Assessment of pain in older people-the key to effective management

Older people are the section of the population which experiences the greatest frequency of painful conditions but receives the least successful pain management. The provision of appropriate pain-relieving interventions depends on accurate assessment. Physical and psychological changes associated with ageing such as impairments in hearing, vision and dexterity may reduce the clinical utility of standard assessment scales. Where intensity is measured, simple scales such as the verbal rating scale and numeric rating scale are recommended, while the visual analogue scale is not. For those with cognitive impairment or other communication difficulties pain may be inferred from behavioural cues. The use of appropriate language and an understanding both of the beliefs of older people about their pain and their personal strategies for pain management are essential elements of assessment.