out from March to June 2025 among individuals aged 60 years and older attending health care centers in Sari, Mazandaran Province, Iran. According to the general rule of thumb for methodological studies, the minimum required sample size is estimated at 10 participants per item of the questionnaire(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Since the GPM-24 consists of 24 items, the minimum required sample was 240, and with an additional 50 participants to account for possible dropouts, the final sample size was determined to be 290 to enhance the validity of results. Sampling was conducted using a convenience (non-probability) method among older adults attending health centers in Sari, Mazandaran. After obtaining the necessary research approvals, participants were informed about the study objectives, assured of confidentiality, and provided written informed consent (from caregivers if needed). Questionnaires were completed by the participants under the supervision of the researcher.\u003c/p\u003e\u003cp\u003eInclusion criteria were: age\u0026thinsp;\u0026ge;\u0026thinsp;60 years, ability to communicate and respond to the questionnaire, fluency in Persian, informed consent, and achieving a score of 7 or higher on the Abbreviated Mental Test (AMT)(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Exclusion criterion was incomplete completion of the questionnaire.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3. Data collection measures\u003c/h2\u003e\u003cp\u003eThe following instruments were used in this study:\u003c/p\u003e\u003cp\u003eDemographic information form: A checklist collected demographic characteristics including age, gender, marital status, education level, perceived economic status, occupation, Living Status, chronic diseases, and living companions.\u003c/p\u003e\u003cp\u003eAbbreviated Mental Test Score (AMTs):This tool consists of 10 questions and is designed to screen for cognitive impairment in older adults. Its validity and reliability have been confirmed in Iranian elderly, with a Cronbach\u0026rsquo;s alpha of 0.76 and an inter-rater correlation of 0.89, indicating satisfactory validity and reliability. A score of 7 provides 100% sensitivity and 71% specificity(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eGeriatric Pain Measure (GPM-24): The GPM-24 was developed by Ferrell et al. in 2000 to design and evaluate a multidimensional, elderly-specific tool for assessing pain. The questionnaire consists of 24 items, with a total score ranging from 0 to 42; to calculate the final score, the raw score is multiplied by 2.38. A score below 30 indicates mild pain, 30\u0026ndash;69 indicates moderate pain, and above 70 indicates severe pain. Factor analysis of the GPM-24 identified five subscales: \u0026ldquo;withdrawal due to pain\u0026rdquo; (items 9, 10, 11, 12, 15, 18, 24); \u0026ldquo;pain intensity\u0026rdquo; (items 13, 17, 19, 20, 21, 22, 23); \u0026ldquo;pain while walking\u0026rdquo; (items 4, 5, 6, 7); \u0026ldquo;pain with strenuous activities\u0026rdquo; (items 1, 2, 3); and \u0026ldquo;pain with other activities\u0026rdquo; (items 8, 13, 14, 15, 16). All items loaded on at least one factor, with only two items loading on two subscales. Internal consistency was excellent, with a Cronbach\u0026rsquo;s alpha of 0.94. The average inter-item correlation was 0.41 and the homogeneity ratio was 0.45, confirming strong reliability and validity of the questionnaire in older adults with multiple medical problems(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eVisual Analogue Scale (VAS):This tool consists of a 10 cm line divided into 1 cm intervals and numbered from 1 to 10, where participants are asked to mark their level of pain. Higher numbers indicate greater pain. The VAS has shown good positive correlation with pain intensity and has been used in numerous studies. Its reliability has been reported between 0.60 and 0.77, and validity between 0.76 and 0.84(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMcGill Pain Questionnaire (MPQ): The MPQ contains 20 sets of descriptors assessing different dimensions of pain perception. Items 1\u0026ndash;10 measure sensory perception, 11\u0026ndash;15 affective perception, item 16 evaluative perception, and items 17\u0026ndash;20 miscellaneous pain. If none of the descriptors fit the participant\u0026rsquo;s pain, a score of zero is given for that set. Subscale scores are calculated by summing the items within each dimension, and the overall score is the total across all items, with higher scores reflecting greater pain perception. In a study on Iranian cancer patients, the Persian version demonstrated a Cronbach\u0026rsquo;s alpha of 0.85 and subscale reliabilities above 0.80, confirming satisfactory internal consistency(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTimed Up and Go (TUG) test:This test measures balance and functional mobility in older adults. It records the time needed to rise from a chair, walk three meters, turn, and return to sitting. The mean of three trials is taken as the final score. The TUG has demonstrated strong validity and reliability, with ICC\u0026thinsp;=\u0026thinsp;0.95 and correlation coefficient\u0026thinsp;=\u0026thinsp;0.77(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). The optimal cut-off point for older adults has been identified as 9.025 seconds(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4. GPM cross-cultural adaptation\u003c/h2\u003e\u003cp\u003eBefore initiating the translation process, written permission was obtained via email from the original developer of the Polish version of the instrument. The cross-cultural adaptation was carried out according to internationally recognized guidelines (including those of Beaton et al.) to ensure both linguistic accuracy and cultural appropriateness(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eStep 