COSMIN database

Instruments for the assessment of pain in older persons with cognitive impairment

Stolee, P., Hillier, L. M., Esbaugh, J., Bol, N., McKellar, L., and Gauthier, N.
Pain in older persons with cognitive impairment is often unrecognized and inadequately treated. A major problem associated with this undertreatment is the challenging nature of pain assessment and in particular the selection of accurate and useful assessment instruments. The purpose of this study was to review pain measurement instruments for acute and chronic pain suggested for use with cognitively impaired older persons and to summarize available evidence on their reliability and validity. A systematic search for pain instruments was conducted using several bibliographic databases, supplemented by a manual search of the bibliographies of retrieved articles and review chapters and by articles received from experts and clinicians in the field. Instruments were retained for review when the pain instrument was used or recommended for use with older persons with cognitive impairment. Thirty-nine instruments were reviewed; nine were excluded for various reasons. Of the remaining 30, 18 were self-report and 12 were staff administered. There were no instruments for which all major tests of reliability or validity were reported. Reliability and validity data were basic or unavailable for many instruments. One instrument had excellent validity but no reliability data. The remaining instruments had weak or adequate reliability and validity. The authors conclude that there is a need for further rigorous development and testing of pain instruments for use with cognitively impaired older persons. An adequate instrument would be one component of an effective program for assessment and management of pain in this population.
J Am Geriatr Soc
0002-8614 (Print)
Publication year:
Symptom status:
Physical state
Seniors (65+)
Factors influencing health status and contact with health services
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
PRO / non-PRO:
Non-patient Reported Outcome
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
2 - Interviews
6 - Clinical rating scales
7 - Observations
21 Box Scale
BCL - Behavior Checklist
BPI - Brief Pain Inventory
Checklist of Nonverbal Pain Indicators
DS-DAT - Discomfort Scale –Dementia of Alzheimer Type
Elderly Pain Caring Assessment
Facial Affective Scale   
Facial Grimace Scale
FACS - Facial Action Coding System (versions: Baby FACS)
FPS-R - Faces Pain Scale-Revised (versions: FPS; FPS-6; FPS-7)   
Gracely Box Scale
McGill Present Pain Intensity Scale
MDS-PBS - Minimum Data Set – Pain Behavior Scale
Mechanical VAS - Mechanical Visual Analogue SCale
Memorial Pain Assessment Card
MPQ - McGill Pain Questionnaire (versions MPQ-SF)    
NRS - Numeric Rating Scale (versions: NRS-6; NRS-11; NRS-21)   
PADE - Pain Assessment for the Dementing Elderly
PAINAD - Pain Assessment in Advanced Dementia Scale (versions: C-Painad - Chinese PAINAD)
Pain Behavior Interview
Pain Behavior Measure
Pain Thermometer
Philadelphia Pain Intensity Scale
Proxy Pain Questionnaire
Rand COOP Chart
VAS - Visual Analogue Scale (versions: vertical; horizontal)   
VDS - Verbal Descriptor Scale
Verbal Rating Scale