The clinician must ask about pain. Obstacles to pain assessment Pain assessment in the elderly presents challenges not often found in younger populations. They are at risk for new painful conditions that can be overlooked because of overlapping symptoms. Arthritis may obscure gout or injury, for example. Psychomotor retardation from depression is often mistaken for senile dementia in the elderly.
Cognitive impairment is a major obstacle to pain assessment.
It is estimated to occur in 15 percent of the elderly. Evaluation processes are slowed or ineffective, especially in the case of Alzheimer's disease, when higher functions such as abstract thought and conceptualization regress first. Thus, new learning and recall are affected the most, while deficits in old skills, such as reading, writing, and calculation, may be less noticeable. Deficits in hearing and sight can further impair communication, and depression confounds the picture. Despite these obstacles, two recent studies found that cognitively impaired elderly patients can respond to commonly used pain intensity scales with reliable reports of pain of the moment.