**6. Assessment of pain in older persons**

There are various ways of assessing pain in older persons and this is challenging for various reasons such as those with diminished cognitive ability, dementia, disorders in communication, and cultural barriers [13, 19, 21, 30, 31, 36, 40, 41]. The first step in an effective pain management is assessment of the pain [31]. Assessment of pain in older persons should include the assessment of the older person functional abilities [10, 42] and it requires a multidisciplinary approach for making a diagnosis. This includes understanding the atypical presentations of pain in older persons including its pathophysiology, the physiological changes associated with aging, common pain presentations and the use of validated pain assessment tools [11, 19, 36]. Self-reporting is the best method of assessing pain and there is a wide range of self-report scales as it provides the most accurate and reliable information [36, 43].

There are many validated pain assessment tools that can be used in the assessment of pain in older persons while each of the tools have its merits and demerits as no single tool will be useful for every patient [39, 43]. Commonly used scales in the assessment of pain in older persons are the visual analogue scales, verbal rating scales, numeric rating scales, McGill pain assessment questionnaire, pain attitudes, brief pain inventory and geriatric pain measure [33, 40, 43]. There may be other medical signs and symptoms that can make the pain assessment difficult [13]. Polypharmacy increases sensitivity to analgesics [35]. Sometimes elderly persons find it difficult using self – report pain scales correctly [38, 43].
