What methods can be used to assess pain in the cognitively impaired elderly?
The use of VAS and VDS scales can be limited in a patient with dementia or cognitive impairment, placing this elder population at an even higher risk for underdiagnosis and treatment. In a study of elderly patients with dementia, 84% were not receiving pain medication, despite diagnoses likely to elicit pain.
In the cognitively impaired, observation for vocalizations or changes in function/behavior patterns can provide insight toward underlying pain. The Hierarchy of Pain Assessment is a tool that can provide a framework for assessment, diagnosis, and treatment in the cognitively impaired. It begins with self-report in those with mild to moderate dementia, progresses to considering common pain etiologies and searching for potential causes of pain, observing behaviors, considering proxy reports by caregivers and family, and lastly an analgesic trial with close follow-up on results.