Ms Booker, thank you for your response to our article. We appreciate your efforts to ensure all critically ill elderly patients pain is managed effectively. You have made several great points, all of which are backed by research, and we agree that nurses need a wide range of assessment tools and strategies to ensure each patient has an individualized pain management plan. We support your recommendations for using The Faces Pain Scale-Revised and the Iowa Pain Thermometer. Thank you. We point out that the Critical-Care Pain Observation Tool also works well in those unable to rate their own pain. We also mention that it is best to "partner" with patients in managing their care and to respect elders' decisions about their pain management. The strategies we recommend in the article have worked well for us, with positive outcomes for the patients. Finally, the alternative measures we recommend are those to be performed by practitioners in the intensive care unit, not by the elders at home. Thanks again for your letter. We believe that scholarly discussions ultimately improve care for all.

Sincerely,

Binta Diallo, BSN, RN, CRRN

Neurosurgery Intensive Care Unit

University of North Carolina Hospital

Chapel Hill

Donald D. Kautz, PhD, RN, CRRN, CNE, ACNS-BC

The University of North Carolina

Greensboro