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Pain Assessment in People with Dementia

Horgas, Ann PhD, RN, FGSA, FAAN; Miller, Lois PhD, RN, FGSA

AJN The American Journal of Nursing: July 2008 - Volume 108 - Issue 7 - p 62–70
doi: 10.1097/01.NAJ.0000325648.01797.fc
FEATURE: How to Try This

Pain in older adults is very often undertreated, and it may be especially so in older adults with severe dementia. Changes in a patient's ability to communicate verbally present special challenges in treating pain, and unrelieved pain can have serious consequences, including declines in physical function and diminished appetite. The Pain Assessment in Advanced Dementia (PAINAD) scale has been designed to assess pain in this population by looking at five specific indicators: breathing, vocalization, facial expression, body language, and consolability. A trained nurse or other health care worker can use the scale in less than five minutes of observation. For an online video showing nurses using the PAINAD scale and other pain-assessment tools, go to

The Pain Assessment in Advanced Dementia (PAINAD) scale employs behavioral indicators for use in patients who can't respond to questions.

Ann Horgas is associate professor and associate dean for research at the University of Florida College of Nursing in Gainesville. Lois Miller is a professor at the Oregon Health and Science University School of Nursing in Portland.

The authors of this article have no significant ties, financial or otherwise, to any company that might have an interest in the publication of this educational activity.

Contact author: Ann Horgas,

How to Try This is a three-year project funded by a grant from the John A. Hartford Foundation to the Hartford Institute for Geriatric Nursing at New York University's College of Nursing in collaboration with AJN. This initiative promotes the Hartford Institute's geriatric assessment tools, Try This: Best Practices in Nursing Care to Older Adults: The series will include articles and corresponding videos, all of which will be available for free online at Nancy A. Stotts, EdD, RN, FAAN (, and Sherry A. Greenberg, MSN, GNP-BC (, are coeditors of the print series. The articles and videos are to be used for educational purposes only.

Routine use of Try This tools or approaches may require formal review and approval by your employer.

The Pain Assessment in Advanced Dementia (PAINAD) scale relies on observation of five behavioral indicators of pain.

© 2008 Lippincott Williams & Wilkins, Inc.