Elderly Patient

In order to provide optimal treatment for pain, care providers must ensure their pain assessment processes are thorough, accurate and reliable. Whilst a number of pain assessment tools exist, generally, the usage of formal pain assessments among care providers remains low. There are several reasons for this, such as; a high degree of subjectivity, unintentional assessor bias, highly time-consuming, poor reporting of data and lack of engagement from staff.

There are several pain assessment scales for elderly people available and yet still there is a gap in consistent, reliable pain assessment across the sector. It is therefore important to review the needs of all residents to identify the best route forward in ensuring all pain is effectively assessed and therefore managed. When looking at the average care home population, approximately 70% of residents live with a form of dementia. It is assumed then, that the average care home looks after people at different stages of their dementia journey and therefore a range of self-reporting abilities.

Pain assessment scales for elderly populations for people who cannot self-report their pain

There are many reasons why a care home resident may not be able to reliably self-report their pain, however, dementia is a leading cause in residential aged care. This poses significant challenges to the care sector, as a high degree of clinical knowledge and training is required to ensure manual pain assessments are effective.


There are many ways in which carers can improve the accuracy of assessments and pain scales for elderly people. These include:

    • High level of knowledge on an individual’s usual behaviours and routines.
    • Know the residents’ history of painful conditions.
    • Be in regular contact with relatives
    • Collaboration with healthcare professionals

However, even with these in place, there will be a significant degree of variability between different assessors, including unintentional assessor bias.

To combat the widespread subjectivity of assessing pain, PainChek has developed its AI-powered assessment tool with a binary checklist-based approach to minimise this barrier as much as possible. In contrast to existing paper-based assessments which ask the assessor to rank (usually between 0-3) the severity of an indicator of pain, the PainChek assessment asks the assessor whether a pain indicator is either present or absent.

One assessment tool for all care home residents

A significant challenge across aged care has been that not one pain assessment can be used for all residents. This comes back to a person’s ability to self-report.

Residents who can self-report

For people who can self-report, the gold standard in assessing pain is to ask the person to rate the severity of their pain between 0-10, known as the Numeric Rating Scale (NRS). This allows healthcare professionals to treat the person’s pain to the best of their knowledge. It should also be noted however that there are still barriers associated with self-reporting as discussed in the US pharmacist. Here they identify how psycho-cultural biases can still impact self-reported pain assessments:

    • Fears of side effects
    • Altered tolerance to a specific drug(s)
    • Potential addiction
    • Loss of independence
    • The belief that pain is an evitable part of ageing
    • Belief pain reflects weakness.

Whilst these barriers are out of the realm of control for healthcare professionals, it is important to be aware of them. As discussed above, it is important for healthcare professionals to have in-depth knowledge of a person’s background, usual behaviours and remain close to relatives and loved ones to improve their ability to identify any potential barriers to a person’s self-reported pain.

Residents who cannot self-report

There are many challenges associated with assessing the pain of someone who cannot self-report their pain. There are many paper-based methods available, but remain widely underused and lack consistency. These challenges are highlighted in a whitepaper on this topic here. The whitepaper outlines the barriers for the sector and discusses how PainChek works to alleviate these issues.

However, it wasn’t until recently, when PainChek introduced PainChek Universal that the ability to utilise a single solution for all residents, regardless of their ability to self-report, arose. PainChek Universal builds upon the original PainChek solution to incorporate the NRS. Now, as someone completes an assessment, the system prompts the user to indicate whether they are recording an NRS assessment or a PainChek assessment, thus allowing all residents to benefit from PainChek’s reporting suite.

To summarise, there have been several pain assessment scales for elderly populations over the years. However, due to the various barriers highlighted, there has been a lack of consistency surrounding the frequency of these assessments and their outcomes. PainChek is working to close that gap and empower care providers in ensuring pain is effectively assessed, documented and followed up to ensure no pain goes untreated.

Want to learn more? Get in touch with the team today.

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