Gender disparities in perceived health and functional limitations among institutionalized older adults with Age-Related Macular Degeneration: Implications for secondary chronic pain and multimorbidity

Background: Age-related macular degeneration (AMD) causes severe central vision loss in adults >55 without direct ocular pain, but impairs autonomy and quality of life. In long-term care, AMD disproportionately burdens women due to longevity, biological/hormonal, and sociocultural factors, worsening access to care/rehabilitation and amplified multimorbidity (musculoskeletal, cardiovascular, and frailty), falls, dependence, isolation, and caregiver load—all driving secondary chronic pain (physical from immobility/falls; psychosocial/emotional from autonomy loss). Objective: We examined gender patterns in perceived health and functional domains among 314 institutionalized AMD residents (EDAD 2023, INE, Spain), highlighting non-visual limitations as key drivers of secondary pain, with greater female impact. Methods: Secondary analysis of sociodemographics and functional subscales was conducted (high reliability, Cronbach’s α >0.88). Bivariate Pearson correlations (p<0.01) linked difficulties (with/without assistance) to ordinal perceived health. Results: Women predominated (79.3%, n=249), and were older (88.56 ± 8.14 vs. 85.51 ± 13.39 years), with higher severe disability and poorer health perceptions. Strongest correlations were found with negative health: mobility (assisted while walking outside r=0.336*), self-care (assisted eating r=0.376*), and communication/learning (assisted understanding r=0.406*). Visual items were weaker (reading r=0.228*), mitigated by aids, indicating that pain from functional/multimorbid consequences disproportionately affects women. Conclusions: Institutionalized women with AMD face amplified vulnerabilities, poorer health, and higher secondary chronic pain risk from mobility/self-care deficits and multimorbidity. Prioritizing gender-sensitive holistic pain assessment, non-visual interventions, equitable rehabilitation, caregiver VR empathy training, and psychosocial support can reduce the burden in this female-majority group. Future gender-stratified models for personalized care are needed.