The pain scales must be administered with sensitivity to the patient's disabilities. For example, large print or hearing devices may be helpful. Cognitively impaired patients may slightly underreport pain, require time to assimilate questions about pain, and become easily distracted, but they can reliably report pain occurring at the moment. This finding has implications for history taking, patient instructions, and compliance with treatment. Pain assessment in the cognitively impaired requires frequent monitoring of pain to be useful.
More time is needed to allow the impaired elderly patient to understand and respond to questions.
Family caregivers may be the source of history, but accuracy may require the combined perceptions of caregivers and patient as caregivers have their own biases. Instructions must be written to ensure that the patient and all caregivers receive the same information. In the hospital, one of the most efficient ways to assess pain is to measure it as a vital sign and record it frequently on the vital sign sheet. All care providers will see the pain measurement, and treatment can be altered according to patient response. Number scales in vertical format can be useful for non-English speaking patients, once explained in the patients' language.