1\u003c/b\u003e: Forward translation: Two translators fluent in both Persian and English and familiar with medical concepts independently translated the questionnaire into Persian. \u003cb\u003eStep 2\u003c/b\u003e: Synthesis: The two forward translations were reviewed by the research team, and through consensus, the preliminary Persian version of the instrument was prepared. \u003cb\u003eStep 3\u003c/b\u003e: Expert review: The preliminary version was then reviewed and confirmed by two independent translators who were not involved in the earlier stages but were proficient in both Persian and English. \u003cb\u003eStep 4\u003c/b\u003e: Linguistic editing: After expert approval, the Persian version underwent linguistic and grammatical editing by a specialist in Persian language and literature. \u003cb\u003eStep 5\u003c/b\u003e: Back-translation: The edited Persian version was translated back into English by a bilingual expert and sent to the original developer of the instrument. \u003cb\u003eStep 6\u003c/b\u003e: Final approval: The developer reviewed the back-translated version and confirmed its equivalence to the original. This structured process ensured that the Persian version of the instrument was not only linguistically accurate but also culturally relevant for the Persian-speaking population.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.5. Data analysis\u003c/h2\u003e\u003cp\u003eDescriptive statistics, including mean, standard deviation, median, frequency, and percentage, were used in the analysis. Normality of data distribution was examined using graphical methods and statistical indices, and after confirming the assumption of normality, inferential analyses were performed using parametric tests. Independent t-test (for two groups) and one-way ANOVA (for more than two groups) were applied to compare means. Pearson\u0026rsquo;s correlation test was used to examine relationships between continuous variables. Multiple linear regression analysis was performed to identify factors associated with the GPM-24 score (chronic pain in older adults) while controlling for confounding variables.\u003c/p\u003e\u003cp\u003eAll analyses were conducted using SPSS version 22 and the lavaan package in R version 4.1.1 (for confirmatory factor analysis), with the significance level set at p\u0026thinsp;\u0026le;\u0026thinsp;0.05. Psychometric evaluations in this study followed COSMIN guidelines(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Face and content validity were assessed using data from 30 older adults aged 60\u0026ndash;90 years and 10 gerontology experts. The content validity ratio (CVR), content validity index (CVI), and impact score were calculated. Construct validity was evaluated through confirmatory factor analysis (CFA), with model fit indices including chi-square/degree of freedom ratio (χ\u0026sup2;/df), comparative fit index (CFI), Tucker\u0026ndash;Lewis index (TLI), standardized root mean square residual (SRMR), and root mean square error of approximation (RMSEA). Convergent validity was assessed by calculating correlations between the GPM-24 and other measures, including the Visual Analogue Scale (VAS), the McGill Pain Questionnaire (MPQ), and the Timed Up and Go (TUG) test. Reliability was examined using the intraclass correlation coefficient (ICC) for test\u0026ndash;retest stability and Cronbach\u0026rsquo;s alpha for internal consistency. The standard error of measurement (SEM) was also calculated using the formula: SEM\u0026thinsp;=\u0026thinsp;SD \u0026times; \u0026radic;(1\u0026thinsp;\u0026minus;\u0026thinsp;ICC).\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.1. Descriptive statistics\u003c/h2\u003e\u003cp\u003eA total of 290 older adults aged 60 years and above were included in the study. The mean (SD) age of participants was 69.45 (6.47) years, ranging from 60 to 91 years. The majority were women (56.6%), married (71%), and reported an average economic status (51.4%). Regarding educational level, the largest group were individuals with primary education (35.9%). Moreover, 66.2% of participants reported having chronic diseases. Additional demographic characteristics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, The mean (SD) score of the GPM was 24.43 (8.78), and the adjusted GPM score was 58.15 (20.91). The mean score of the MPQ was 22.94 (8.83), the mean VAS score was 6.74 (2.26), and the mean TUG score was 12.69 (3.52).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.2. Data normality\u003c/h2\u003e\u003cp\u003eNormality was confirmed using the Kolmogorov\u0026ndash;Smirnov test, skewness and kurtosis indices, and graphical methods. Therefore, parametric tests were used for inferential analyses.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.3. Content validity\u003c/h2\u003e\u003cp\u003eFace validity, as part of content validity, was assessed using impact scores, and all items achieved scores\u0026thinsp;\u0026ge;\u0026thinsp;1.5, thus retained. In the quantitative content validity assessment, 10 gerontology experts evaluated the CVR and CVI. The overall CVR was 0.75, and the overall CVI was 0.99, both indicating satisfactory content validity of the instrument.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic Characteristics of Participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMean (SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eF /t\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e126\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e43.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e21.38 (7.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e5.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e164\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e56.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e26.76 (8.70)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eMarital Status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e22.86 (9.