Assessing Pain in Persons with Dementia

WHY: There is no evidence that persons with dementia physiologically experience less pain than do other older adults. Rather than being less sensitive to pain, cognitively-impaired elders may fail to interpret sensations as painful, are often less able to recall their pain, and may not be able to verbally communicate it to their care providers. As such, cognitively impaired older adults are often under-treated for pain (Horgas & Tsai, 1998). As with all older adults, those with dementia are at risk for multiple sources and types of pain, including chronic pain from conditions such as osteoarthritis and acute pain. Untreated pain in cognitively impaired older adults can delay healing, disturb sleep and activity patterns, reduce functioning, reduce quality of life, and prolong hospitalization. TARGET POPULATION: Older patients who, because of cognitive impairments, may not be able to be assessed for pain using standardized pain assessment instruments. Thus, beginning with the individual’s reentrance into the hospital, whether through planned or emergent entry, interpreting behaviors and assessing pain is essential. BEST TOOLS: Currently, there are few valid and reliable tools available specifically to measure pain in older adults with dementia. We recommend the following: 4 Use a standardized tool to assess pain, if possible. Many persons with dementia can respond to pain measures such as the Verbal Descriptor Scale (Herr, 2002; see also Try This on pain assessment). This tool measures pain intensity by asking participants to select a word that best describes their present pain (e.g., no pain to worst pain imaginable). This measure has been found to be a reliable and valid measure of pai