{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T11:49:09Z","timestamp":1773056949555,"version":"3.50.1"},"reference-count":53,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2017,6,1]],"date-time":"2017-06-01T00:00:00Z","timestamp":1496275200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacy"],"abstract":"<jats:p>Elderly people are susceptible to both falls and cognitive impairment making them a particularly vulnerable group of patients when it comes to pain assessment and management in the emergency department (ED). Pain assessment is often difficult in patients who present to the ED with a cognitive impairment as they are frequently unable to self-report their level of pain, which can have a negative impact on pain management. This paper aims to review how cognitive impairment influences pain assessment in elderly adults who present to the ED with an injury due to a fall. A literature search of EMBASE, ProQuest, PubMed, Science Direct, SciFinder and the Curtin University Library database was conducted using keyword searches to generate lists of articles which were then screened for relevance by title and then abstract to give a final list of articles for full-text review. Further articles were identified by snowballing from the reference lists of the full-text articles. The literature reports that ED staff commonly use visual or verbal analogue scales to assess pain, but resort to their own intuition or physiological parameters rather than using standardised observational pain assessment tools when self-report of pain is not attainable due to cognitive impairment. While studies have found that the use of pain assessment tools improves the recognition and management of pain, pain scores are often not recorded for elderly patients with a cognitive impairment in the ED, leading to poorer pain management in this patient group in terms of time to analgesic administration and the use of strong opioids. All healthcare professionals involved in the care of such patients, including pharmacists, need to be aware of this and strive to ensure analgesic use is guided by appropriate and accurate pain assessment in the ED.<\/jats:p>","DOI":"10.3390\/pharmacy5020030","type":"journal-article","created":{"date-parts":[[2017,6,1]],"date-time":"2017-06-01T10:36:36Z","timestamp":1496313396000},"page":"30","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Pain Assessment of Elderly Patients with Cognitive Impairment in the Emergency Department: Implications for Pain Management\u2014A Narrative Review of Current Practices"],"prefix":"10.3390","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0639-0823","authenticated-orcid":false,"given":"Joshua","family":"Jones","sequence":"first","affiliation":[{"name":"School of Pharmacy, Curtin University, Western Australia 6102, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0068-5006","authenticated-orcid":false,"given":"Tin","family":"Sim","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Curtin University, Western Australia 6102, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeff","family":"Hughes","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Curtin University, Western Australia 6102, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2017,6,1]]},"reference":[{"key":"ref_1","unstructured":"Registered Nurses\u2019 Association of Ontario (2013). Assessment and Management of Pain, Registered Nurses\u2019 Association of Ontario. [3rd ed.]."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"914","DOI":"10.12968\/bjon.2008.17.14.30659","article-title":"Guidance for the assessment of pain in older adults: A literature review","volume":"17","author":"Schofield","year":"2008","journal-title":"Br. J. Nurs."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1847","DOI":"10.1046\/j.1532-5415.2002.50514.x","article-title":"Outcomes of pain in frail older adults with dementia","volume":"50","author":"London","year":"2002","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1007\/s00391-013-0475-y","article-title":"Self- and proxy report for the assessment of pain in patients with and without cognitive impairment","volume":"3","author":"Lukas","year":"2013","journal-title":"J. Gerontol. Geriatr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1159\/000022133","article-title":"Visual analogue scales for pain assessment in Alzheimer\u2019s disease","volume":"46","author":"Scherder","year":"2000","journal-title":"Gerontology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1067\/mgn.2000.105793","article-title":"Comparison of pain assessment instruments in cognitively intact and cognitively impaired nursing home residents","volume":"21","author":"Wynne","year":"2000","journal-title":"Geriatr. Nurs."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.ejpain.2008.05.001","article-title":"Influence of dementia on multiple components of pain","volume":"13","author":"Kunz","year":"2009","journal-title":"Eur. J. Pain"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1016\/S0140-6736(16)31678-6","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990\u20132015: A systematic analysis for the global burden of disease study 2015","volume":"388","author":"Vos","year":"2016","journal-title":"Lancet"},{"key":"ref_9","unstructured":"World Health Organization (2007). WHO Global Report on Falls Prevention in Older Age, World Health Organization."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.jsr.2016.05.001","article-title":"The direct costs of fatal and non-fatal falls among older adults-united states","volume":"58","author":"Burns","year":"2016","journal-title":"J. Saf. