Pain in the older adult: an imperative across all health care settings.

Across all care settings for older patients, pain is often ineffectively managed. A gap still exists between best-practice recommendations for pain assessment/treatment and current clinical practice, despite the availability of guidelines. Using a validated pain scale is critical to objectively evaluate pain intensity. Assessing pain in patients with cognitive impairment can be particularly challenging, but using pain behaviors and specifically designed, reliable, and valid tools can assist the process. Other guiding principles when selecting pain assessment tools, such as clinical usability and potential limitations, are discussed. Once pain is identified, the goals of care for older patients center on positively affecting function. Pain undertreatment is a particularly important phenomenon to address, because unrelieved persistent pain can significantly affect older individuals. Approaches tailored to an individual's needs and supported by the best available evidence should be implemented to improve patient outcomes and to increase the consistency with which care is delivered to the growing population of older Americans. The goal of this paper was to provide current evidence-based strategies and tools for pain assessment in older adults, including those with cognitive impairment.