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e14.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e206\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e71.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e22.48 (8.77)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e30.00 (6.68)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWidowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e25.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e(6.44)29.77\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003eEducation Level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIlliterate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e31.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e29.93 (4.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e15.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e35.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e20.52 (8.88)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e21.30 (7.66)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh School\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e26.36 (5.30)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDiploma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e23.87 (9.41)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUniversity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e21.64 (10.28)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eLiving Companion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAlone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e28.70 (8.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e10.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWith Spouse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e161\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e55.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e22.94 (9.10)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWith Children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e29.94 (5.31)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWith Spouse \u0026amp; Children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e20.77 (7.18)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWith Caregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e29.33 (4.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eChronic Disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e192\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e66.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e25.74 (7.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e3.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e33.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e21.90 (10.23)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eLiving Status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOwner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e277\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e95.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e24.37 (8.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTenant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e25.77 (6.29)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePerceived Economic Status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e36.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e25.98 (8.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e5.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e51.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e24.30 (8.11)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e20.34 (8.11)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eOccupation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e33.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e21.66 (8.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e7.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmployee\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e34.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e23.67 (8.22)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSelf-employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e22.14 (7.46)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e28.43 (9.32)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHousewife\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e132\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e45.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e27.08 (8.55)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescriptive statistics of quantitative variables\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean (SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eObserved Range\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e69.45 (6.47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60\u0026ndash;91\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP-GPM score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24.43 (8.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u0026ndash;41\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdjusted GPM score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e58.15 (20.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.76\u0026ndash;97.58\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMcGill Pain score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e22.94 (8.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u0026ndash;46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVisual Analogue Scale (VAS)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6.74 (2.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTUG test\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12.69 (3.