Challenges of Assessing Pain in the Older Patient
Assessment of pain is the critical first step in the management of pain. It is important to identify the cause of the pain so that it can be treated appropriately. This requires a complete history, including medication use, and physical examination. Assessment of pain in the older adult can be complicated by numerous factors, including the high prevalence of disability, dementia and sensory disturbances in this population. Difficulties with communication of pain intensity can lead to the undertreatment of pain in the cognitively impaired.
Various tools for assessing pain have been developed and several have been validated in the older population. In cognitively intact older persons, several pain assessment tools have been validated including the Verbal Descriptor Scale, Visual Analogue Scale, Numerical Rating Scale and Faces Pain Scale.[6,21–25] With cognitive decline or acute delirium states, assessment of pain is more challenging. In addition, vision and hearing impairments, common in the older population, may confound the assessment of pain. In nonverbal cognitively impaired individuals, behavioral pain scales may be more reliable.[26,27] Assessment of pain in the older adult can be more time consuming and difficult and a thorough assessment should include, if possible, direct patient response, provider observation, as well as input from family and/or caregivers. Table 1 summarizes several pain assessment tools that have been validated in the elderly.[22,25,27,28]
Aging Health. 2011;7(6):813-828. © 2011 Future Medicine Ltd.