Background Three versions of Perceived Stress Scale (PSS-14, PSS-10, and PSS-4) are among the most widely used measures of stress. The aim of current study was to validate this instrument in a sample of non-demented elderly adults to facilitate studies of the impact of stress on health. Methods 768 nondemented adults over the age of 70 years completed the PSS-14 questionnaire and other neuropsychological tests. Exploratory Factor Analysis (EFA) was used to determine the underlying factor structure of all PSS versions and Confirmatory Factor Analysis (CFA) was used to test the construct validity of factors. The internal consistency reliability of the scales was assessed using Cronbach's alpha, and concurrent validity was evaluated by examining PSS relation with age, gender, depression, anxiety, and Positive Affect and Negative Affect Schedule (PANAS). Results A two-factor model was the optimal fit for the 14- and 10-item versions of PSS. For the PSS-14, all items’ loadings exceeded 0.4 for one of the two factors except item 12. Therefore, we studied a 13-item version of PSS as well as 10- and 4-item subsets representing PSS-10 and PSS-4. Internal consistency coefficients were satisfactory for the full scale of PSS-13 and PSS-10, but not for PSS-4. Women reported higher levels of stress than men. Higher levels of total PSS scores showed association with higher levels of depression, anxiety, and negative affect, and lower level of positive affect. Conclusions The 13- and 10-item versions of PSS may be used to understand the experience of stress among older adults.

Objectives To determine the prevalence of bodily pain measures (pain intensity and pain interference) in elderly people and their relationship with perceived stress scale (PSS) scores. Design Cross-sectional. Setting Community. Participants A representative community sample of 578 subjects aged 70 and older. Measurements The prevalence of pain intensity and pain interference and their relationship with perceived stress scale scores, demographic factors, past medical history, and neuropsychological testing scores were examined. Pain intensity and pain interference were measured by the SF-36 bodily pain questions. Results The study sample of 578 participants has a mean age of 78.8 years and is 63% female. Bivariate analysis for pain measures showed that higher scores on the perceived stress scale, lower neuropsychological test scores, and medical histories were associated with both pain intensity and interference. Logistic regression showed that higher scores on the perceived stress scale were significantly associated with increased odds of having moderate/severe pain intensity and moderate/severe pain interference (with and without the inclusion of for pain intensity in the models). Conclusion Higher PSS scores are associated with higher levels of pain intensity and pain interference. In this cross-sectional analysis, directionality cannot be determined. As both perceived stress and pain are potentially modifiable risk factors for cognitive decline and other poor health outcomes, future research should address temporality and the benefits of treatment.

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