To study the effect of utilizing a combination of three easily-administered pain assessment instruments on the frequency of diagnosing pain among elderly nursing home residents, a Moss-sectional study was conducted at two academic skilled nursing facilities: an 899-bed facility in Long Island, New York, and a 201-bed facility in Maryland Heights, Missouri. A total of 305 randomly selected elderly (greater than or equal to 60 years) subjects were enrolled in this study. The study involved medical records abstracting and patient interviews. Pain wets assessed in 150 (49%) subjects using the question "Do you have pain?" (Group 1). In the remaining 155 (51 %) subjects (Group 2), pain was assessed using three pain assessment instruments: the visual analog scale, the behavior (faces) scale and the pain descriptive scale. The overall frequency of diagnosing pain was greater in the subjects in Group 2 compared to the subjects in Group, 1 (30 % vs. 15 %, P < 0.01). Using the three pain assessment scales greatly increased the frequency of diagnosing pain among the old-old (<greater than or equal to> 85 years) residents (32 % Group, 2 vs. 6% Group 1, P < 0.001). The frequency of diagnosing-pain among cognitively impaired residents showed a similar trend (16 % Group 2 vs. 10 % Group 1, P = 0.2). These data indicate that using three easily-administered pain assessment scales increased the frequency of diagnosing pain among nursing home residents. J Pain Symptom Manage 2001;21:450-455. (C) U.S. Cancer Pain. Relief Committee, 2001.