Pain Assessment in Verbal, Well-Oriented Geriatric Patients
For verbal, well-oriented geriatric patients, self-report using standardized pain assessment tools is the most accurate and reliable method for pain assessment. 1
Recommended Pain Assessment Tools
Numerical Rating Scale (NRS): Ask "What number describes your worst pain in the past 24 hours from 0 (no pain) to 10 (worst pain you can imagine)?" 1
Verbal Descriptor Scale (VDS): Offers phrases describing different pain intensity levels (e.g., "no pain," "mild pain," "moderate pain," "severe pain," "extreme pain") 1
Visual Analogue Scale (VAS): A 10-cm line with "no pain" on the left and "worst pain imaginable" on the right 1
Faces Pain Scale (FPS): Shows progressively distressed facial expressions that patients select based on their pain intensity 1
Comprehensive Pain Assessment Approach
Assess multiple pain dimensions: At minimum, ask about "current" pain, "worst" and "usual" pain in the past 24 hours 1
For more thorough assessment: Include worst pain in past week, pain at rest, and pain with movement 1
Select appropriate tool: Choose based on the patient's ability to read, hear, and understand how to complete the assessment 1
Regular reassessment: Pain should be regularly evaluated after interventions to ensure adequate pain relief 1
Common Pitfalls in Geriatric Pain Assessment
Undertreatment: Studies show 42% of patients over 70 years don't receive adequate analgesia despite reporting moderate to high pain levels 1
Age bias: Older adults experience the same pain intensity as younger patients with similar conditions (e.g., fractures, dislocations) but often receive less pain medication 1
Communication barriers: Even verbal, well-oriented geriatric patients may underreport pain due to stoicism, fear of consequences, or belief that pain is normal with aging 1, 2
Cognitive fluctuations: Even well-oriented patients may have subtle cognitive changes affecting pain reporting at different times of day 1
Supplementary Assessment Approaches
Observe pain behaviors: Even in verbal patients, observe for nonverbal cues such as facial expressions, body movements, and changes in function 1
Family/caregiver input: Obtain collateral information about usual pain behaviors and baseline function 1
Cultural considerations: Be aware that cultural and linguistic diversity may impact pain expression and reporting 1
Pain Management Considerations
Early intervention: Administer analgesics promptly when pain is identified 1
Medication selection: Consider age-related changes in pharmacokinetics and pharmacodynamics 1
Non-pharmacological approaches: Implement measures such as immobilizing affected limbs and applying dressings or ice packs alongside medication 1
Regular monitoring: Frequently assess for medication effectiveness and adverse effects 1