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.archger.2013.07.006","article-title":"Accidental falls, health-related quality of life and life satisfaction: A prospective study of the general elderly population","volume":"58","author":"Stenhagen","year":"2014","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_12","unstructured":"Bradley, C. (2017, May 05). Trends in Hospitalisations due to Falls by Older People, Australia 1999-00 to 2010-11 (Injury Research and Statistics Series No. 84. Cat. No. INJCAT 160), Available online: Http:\/\/www.aihw.gov.au\/publication-detail\/?id=60129543594."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1111\/jocn.13529","article-title":"Risk factors for incident delirium in an acute general medical setting: A retrospective case-control study","volume":"26","author":"Tomlinson","year":"2017","journal-title":"J. Clin. Nurs."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1007\/s11739-013-0968-0","article-title":"Delirium in elderly patients hospitalized in internal medicine wards","volume":"9","author":"Fortini","year":"2014","journal-title":"Intern. Emerg. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1093\/gerona\/58.1.M76","article-title":"Relationship between pain and opioid analgesics on the development of delirium following hip fracture","volume":"58","author":"Morrison","year":"2003","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1097\/JGP.0b013e318033ed97","article-title":"Increased prevalence of falls among elderly individuals with mental health and substance abuse conditions","volume":"15","author":"Finkelstein","year":"2007","journal-title":"Am. J. Geriatr. Psychiatry"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5, American Psychiatric Association. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1111\/jgs.14103","article-title":"Length of stay in the emergency department and occurrence of delirium in older medical patients","volume":"64","author":"Bo","year":"2016","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1016\/j.annemergmed.2013.05.008","article-title":"Profiles of older patients in the emergency department: Findings from the interRAI Multinational Emergency Department Study","volume":"62","author":"Gray","year":"2013","journal-title":"Ann. Emerg. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"4","DOI":"10.3109\/10903127.2010.514093","article-title":"Prevalence of depression and cognitive impairment in older adult emergency medical services patients","volume":"15","author":"Shah","year":"2011","journal-title":"Prehosp. Emerg. Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1111\/acem.12616","article-title":"Process quality indicators targeting cognitive impairment to support quality of care for older people with cognitive impairment in emergency departments","volume":"22","author":"Schnitker","year":"2015","journal-title":"Acad. Emerg. Med."},{"key":"ref_22","unstructured":"White, C., and Katz, B. (2017, May 05). Position Statement 21: Pain in Older People. Available online: http:\/\/www.anzsgm.org\/documents\/PositionStatementNo21PaininOlderPeople_000.pdf."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1353\/cja.2004.0032","article-title":"Barriers and facilitators in pain management in long-term care institutions: A qualitative study","volume":"23","author":"Fox","year":"2004","journal-title":"Can. J. Aging"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.aenj.2016.04.002","article-title":"Characteristics of older people with cognitive impairment attending emergency departments: A descriptive study","volume":"19","author":"Schnitker","year":"2016","journal-title":"Australas. Emerg. Nurs. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1016\/j.ijnurstu.2015.04.013","article-title":"Emergency nurses perceptions of the role of family\/carers in caring for cognitively impaired older persons in pain: A descriptive qualitative study","volume":"52","author":"Fry","year":"2015","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_26","unstructured":"Hughes, R. (2008). Improving the quality of care through pain assessment and management. Patient Safety and Quality: An Evidence-Based Handbook for Nurses, Agency for Healthcare Research and Quality."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1097\/00000446-200510000-00032","article-title":"No self-report means no pain-intensity rating: Assessing pain in patients who cannot provide a report","volume":"105","author":"Pasero","year":"2005","journal-title":"Am. J. Nurs."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1111\/j.1532-5415.2006.00766.x","article-title":"Pain in severe dementia: Self-assessment or observational scales?","volume":"54","author":"Pautex","year":"2006","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2478","DOI":"10.1111\/j.1365-2702.2008.02776.x","article-title":"Assessment of pain: Can caregivers or relatives rate pain in nursing home residents?","volume":"18","author":"Biemold","year":"2009","journal-title":"J. Clin. Nurs."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.jen.2016.10.007","article-title":"Painful discrimination in the emergency department: Risk factors for underassessment of patients\u2019 pain by nurses","volume":"43","author":"Pierik","year":"2017","journal-title":"J. Emerg. Nurs."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1016\/S0885-3924(01)00287-1","article-title":"Utilizing pain assessment scales increases the frequency of diagnosing pain among elderly nursing home residents","volume":"21","author":"Kamel","year":"2001","journal-title":"J. Pain Symptom Manag."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1136\/emj.2008.062539","article-title":"Measuring acute pain in the prehospital setting","volume":"26","author":"Jennings","year":"2009","journal-title":"Emerg. Med. J."