Although pain is common in older persons, it is often unrecognized and under-treated, especially among older persons with cognitive impairment. One reason for this may be the lack of generally accepted, reliable and valid instruments for the assessment of pain in persons with cognitive impairment. We undertook a review of pain assessment tools that have been suggested for use with cognitively impaired older persons. A comprehensive literature search was conducted, including a search of computerized bibliographic databases, manual journal searches, bibliographies of retrieved articles, and information from health professionals working with older persons. All tools were evaluated and rated for reliability and validity (thoroughness of testing and results)using the criteria outlined by McDowell and Newell(1996). We identified 27 pain assessment instruments that have been suggested for use with cognitively impaired older adults. Of these tools, five had not yet been tested with this population. The majority of these tools were self-report (n=14) or behavioural measures (n=7). Only one tool reported on all major forms of reliability or validity testing. Evidence for reliability was not available for twelve of the tools and eight tools had no validity data. Only one tool had excellent reliablity and validity; the remaining had adequate or weak ratings. Rigorous testing of pain assessment tools for cognitively impaired older persons has been limited. Further research is required to develop and test instruments that will accurately assess pain in older person with cognitive impairment and lead to more effective identification and managemant of pain in this population.
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