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e3.4. Construct validity (confirmatory factor analysis)\u003c/h2\u003e\u003cp\u003eResults of the confirmatory factor analysis indicated that the model fit indices were within acceptable ranges. The chi-square to degrees of freedom ratio (χ\u0026sup2;/df) was 1.10, suggesting a good model fit. The comparative fit index (CFI\u0026thinsp;=\u0026thinsp;0.917) and Tucker\u0026ndash;Lewis index (TLI\u0026thinsp;=\u0026thinsp;0.905) also showed favorable values. The RMSEA was 0.073, which was within the acceptable range. Although the SRMR was reported as 0.11, slightly higher than the optimal cutoff (0.08), the overall model fit was considered satisfactory based on the other indices (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The five-factor structure of the GPM-24 was confirmed by CFA. As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, each of the five factors (F1\u0026ndash;F5) loaded on a distinct set of items, and all factor loadings were greater than 0.40, indicating meaningful contributions of all items in explaining the main construct of chronic pain in older adults.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e3.5. Construct validity (convergent validity)\u003c/h2\u003e\u003cp\u003eTo evaluate convergent validity, Pearson correlation coefficients between the GPM and other instruments were calculated (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The results showed significant positive correlations between the GPM and the MPQ, VAS, and TUG (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), indicating that the GPM demonstrated satisfactory convergent validity with other measures relevant to older adults\u0026rsquo; pain status.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e3.6. Reliability\u003c/h2\u003e\u003cp\u003eInternal consistency of the questionnaire was assessed using Cronbach\u0026rsquo;s alpha, which was 0.84, reflecting good internal consistency among the items. Test\u0026ndash;retest reliability was examined with a two-week interval in a subsample of 30 participants. The intraclass correlation coefficient (ICC) between the two administrations was 0.98 (95% CI: 0.95\u0026ndash;0.990, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), confirming excellent stability and reproducibility of the instrument.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eGoodness-of-fit indices for the measured model of the P-GPM\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModel\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChi2/df\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCFI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTLI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRMSEA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSRMR\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRecommended value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u0026thinsp;\u0026le;\u0026thinsp;Chi2/df\u0026thinsp;\u0026le;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.08\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP-GPM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.917\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.905\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.073\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.114\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eA correlation matrix of the study\u0026rsquo;s main variables\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eScale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGPM\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMPQ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTUG\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eVAS\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP-GPM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMPQ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.64\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTUG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.39\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.33\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVAS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.85\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.66\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.42\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eCorrelation is significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.001**, P-GPM: Persian-Geriatric Pain Measure. MPQ: McGill Pain Questionnaire, TUG: Timed Up and Go, VAS: Visual Analogue Scale\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e3.7. Measurement error\u003c/h2\u003e\u003cp\u003eThe standard error of measurement (SEM) was found to be 1.24. A lower SEM indicates greater measurement precision. The observed value reflects the average range of error around each individual\u0026rsquo;s observed score.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003e3.8. Assessment of score distribution (floor and ceiling effects)\u003c/h2\u003e\u003cp\u003eFloor and ceiling effects are considered present when more than 15% of respondents achieve the lowest or highest possible score, respectively. The presence of such effects suggests that extreme response categories are not adequately captured by the instrument. In the present study, descriptive findings (frequency/percentage) indicated that only 1% of participants achieved the lowest possible score and 1% the highest score, suggesting the absence of significant floor or ceiling effects in the Persian GPM.