[Pain assessment in the geriatric patient. Part I: pain diagnostics]

The geriatric pain patient is a frail patient at risk of losing the ability to take care of him/herself and, therefore, at risk of losing personal independence. There is a growing probability of comorbidity and of cognitive impairment with increasing age. One of the main objectives of geriatrics is the preservation and promotion of the capacity to perform everyday tasks (activity) and to participate in social life (participation). Comorbidity impacts on disability to a higher degree than pain does. Cognitive restrictions contribute to a decreased validity of the assessment instruments. For these reasons, geriatric assessment has to be multidimensional and has to take into account the patient's psychological and social situation in addition to the pain and physical status. In geriatrics, a set of standardized instruments is used to accomplish this task. It may not be practical to handle the whole set in the practice of the pain specialist; nevertheless, some simple measures for the assessment of functional as well as cognitive status should be incorporated into the diagnostic procedure for the elderly pain patient. Written questionnaires should not be used in cases of sensory or cognitive impairment of the patient. The adequate tool for these patients is a structured pain interview.