Various studies suggest a large portion of seniors with dementia have unrecognized, severe pain. A recent study out of the University of Rochester suggests that nearly a third of severe pain cases go unrecognized when seniors have dementia.1-3 Pain in dementia can lead to other problems such as agitation, aggression, hallucinations, delusions, depression, impaired physical function, and increased mortality risk. What can we do?

It can be difficult for family caregivers to recognize pain, even severe pain when loved ones have dementia. Doctors and nurses often rely on reports from family caregivers. When it comes to questions about pain, clinicians should take a moment to try to engage a patient directly. They also need to do observational assessments. Tools such as the Pain Assessment in Advanced Dementia (PAINAD) scale can be used to standardize, quantify, and rate pain assessments. Importantly, tools such as these can guide clinicians in observation techniques that can improve the detection of pain among patients with dementia. Family caregivers can try free tools such as these themselves. Moreover, they can prompt their clinicians to use a pain assessment scale specifically designed for patients with dementia.

Pain Assessment in Advanced Dementia Scale (PAINAD):


  1. Wang J, Monroe TB, Simning A, Conwell Y, Caprio TV, Cai X, Temkin-Greener H, Muench U, Yu F, Ge S, Li Y. Pain management in home health care: relationship with dementia and facility admissions. Pain Management Nursing. 2021 Feb 1;22(1):36-43.
  2. Paulson CM, Monroe T, Mion LC. Pain assessment in hospitalized older adults with dementia and delirium. Journal of Gerontological Nursing. 2014 Jun 1;40(6):10-5.
  3. Wu N, Miller SC, Lapane K, Roy J, Mor V. Impact of cognitive function on assessments of nursing home residents’ pain. Medical Care. 2005 Sep 1:934-9.