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Mrs. Rose is an 89-year-old, widowed white female who has resided in a nursing home for the past 3 months.  Admission was precipitated by inability to function independently, related to Dementia Alzheimer’s –type (DAT) and to widespread arthritic pain.  Her mobility is severely limited.

Margaret Andersen is an 85-year-old woman with limited communication who demonstrates changes in behavior two weeks after entering a nursing care facility.

Mildred is 83 years old and suffers from chronic, constant knee pain that prevents her from doing things around the house. She recently moved next door to her son so he can provide the extra help she needs with grocery shopping, cooking, and doing heavier housework. An x-ray of her knee displays moderate to severe knee osteoarthritis.

Mr. Clark is an 80 year old, moderately overweight Caucasian male who awoke two nights ago with severe pain in his left foot. He has tried elevating his foot and has taken ibuprofen, with minimal pain relief. His wife states that he has some problems with his memory. She states that he has not been able to sleep, and asks the urgent care staff to give him something for the pain as well as something to help him sleep.

Mr. Frank is an 80-year-old nursing home resident. Recent years have been marked by progressive cognitive decline attributed to Alzheimer’s disease. Two days prior to admission, the nursing home staff noted decreased oral intake and resistance to care but were able to dose usual medications. This progressed over the subsequent day with Mr. Frank noted to be agitated, resistant to care and uncharacteristically aggressive. Transfer to acute care facility was arranged after Mr. Frank fell from his chair.

This is an overview of competencies of pain assessment specific to cognitively impaired older adults.