Pain Assessment Strategies in Older Patients

The prevalence of pain and pain undertreatment in older persons, along with the many potential detrimental consequences of undertreated pain, pose a substantial burden to the individual, their family, and society. An accurate pain assessment is the foundation for treating pain; yet, thorough pain assessments and regular reassessments are too often neglected. Older adults typically present with multiple pain etiologies, making it all the more imperative that a comprehensive assessment is conducted. Comprehensive assessments should include a detailed investigation of a patient's pain and medical history, a physical examination, and diagnostic testing, if needed. Both the impact of pain and its severity should be established by questioning about the presence of pain and using pain assessment instruments. Tools for pain assessment should be tested in older adult populations to establish reliability, validity, and sensitivity to changes from treatment. Self-report is the gold standard for assessing pain; however, in many clinical circumstances with older adults, the patient's verbal report is unobtainable. Following an unsuccessful attempt at self-report from a nonverbal older adult, the potential causes of pain should be explored. Direct observation can then be used to identify behaviors suggestive of pain, and the patient's response to an analgesic trial can be observed. A pain behavior tool can also provide useful information suggesting the presence of pain. Perspective: A comprehensive assessment of pain in older persons is essential, although more complex and challenging due to comorbidities, sensory and cognitive impairments, and misbeliefs about pain in aging. Best practice recommendations guide approaches and tool selection to facilitate effective pain assessment. (C) 2011 by the American Pain Society