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e3.9. Multiple linear regression\u003c/h2\u003e\u003cp\u003eResults of the multiple linear regression analysis showed that gender, education level, occupation, perceived economic status, presence of chronic disease, and age were significant predictors of GPM-24 scores. Women had higher scores than men (B\u0026thinsp;=\u0026thinsp;5.58, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating greater pain in this group. Among education levels, only participants with primary education had lower scores compared to illiterate participants (B\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;4.32, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), reflecting lower pain, while other education levels showed no significant differences (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Regarding occupation, employees (B\u0026thinsp;=\u0026thinsp;6.14, p\u0026thinsp;=\u0026thinsp;0.011) and self-employed individuals (B\u0026thinsp;=\u0026thinsp;3.59, p\u0026thinsp;=\u0026thinsp;0.07) reported higher pain scores than retirees, while other occupational groups did not differ significantly (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Participants reporting better economic status had lower GPM scores (B\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;7.18, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating less pain. Presence of chronic disease was associated with higher scores and greater pain (B\u0026thinsp;=\u0026thinsp;5.59, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while those without chronic conditions reported less pain. Age also showed a significant positive relationship with GPM scores (B\u0026thinsp;=\u0026thinsp;0.45, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), such that with each additional year of age, the GPM score increased by an average of 0.45 points. Other variables, including marital status, living companions, and housing conditions, showed no significant associations with the reference groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Detailed coefficients and related statistics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eResults of Multiple Linear Regression Analysis\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables(reference)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStandard Error\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSig\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eGender (Male)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eMarital Status (Single)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.243\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.147\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWidowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.286\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eEducation Level (Illiterate)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-4.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMiddle school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-2.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.349\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.454\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiploma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.506\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcademic degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.801\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eOccupation (Retired)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHomemaker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.088\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.199\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmployee\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.011\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiving Arrangement (Alone)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.815\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpouse and children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-3.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.295\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChildren\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.492\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpouse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-3.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.369\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eHousing Status (Owner)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTenant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.651\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003ePerceived Economic Status (poor)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAverage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.281\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-7.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eChronic Disease (Yes)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-5.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe aim of the present study was to translate, culturally adapt, and evaluate the psychometric properties of the Persian version of the GPM-24. This cross-sectional study was conducted among 290 Iranian older adults. Although numerous studies have been conducted on pain assessment in older adults using various tools, few have examined the psychometric properties of the GPM-24. Therefore, direct comparisons of the present findings with other studies were limited.\u003c/p\u003e\u003cp\u003eIn this study, the severity of pain among participants, based on the GPM-24 scores, was assessed at a moderate level. This finding is consistent with the Portuguese version, in which the mean overall scores across three stages were also reported at a moderate level(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). This can be explained by physiological decline during aging and the high prevalence of chronic diseases in this age group\u0026mdash;factors that contribute to the onset and persistence of chronic pain in older adults(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRegarding pain classification, 14.5% of participants had mild pain, 49% moderate pain, and 36.3% severe pain. This pattern differs significantly from a Turkish study that used the Turkish GPM in 244 outpatients in an internal medicine clinic, reporting 48.8% mild, 43% moderate, and 8.2% severe pain(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Similarly, in the original study by Ferrell et al., the distribution was 48% mild, 42% moderate, and 10% severe(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). These comparisons suggest that in the Iranian population, the proportion of older adults with severe pain is considerably higher. Evidence indicates that current health services in Iran may not adequately meet the needs of older adults for pain management(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), which may account for the higher severity of pain observed.