Recognizing pain in the institutionalized elder with dementia

Of the approximately 2 million elders residing in nursing homes, experts estimate that 49% to 83% are experiencing pain. Elders in nursing homes have a high incidence of cognitive impairment, possibly as high as 50%. The verbalization of pain can be difficult for those with cognitive impairment, and elders with dementia may be undertreated and unknowingly allowed to suffer. This article summarizes what is known about pain assessment in the cognitively impaired elderly who reside in nursing homes. Clinical practice implications were derived from this summary. Until accurate ways of assessing pain are discovered, nurses must be educated to the prevalence of pain in cognitively impaired elders and the subtle ways in which it might be detected. Nursing practice is about eliminating suffering. Relieving suffering in those most vulnerable and unable to express their needs is critical.