Background <p>Falls impose a substantial disease burden on older adults, yet whether ADL impairment mediates the pain-falls pathway remains unclear. This study investigates whether ADL impairment acts as a mediator in the relationship between pain and incident falls among Chinese community-dwelling older adults.</p> Methods <p>We conducted a prospective cohort study using data from the China Health and Retirement Longitudinal Study (CHARLS) on respondents aged ≥ 60 years. Baseline and follow-up information was obtained through structured interviews. Logistic regression first quantified the pairwise associations among pain, ADL impairment, and falls. Subsequently, bootstrap-based mediation analysis was applied to test whether ADL impairment mediated the pain-falls relationship, restricting the model to variates that were significant in all three logistic regressions.</p> Results <p>A total of 6,280 participants was included in the analysis. Pain frequency (PF) (OR = 1.16, 95% CI: 1.10 to 1.22) and number of pain sites (NPS) (OR = 1.22, 95% CI: 1.13 to 1.31) were significantly associated with falls. PF (OR = 1.56, 95% CI: 1.49 to 1.63) and NPS (OR = 1.96, 95% CI: 1.83 to 2.11) were significantly associated with ADL impairment. ADL impairment was significantly associated with falls. Mediation analysis revealed that ADL impairment mediated the association between PF (mediation effect = 6.06e-03, proportion = 22.47%) and falls, and between NPS (mediation effect = 1.10e-02, proportion = 25.01%) and falls. Specifically, the mediating effect of impairments in dressing, bathing and toileting were significant.</p> Conclusion <p>Our study illuminates the mechanistic cascade from pain to falls via ADL impairment and offer concrete, modifiable targets for fall-prevention programs tailored to Chinese community-dwelling older adults. Coupling effective pain management with targeted support for dressing, bathing, and toileting is likely to curtail fall risk and enhance quality of life in older adults.</p>