\u003c/p\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003e4.1. Cross-cultural adaptation and psychometric properties of the GPM\u003c/h2\u003e\u003cp\u003eThis study followed the standardized Beaton guidelines (2000) for translation and cross-cultural adaptation to ensure that the Persian version of the GPM-24 was not only linguistically accurate but also culturally appropriate(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Given that the GPM-24 was originally developed within a predefined theoretical framework including five dimensions (\u0026ldquo;withdrawal due to pain,\u0026rdquo; \u0026ldquo;pain intensity,\u0026rdquo; \u0026ldquo;pain while walking,\u0026rdquo; \u0026ldquo;pain with strenuous activities,\u0026rdquo; and \u0026ldquo;pain with other activities\u0026rdquo;), confirmatory factor analysis (CFA) was used instead of exploratory factor analysis (EFA) to test the fit of this five-factor model in Iranian older adults. The findings confirmed that the five-factor structure of the instrument demonstrated acceptable and adequate fit in this population, consistent with the results of Clough-Gorr et al. in three European countries(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn this study, the internal consistency of the GPM-24, measured by Cronbach\u0026rsquo;s alpha, was 0.84, indicating good internal consistency among Iranian older adults. In the original study by Ferrell et al., Cronbach\u0026rsquo;s alpha was 0.94, indicating excellent reliability(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Similarly, studies in Turkey (0.85)(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), South Korea (0.92)(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), and Poland (0.89)(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) reported alpha values within satisfactory ranges. In contrast, the Portuguese version yielded a lower alpha (0.73), which, although less than other studies, was still acceptable(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Variations in Cronbach\u0026rsquo;s alpha across studies may be attributable to sample characteristics and data collection conditions. Cultural differences in the perception and reporting of pain experiences may also influence item intercorrelations and, consequently, reliability indices.\u003c/p\u003e\u003cp\u003eIn the present study, the test\u0026ndash;retest correlation coefficient (ICC) after a two-week interval was 0.98, indicating excellent stability of the instrument. This was substantially higher than the Korean version, where a moderate temporal stability (r\u0026thinsp;=\u0026thinsp;0.643) was reported after 2\u0026ndash;4 weeks. Differences between findings may be due to variations in retest intervals as well as population characteristics.\u003c/p\u003e\u003cp\u003eTo complement reliability evaluation, the standard error of measurement (SEM) was also calculated, providing a more direct estimate of score precision. Considering the scale range, the relatively low SEM found in this study indicates that the GPM-24 is capable of distinguishing between different levels of pain severity among older adults with acceptable precision. This enhances confidence in its application for both clinical and research purposes.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003e4.2. Factors affecting pain in Older Adults\u003c/h2\u003e\u003cp\u003eThe study revealed that gender, education, occupation, perceived economic status, presence of chronic disease, and age significantly influenced GPM-24 scores. Women had higher scores than men, indicating greater pain severity. This finding aligns with the results of Cicekci et al. in Turkey, where women consistently reported higher pain scores across different severity levels(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). This similarity may reflect the influence of biological (e.g., hormonal differences), psychological, and social factors on women\u0026rsquo;s pain experiences compared to men.\u003c/p\u003e\u003cp\u003eOlder adults reporting better economic status had lower GPM-24 scores and less pain. This is consistent with the Turkish study, which also found that lower income was associated with higher pain intensity and poorer quality of life(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). This relationship may be explained by the role of economic status in access to health care and the ability to manage pain effectively.\u003c/p\u003e\u003cp\u003eIn this study, only those with primary education reported lower pain scores compared to illiterate participants, while other education levels showed no significant differences. This contrasts with findings from Turkey, where higher education levels were generally associated with lower pain(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Such differences may arise from cultural, socioeconomic, or health care accessibility differences between the two populations.\u003c/p\u003e\u003cp\u003eFurthermore, employed participants (employees and self-employed) reported higher pain scores compared to retirees, whereas in the study by Dursun et al. in Turkey, housewives reported the highest scores(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). These discrepancies may reflect differences in cultural and social conditions across settings.