Assessment and measurement of pain in older adults

Abstract

A variety of self-report pain measurement tools are appropriate to use with older adults in both clinical and research settings, depending on the individuals' cognitive, verbal, auditory, and motor abilities and educational level. It should be noted, however, that research examining the cognitively impaired older adult's ability to use pain scales has provided limited evidence of understanding of tool use, validity of pain report, and determination of levels of cognitive impairment to direct tool choice. At this time, the key for practice is to find an assessment tool that patients can easily use and consistently use with each assessment. Although VDS, PT, NRS, and FPS have acceptable validity when used among older adults, studies suggest that older adults prefer VDS and NRS. Because of its established psychometric properties, increased ability to discriminate levels of pain, and common use in clinical practice for other populations, use of a 0 to 10 NRS is a good first choice for most older adults. For adults with mild to moderate cognitive impairment, the PT and VDS are recommended, followed by the FPS, for measuring pain intensity, and the pain map (discussed earlier) is suggested for determining the location and extent of pain. If the patient has severe cognitive deficits, other methods of assessment are necessary, including observation of behavior and surrogate reporting.