Assessment of pain in older adults with severe cognitive impairment

Pain is inadequately recognized and treated in older adults with severe cognitive impairment. Barriers to assessment include the inability of 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 practice, current guidelines and research can provide recommendations to improve assessment practices, such as use of surrogate reporters, direct observation of potential pain indicators, monitoring for changes in baseline activity patterns, and ruling pain out as a potential cause of behaviors.