Challenges of pain assessment in aged care 1

This post was created in partnership with VCare International, New Zealand’s leading Retirement Village and Aged Care software solution provider.

The International Association for the study of pain (IASP) reports that pain is a prevalent problem for older persons, with chronic pain affecting more than 50% of older persons living in the community setting, and more than 80% of aged care residents1.

Pain management in residential aged care facilities and care centres is a challenge that staff are constantly managing. Several barriers make effective pain management more difficult to control. By providing an evidence-based approach to pain assessment and management, your team will have the knowledge and expertise to provide your residents with the best quality of life.

5 common challenges of pain assessment and pain management in residential aged care include:

    1. Cognitive impairment of residents
    2. Communication difficulties between residents and staff
    3. Maintaining up to date records of pain assessments
    4. Lack of familiarity between residents and staff
    5. Staff knowledge around the variety of pain assessment tools

Below, we share how carers and nurses can effectively navigate these challenges to improve quality of care for residents.

1. Cognitive impairment of residents

Cognitive impairment refers to when a person has trouble with aspects of their day-to-day life such as memory, learning new skills, recognising people or in more advanced cases, such as people with dementia, trouble speaking and understanding.

When residents have any form of cognitive impairment, it is challenging and sometimes impossible to carry out an accurate pain assessment with verbal or numerical pain scales. Each individual’s pain experience is subjective and these methods require patients to understand questions to articulate or demonstrate the correct response.

Pain assessment tools can be used in these situations to enhance the reliability of existing methods to give a more comprehensive pain assessment. Tools such as PainChek use AI driven facial recognition technology, together with a modern assessment framework to more accurately record pain in older people with cognitive impairment who cannot accurately verbalise or demonstrate their pain level. Incorporating tools into the pain assessment process can result in better outcomes for residents and staff.

2. Communication difficulties between residents and staff

While cognitive impairment can cause communication difficulties between staff and residents, so can something as simple as not speaking the same language. Not being able to communicate effectively can cause frustration for residents, and in some cases, this frustration can be mistaken for pain and be misdiagnosed by staff.

Not only can communication difficulties cause frustration for residents and staff, but they can also result in inappropriate pain management if a resident cannot understand questions and therefore not verbalise or demonstrate their pain.

Many facilities now have the luxury of having a diverse staffing unit with knowledge in a wide range of languages; however, ensuring the correct staff members are assigned to the correct resident is essential but sometimes not possible. As with cognitive impairment, similar steps can be taken to ease the burden of communication difficulties between staff and residents using digital pain assessment tools in aged care, such as PainChek.

Challenges of pain assessment in aged care4

3. Maintaining up to date records of pain assessments

Traditional paper-based methods of recording pain assessments can be challenging, and assessments are carried out regularly and constantly recorded on paper files. One of the most significant issues with a paper-based system in the aged care sector is the size of residents’ files and how difficult and time-consuming it is to find relevant information quickly. In addition, pain assessments can be missed or not completed due to human error or the loss of paper files.

Incorporating an electronic management system into your facility can help ease the stresses caused by paper-based methods. For example, using an electronic management system such as VCare allows resident records to be available at the press of a button, and records are always up to date. This ensures staff always have the information they need to provide the highest level of care to residents, and their assessments have factored in previous actions.

4. Lack of familiarity between residents and staff

Intuition plays a massive part in pain recognition, especially in those residents with chronic pain. Staff who are familiar with residents, especially those with a long pain history or those with dementia or other medical conditions that cause the residents to deteriorate at varying rates, are better able to identify changes in behaviour.

In aged care, while staff develop relationships with residents, shift work often results in changes in who manages and carries out pain assessments on specific residents. These changes and lack of familiarity with the resident can result in resistance from residents to complete assessments, misdiagnosis of pain changes and unnecessary stress for both staff and resident.

To overcome the lack of knowledge, pain management for residents in large facilities or those with rapidly changing medical or pain conditions can be improved with detailed notes, constant communication between staff and the use of stored data in systems such as PainChek or VCare.

5. Staff knowledge around the variety of pain assessment tools

The three categories of pain assessment are verbal, observational, and behavioural. While they all have varying benefits depending on the needs and situation of the resident, none can be completely reliable and valid when it comes to carrying out pain assessments of residents who live with any degree of cognitive or physical impairment.

While these assessments can be supplemented with electronic pain management tools as mentioned above, it is essential for staff to understand which method of pain assessment should be used with which resident. Better care outcomes for patients can be achieved when continual staff training is paired with the latest management tools.

Looking to improve pain assessment in your facility? Learn more about the PainChek and VCare integration here.


1 Ferrell et al. 1995, Helme & Gibson 2001
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