n CHAP T E R 6 n Older Adults With Severe Cognitive Impairment: Assessment of Pain

Despite the prevalence and consequences of pain among older adults, pain is inadequately recognized and treated, especially in those with severe cognitive impairment. Among the barriers to assessment of pain in this challenging population are the inability of some older patients to communicate their pain experience and the misconception that pain is less severe in those with cognitive impairment. Although continued research is needed to evolve the evidence for best practices, current guidelines and research can provide recommendations to improve assessment practices when caring for this vulnerable popula-tion. Use of surrogate reporters, direct observation of potential pain indicators, monitoring for changes in baseline activity patterns, and ruling pain out as a possible cause of behaviors through nondrug and analgesic trials are identified as key elements of an approach to assessing pain in those with severe cognitive impairment. 92 n Keela Herr and Sheila Decke