\u003c/p\u003e\u003cp\u003eThe presence of chronic disease was associated with higher GPM scores and greater pain, consistent with findings from Poland, where chronic pain was significantly linked to functional limitations(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Similarly, older age was significantly associated with greater pain severity. In Poland, pain intensity was notably higher in adults over 85 years(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Overall, aging is characterized by physiological decline, reduced functional capacity, and increased prevalence of chronic diseases, all of which may exacerbate pain in later life.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003e4.3. Limitations\u003c/h2\u003e\u003cp\u003eThis study has several limitations. First, it was conducted only in health centers in Sari, which may limit the generalizability of findings to older adults in other regions. Second, the self-reported nature of the questionnaire increases the likelihood of recall bias and social desirability bias. Finally, inter-rater reliability was not assessed, preventing conclusions regarding the consistency of results when administered by different evaluators.\u003c/p\u003e\u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eGiven the high prevalence of chronic pain in older adults and its extensive physical, psychological, social, and economic consequences, access to accurate and culturally adapted assessment tools is essential. The findings of this study demonstrated that the Persian version of the GPM-24 possesses satisfactory validity and reliability and can be considered a valid and reliable tool for multidimensional pain assessment in Iranian older adults. This instrument not only captures pain intensity but also its psychological and functional dimensions, making it suitable for populations with multiple medical conditions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to acknowledge the Mazandaran University of Medical Sciences for their support. We also express our sincere gratitude to the older adults and healthcare centers in Sari County for their valuable cooperation in this research. The data for this study were extracted from the Master’s thesis of Hadiseh Sattari, Department of Geriatric Health, School of Health, Mazandaran University of Medical Sciences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eH.S. and Sh.P., together with A.J. and G.P., conceptualized and designed the study and were responsible for manuscript editing. H.S. and Sh.P., along with S.S.K. and A.J., contributed to the literature review, data collection, and drafting of the final manuscript. A.Hn. and M.Gh. carried out the statistical analyses and assisted in manuscript revision. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no financial support was received for the research, authorship, or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset generated and analyzed during the current study is available from the corresponding author upon reasonable request. The data are not publicly available due to privacy and ethical restrictions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;This study adhered to the principles outlined in the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethical approval was obtained from the Research Ethics Committee of Mazandaran University of Medical Sciences (Code: IR.MAZUMS.REC.1403.463). Written informed consent was obtained from all participants, who were also assured of anonymity, confidentiality, and their right to withdraw from the study at any stage without consequences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e\u003csup\u003e[1]\u003c/sup\u003e\u003c/sup\u003e,\u003csup\u003e2\u003c/sup\u003e Department of Geriatric Health, School of Health, Mazandaran University of Medical Sciences, Sari, Iran l \u003csup\u003e3\u003c/sup\u003eOrthopedic Research Center, Department of Rehabilitation, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran l \u003csup\u003e\u0026nbsp;4\u003c/sup\u003eDepartment of Biostatistics, School of Health, Mazandaran University of Medical Sciences, Sari, Iran l \u003csup\u003e5\u003c/sup\u003eDepartment of Health Education and Promotion, School of Health, Mazandaran University of Medical Sciences, Sari, Iran l \u003csup\u003e6\u003c/sup\u003eDepartment of Internal and Environmental Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland l \u003csup\u003e7\u003c/sup\u003eDepartment of Nursing, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrespondence:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Shahab Papi, Assistant Professor of Gerontology, Department of Nursing, School of Nursing and Midwifery, Lorestan University of Medical Sciences.\u003cbr\u003eE-mail: \u003cstrong\[email protected]\u003c/strong\u003e | Tel: \u003cstrong\u003e+98 9160549640\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNooripour R, Ghanbari N, Hosseinian S, Ronzani TM, Hussain AJ, Ilanloo H, et al. 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The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and how to select an outcome measurement instrument. Braz J Phys Ther. 2016;20(2):105\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSingh K, Junnarkar M, Kaur J. Measures of Positive Psychology: Development and Validation. New Delhi: Springer Nature DOI.2016;10:978\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNazari S, Sharifi F, Gashtili N. The Relationship between Aging Perception with Stress. Anxiety and Depression in the Elderly Members of the Tehrans Social Security Retirees in. 2020:78\u0026ndash;88.