Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. Topics in Geriatric Rehabilitation www.topicsingeriatricrehabilitation.com 269 Topics in Geriatric Rehabilitation • Volume 34, Number 4, 269-273 • Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/TGR.0000000000000209 This is a qualitative study that sought to understand the way in which oldest older adults perceive and deal with pain during activities of daily living. We interviewed 32 Brazilian older adults 80 years and older participating in the interna- tional multicenter study of Back Complaints in the Elderly. The following categories emerged from the content analysis: “The constant experience of pain,” “Understanding pain,” and “Performing daily living activities in pain.” Although pain is a constant experience and understood as something inherent to aging and difficult to explain, many older adults continue to perform daily activities while in pain and/or despite pain. Key words: activities of daily living, aging, anthropology, gerontology, oldest older adult, pain, qualitative study Perception of Oldest Older Adults About Pain in Performing Daily Activities Bárbara Pires de Andrade Lage Cabral, MD; Karla Cristina Giacomin, PhD; Simone Costa de Almeida, PhD; Leani Souza Máximo Pereira, PhD; Marcella Guimarães Assis, PhD I n an anthropological approach, pain is an existential fact rather than a purely biological factor, since the indi- vidual suffers in its totality and not only in his or her physical body. 1 Nonetheless, the same person can deal with pain in a variety of ways throughout life. Faced with the same painful stimulus, human beings react in a particular way according to their culture, their values, and their rela- tionship with what surrounds them. 1,2 By belonging to a culture that values and understands their pain, pain is sof- tened and they manage to better control the situation. On the contrary, abandonment and loneliness can increase painful sensation. 1 Thus, it is impossible to fully compre- hend the pain phenomenon without considering the dimension of the meaning of pain. Individuals in pain suffer and question their way of being in the world; they limit their initiative and their social relationships. 2 Pain becomes an obstacle to the perfor- mance of everyday activities, as it compromises individuals’ confidence and their freedom to act in the world. 3 It dis- rupts the flow of everyday life, transforms relationships, promotes social isolation, and affects all activities of the subjects, including their preferred activities. In feeling pain, humanity suffers as a whole. 1 In addition to compromising the quality of life of older adults, pain can lead to a process of disability 4 that can be operationalized by the need for assistance in carrying out activities of daily life. These are divided into 3 groups: basic activities of daily living (BADL), instrumental activities of daily living (IADL), and advanced activities of daily living (AADL). BADL involve daily tasks–related self-care with the body and survival such as bathing, eating, and dress- ing. IADL relate to preserving community life, for example, managing money, shopping, and tidying up the house. 5 AADL are related to higher levels of functionality and demand more sophisticated learning, being influenced by more complex cognitive, physical, sensory, and psychoso- cial abilities such as practicing physical activity, traveling, and participating in religious or social groups. 6 In a study with older adult patients with osteoporosis, osteoarthritis, and low back pain, the participants presented greater dif- ficulty in performing the following activities of daily living (ADL): cleaning the house, kneeling, or squatting; going up and down stairs without assistance; and walking more than 500 m without walking-assist devices. Moreover, it was noticed that advancing age and intense pain were associ- ated with a greater deficit in participation in ADL. 7 Thus, the present study focuses on oldest older adults (older than 80 years) to understand how they perceive and deal with pain during ADL. METHODS AND MATERIALS This is a qualitative study based on the anthropological ref- erence. The participants were older adults of both genders who participated in a longitudinal, multicenter, interna- tional study Back Complaints in the Elderly ( BACE). 8 Among this group, only the older adults 80 years old or older participating in the BACE-Brazil Study were contacted by telephone and consulted about their availability and interest in participating in this research. Older adults with- out cognitive impairments who reported feeling pain and who agreed to participate in the research were interviewed. The exclusion criteria were as follows: refusal or failure to be contacted after 3 or more telephone calls. Among the Author Affiliations: Postgraduate Program in Rehabilitation Sciences (Drs Cabral, Pereira, and Assis), and Department of Occupational Therapy (Dr de Almeida), Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; and Center for Studies in Public Health and Aging (NESPE), Oswaldo Cruz Foundation, Belo Horizonte, MG, Brazil (Dr Giacomin). The authors declare that they have no conflicts of interest regarding this study. Correspondence: Marcella Guimarães Assis, PhD, Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais, Avenida Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, MG, Brazil (mga@ufmg.br).