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Lichtner, V., Dowding, D., Esterhuizen, P., Closs, S.J., Long, A.F., Corbett, A., and Briggs, M. (2014). Pain assessment for people with dementia: A systematic review of systematic reviews of pain assessment tools. BMC Geriatr., 14.","DOI":"10.1186\/1471-2318-14-138"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1017\/S1041610214001732","article-title":"Cognitive impairment is a risk factor for delayed analgesia in older people with long bone fracture: A multicenter exploratory study","volume":"27","author":"Fry","year":"2015","journal-title":"Int. Psychogeriatr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.ienj.2015.06.003","article-title":"Assessment and management of acute pain in the older person with cognitive impairment: A qualitative study","volume":"24","author":"Fry","year":"2016","journal-title":"Int. Emerg. Nurs."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/j.1742-6723.2009.01246.x","article-title":"Patterns of analgesia for fractured neck of femur in Australian emergency departments","volume":"22","author":"Holdgate","year":"2010","journal-title":"Emerg. Med. Australas."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/j.pmn.2010.03.005","article-title":"Pain in the older adult: An imperative across all health care settings","volume":"11","author":"Herr","year":"2010","journal-title":"Pain Manag. Nurs."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.pmn.2006.02.003","article-title":"Pain assessment in the nonverbal patient: Position statement with clinical practice recommendations","volume":"7","author":"Herr","year":"2006","journal-title":"Pain Manag. Nurs."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1016\/j.ajem.2004.09.003","article-title":"Mandated pain scales improve frequency of ED analgesic administration","volume":"22","author":"Nelson","year":"2004","journal-title":"Am. J. Emerg. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1016\/j.jen.2008.08.006","article-title":"Acute pain assessment and pharmacological management practices for the older adult with a hip fracture: Review of ED trends","volume":"35","author":"Herr","year":"2009","journal-title":"J. Emerg. Nurs."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e2","DOI":"10.1136\/emermed-2013-203007","article-title":"A case-control study examining inconsistencies in pain management following fractured neck of femur: An inferior analgesia for the cognitively impaired","volume":"31","author":"McDermott","year":"2014","journal-title":"Emerg. Med. J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1016\/j.ajem.2014.09.025","article-title":"The relationship between patient age and pain management of acute long-bone fracture in the ED","volume":"32","author":"Boccio","year":"2014","journal-title":"Am. J. Emerg. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.ajem.2013.12.012","article-title":"Senior patients with moderate to severe pain wait longer for analgesic medication in EDs","volume":"32","author":"Daoust","year":"2014","journal-title":"Am. J. Emerg. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/j.jemermed.2014.12.043","article-title":"Oligoanalgesia in blunt geriatric trauma","volume":"48","author":"Quattromani","year":"2015","journal-title":"J. Emerg. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1111\/j.1532-5415.2005.00587.x","article-title":"The effect of emergency department crowding on the management of pain in older adults with hip fracture","volume":"54","author":"Hwang","year":"2006","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/S0304-3959(00)00485-1","article-title":"Pain assessment in cognitively impaired and unimpaired older adults: A comparison of four scales","volume":"92","author":"Chibnall","year":"2001","journal-title":"Pain"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1111\/j.1532-5415.1998.tb06644.x","article-title":"Treatment of pain in cognitively impaired compared with cognitively intact older patients with hip-fracture","volume":"46","author":"Feldt","year":"1998","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12877-017-0446-z","article-title":"Drug-based pain management for people with dementia after hip or pelvic fractures: A systematic review","volume":"17","author":"Moschinski","year":"2017","journal-title":"BMC Geriatr."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1097\/AJP.0b013e318172625a","article-title":"Pain assessment as intervention: A study of older adults with severe dementia","volume":"24","author":"Hadjistavropoulos","year":"2008","journal-title":"Clin. J. Pain"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.jpainsymman.2010.04.023","article-title":"Pain documentation and predictors of analgesic prescribing for elderly patients during emergency department visits","volume":"41","author":"Iyer","year":"2011","journal-title":"J. Pain Symptom Manag."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1891\/1939-2095.5.2.124","article-title":"Adoption of a pain assessment tool in older homebound patients with dementia in a housecall practice: A dissemination study","volume":"5","author":"Provost","year":"2012","journal-title":"Clin. Sch. Rev."},{"key":"ref_52","first-page":"11","article-title":"Assessment, physiological monitoring, and consequences of inadequately treated acute pain","volume":"9","author":"Dunwoody","year":"2008","journal-title":"J. Perianesth. Nurs."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.jemermed.2012.11.098","article-title":"Behavioral problems of seniors in an emergency department","volume":"45","author":"Erel","year":"2013","journal-title":"J. Emerg. Med."}],"container-title":["Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2226-4787\/5\/2\/30\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T18:37:37Z","timestamp":1760207857000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2226-4787\/5\/2\/30"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,6,1]]},"references-count":53,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2017,6]]}},"alternative-id":["pharmacy5020030"],"URL":"https:\/\/doi.org\/10.3390\/pharmacy5020030","relation":{},"ISSN":["2226-4787"],"issn-type":[{"value":"2226-4787","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,6,1]]}}}