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKalani Z, Nasiriani K, Maraghi MM. The effect of Benson's relaxation technique on postoperative pain after total knee replacement infielder hospitalized patients in selected hospitals of kashan. Iran J Rehabil Res Nurs. 2019;5(4):1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhosravi M, Sadighi S, Moradi S, Zendehdel K. Persian-McGill pain questionnaire; translation, adaptation and reliability in cancer patients: a brief report. Tehran Univ Med J. 2013;71(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEbrahimpoor M, Lajavardi L, Fallah S, Taghizade G. Sensitivity and specificity of Timed Up and Go test, Functional Reach test, Bend Reach test and step test in functional balance measuring of patients with chronic Cerebrovascular Accident. J Mod Rehabilitation. 2016;9(6):86\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAslankhani MA, Farsi A, Fathirezaie Z, Zamani Sani SH, Aghdasi MT. Validity and reliability of the timed up and go and the anterior functional reach tests in evaluating fall risk in the elderly. Iran J Ageing. 2015;10(1):16\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDursun G, Bektas H. Cultural validation and reliability of the Turkish version of the geriatric pain measure in the elderly. Pain Pract. 2017;17(4):505\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNazaripanah NS, Nadrian H, Bahrevar V, Lotfalinezhad E, Hashemiparast M. Barriers to participation in Iran\u0026rsquo;s Integrated Geriatric Care Program: A qualitative study. PLoS ONE. 2025;20(2):e0315034.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eClough-Gorr KM, Blozik E, Gillmann G, Beck JC, Ferrell BA, Anders J, et al. The self-administered 24-item geriatric pain measure (GPM-24-SA): psychometric properties in three European populations of community-dwelling older adults. Pain Med. 2008;9(6):695\u0026ndash;709.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePark J, Cho B, Paek Y, Kwon H, Yoo S. Development of a pain assessment tool for the older adults in Korea: the validity and reliability of a Korean version of the geriatric pain measure (GPM-K). Arch Gerontol Geriatr. 2009;49(2):199\u0026ndash;203.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePuto G, Repka I, Brzyski P. Pain measurement in the older people: evaluation of the psychometric properties of the Geriatric Pain Measure (GPM-24)\u0026ndash;Polish version. BMC Geriatr. 2021;21(1):560.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCicekci E, Ozisler Z, Ozel S, Unsal-Delialioglu S, Ozisler C. The factors of musculoskeletal pain in geriatric patients and the relationship between pain and quality of life. Int J Clin Med. 2017;8(8):504\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e\u0026Ouml;ZDEMIR N, ŞAHIN ŞK, THE EFFECT OF DEATH ANXIETY, ON PERCEIVED PAIN LEVELS IN ELDERLY PATIENTS. Turkish J Geriatrics/T\u0026uuml;rk Geriatri Dergisi. 2020;23(2).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePuto G, Repka I, Muszalik M. Factors correlating with functional capacity in older people with chronic pain. Int J Environ Res Public Health. 2023;20(3):2748.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Geriatric Pain Measure (GPM-24), Aged, Pain Measurement, Chronic Pain, cross-cultural adaptation, Psychometrics","lastPublishedDoi":"10.21203/rs.3.rs-7784231/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7784231/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eChronic pain is a common issue among older adults that affects not only their physical health but also their psychological well-being and functional abilities. Accurate pain assessment is essential, requiring multidimensional tools adapted to the cultural context of the target population. This study aimed to translate, culturally adapt, and evaluate the psychometric properties of the Persian version of the Geriatric Pain Measure (GPM-24) in Iranian older adults.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This methodological study was conducted in 2025 with a sample of 290 individuals aged 60 years and above living in Sari, Iran. The GPM-24 was translated into Persian and psychometrically tested. Additional tools used included a demographic questionnaire, the McGill Pain Questionnaire (MPQ), the Visual Analogue Scale (VAS), and the Timed Up and Go (TUG) test. Data analysis was performed using SPSS and the lavaan package in R, with significance set at p \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Participants’ mean(SD) age was 69.45(6.47) years. Face and content validity were confirmed with a content validity ratio (CVR) of 75%. Confirmatory factor analysis supported a five-factor structure of the Persian GPM-24, showing acceptable fit indices (χ²/df=1.10, CFI=0.91, RMSEA=0.07). Significant correlations between GPM scores and MPQ (r=0.64), VAS (r=0.85), and TUG (r=0.39) indicated good convergent validity. Reliability was excellent, with Cronbach’s alpha of 0.84 and intraclass correlation coefficient (ICC) of 0.98. Linear regression revealed that age, education, and gender significantly predicted GPM scores (p \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003eThe Persian GPM-24 demonstrates good validity and reliability and is a suitable tool for assessing multidimensional pain in Iranian older adults.\u003c/p\u003e","manuscriptTitle":"Geriatric Pain Measure: Cross-Cultural Adaptation and Psychometric Properties of the Persian Version of Geriatric Pain Measure (P-GPM) among Elderly Adults","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-26 07:01:02","doi":"10.21203/rs.3.rs-7784231/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5829114d-8442-4016-b39b-56430ce0f3f6","owner":[],"postedDate":"November 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-05T07:25:33+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-26 07:01:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7784231","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7784231","identity":"rs-7784231","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}