People of any age have the right to appropriate assessment and management of pain.  They go hand in hand.  A provider has a duty to assess pain appropriately and within the standard of care.

Pain should be assessed in all individuals living in nursing homes.  Caregivers have a duty to use different techniques, depending on the individual’s status.  For instance, in the case of Pain Assessment in Advanced Dementia, it is imperative to use proper tools such as PAINAD Tool at the following time points:

1. At admission to the Nursing Home to establish an initial baseline level of behaviors that may be related to pain
2. At each quarterly nursing review
3. Every shift – in older adults with behaviors suggesting pain is not controlled
4. Any time a change in pain status is reported
5. Following a pain intervention to evaluate treatment effectiveness (within 1-2 hours)

Furthermore, “assessment approaches, including tools, must be appropriate for the individual. Special considerations are needed for those with difficulty communicating. Family members should be included in the assessment process, when possible” per an industry run long term care site.  It is important to note pain can exist even when no physical cause can be found. Thus, pain without an identifiable cause should not be routinely attributed to psychological causes or discounted, and people can have different pain levels and tolerances.

“Unrelieved pain has adverse physical and psychological consequences. Therefore, clinicians should encourage the reporting of pain by individuals who are reluctant to discuss pain, deny pain when it is likely present, or fail to follow through on prescribed treatments,” according to GeriatricPain.org.

A caregiver should actually observe the resident and be able to weigh the patient’s acts against his normal environment.  There are a variety of pain management and education resources available.

from Geriatric Pain. 

See also, Recommendations for Pain Assessment in Older Adults.