Recognition of pain in older persons with dementia is a considerable challenge to quality
pain care for this vulnerable population. Without recognition, pain cannot be thoroughly evaluated
and effectively treated. Observing for pain-related behaviors is the most researched means of identifying
the presence or likelihood of pain in persons with moderate to severe dementia, or those who are
unable to self-report their pain. The purpose of this paper is to discuss the state of observation of pain,
primarily focusing on pain behavior tool development, providing an overview of current pain tools
and discussing the challenges at this stage of the science, including the issue of assessing pain intensity.
We also recommend a number of areas to prioritize future research with the goal to advance effective
pain assessment in older persons with dementia. Central to these recommendations is the refinement
of existing tools to incorporate those behaviors most predictive of pain in persons with dementia
as the science progresses in this area. The future of pain observation in dementia is poised for
considerable advancement through these refinements of tools and techniques. Improving our ability to
detect and evaluate pain in the vulnerable population unable to self-report their pain, through the results
of these suggested research priorities, will likely assist in addressing the related suffering that
results from unrecognized and untreated pain.
Keywords: Aging, assessment, behavior, dementia, measurement, observation, pain, tool.
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