Additional considerations when assessing pain in older people

This section provides specific advice on assessing pain in older people and should be considered alongside the general approach to assessing pain described in this topic.

Older people are often reluctant to disclose pain for fear of being a burden or developing a drug dependence.

Older people may report less pain than younger people and may experience atypical pain. Pain may not present as a ‘warning sign’ of a serious pathology (eg peritonitis) as it would in a younger person.

Cognitive comorbidities, including neurological disorders, may inhibit the patient’s processing and response times. Allow older patients adequate time to give a history and respond to questions. Older patients may use words such as soreness and aching instead of pain. With the patient’s consent, collateral history may be obtained from a relative or carer. If possible, ask the patient to stand and walk because they may acknowledge pain that was not present at rest.

Patients close to death and in a semiconscious state can still be assessed for pain. Facial expressions (eg grimacing) or stiffening of the body when moved may indicate pain. For detail on assessment and management, see Pain in the last days of life.