Assessing pain in nonverbal older adults

Because pain is a subjective experience, pain assessment usually relies heavily on verbal self-report. However, verbal self-report may be difficult or impossible in older adults who are endotracheally intubated, sedated, or unresponsive; or in older adults with communication and cognitive impairments. Patients who can't verbally convey and describe pain are at greater risk for underassessment and undertreatment. To help nurses more confidently identify pain in nonverbal adults, this article describes an evidence-based approach to pain assessment. Provided in six steps, this approach can be applied to or modified for nonverbal older adults across healthcare settings: 1. Faciliate self-report in patients who can communicate nonverbally; 2. Identify potential causes or sources of pain; 3. Observe for indicators or behaviors suggesting pain; 4. Discuss changes in the patient's behavior, mood, and daily function that may indicate pain with all caregivers; 5. If pain is suspected, initiate an analgesic trial; 6. Develop a multimodal pain treatment plan with measurable confort- function-mood-behavior goals.
 

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