Introduction
Pain is recognised as a complex and subjective phenomenon that develops adverse impact on Quality of Life [QoL], particularly among elderly individuals within aged care facilities. Patient with dementia suffers from varied pain based complexities and they are unable to communicate about this because of their cognitive and communication impairment (Tsai, Browne and Inder, 2021). Subsequently, this leads to underassessment and under-treatment of pain and often worsens the situation.
In Australia approximately 45-48% elderly individuals suffers from chronic pain issues due to dementia (The Australian Pain Society, 2025). However, inability to communicate creates adverse impact on patient and drastically impacts their health outcomes. The prior issue complies with misinterpreting pain-related behaviour as a behavioural or psychological issue; this results in neglecting actual needs of service users. Therefore, integration of appropriate pain assessment is crucial for supporting older individuals.
Research revealed that nurse-led pain assessment comprehends with using validated tools such as (PAINAD) the Pain Assessment in Advanced Dementia Scale as this supports in early detection of pain and subsequently, timely interventions could be taken for improving patient outcomes (Atee et al, 2021). Effective pain management mechanism through nurse-led assessment as is crucial, specifically for aged population.
The current literature review will be based on critically assessing contemporary literature based on impacts of regular nurse-led pain assessment on pain management mechanism among older people with dementia. The literature review will emphasis on analyzing the significance of routine assessment in pain management; further, highlights about the challenges faced by nurses and implication for clinical practice would be described.
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Literature Review
Effectiveness of Regular-Nurse-Led Pain Assessment in Pain Management Among Elderly People With Dementia
Consistent nurse-led pain assessment are crucial within aged care settings, this leads to improve the mechanism of pain detection and facilitates effective management for older people suffering from dementia. The study by Felton et al, (2021) revealed that integration of routine assessment tools such as- PAINAD improves the relevancy and accuracy of pain detection, particularly among elderly people; implication of structured and standardised assessment protocols is importance as this reduces the probability of underassessment and untreated pain. Similarly Jonsdottir and Gunnarsson (2021) depicted that conducting regular assessment by nurse supports in identifying the extent of pain and subsequently, relevant action can be taken for reducing distressing symptoms among patients due to untreated pain.
The severity of pain can be easily detected through regular assessment and subsequently, appropriate interventions for supporting patient can be taken. However, Achterberg et al, (2021) depicted that despite multiple benefits inconsistent implication of assessment tool restricts the process and creates drastic impact on pain assessment mechanism. Lack of expertise or professional competency among nurses limits their ability to conduct pain assessment and they are unable to detect the pain. Author further depicted that lack of resources and training with setting impacts the nursing practices in this context and creates drastic impact on older patient outcomes. The technical errors such as- variability within assessment frequency develops persistent gaps in pain detection mechanism; this demonstrate that implication of regular pain-assessment is not possible without integrating standardized protocols.
The literature underpins the importance of considering nurse-led routine assessment for improving pain management and timely detection for older patient suffering from dementia. Nevertheless, it is important to ensure specific focus on integrating training programmes so that nurse’s competence and expertise could be enhanced (Tsai, Browne and Inder, 2023). Furthermore, there is need to adhere with standardised protocols for performing appropriate practice. An accurate pain assessment aligns with improving well-being of patients and reduces distressing symptoms associated with pain.
Regular nurse-led assessment supports in identifying the issues of patient and their severity of pain; literature revealed that patient suffering from dementia are not able to verbally dictate their pain and this leads to create significant issues in taking appropriate measures for pain management. Nurse-led pain assessment supports in identifying non-verbal cues such as- body language, facial expression of patient and body language; accordingly, this enable nurses to take appropriate action which are essential for supporting patient.
Achterberg et al, (2021) articulated that PAINAD is an observational tool that is used for assessing pain in individuals with cognitive impairment; it supports in assessment of pain by considering non-verbal behaviour pattern in five categories and those are- Breathing independent of vocalization, negative vocalization, facial expression, body language and Consolability. These aspects are rated on scale of 0-10 and subsequently, person-centred care interventions are implemented for supporting patient with dementia. Regular nurse-led assessment is crucial due to varied reasons; the inability of patient in communicating pain creates difficulty in expressing extent of pain.
Additionally, there might be possibility that pain is an underlying symptom of any other condition and therefore, its timely detection is crucial for supporting patient. Pain assessment facilitates improvement in care quality, these assessment has been specifically undertaken for supporting older people and based on this their needs are identified which enables nurses to implement person-centred care interventions (Minaya‐Freire et al, 2021). Hence, this can be said that regular nurse-led pain assessment is important because pain level can fluctuate and older people are unable to communicate this due to cognitive impairment. Thus, untreated pain leads to create drastic impact on wellbeing of service users and therefore, regular assessment is important so that relevant intervention could be integrated.
Complexities in Integration of Routine Nurse-Led Pain Assessment
Findings from literature supported the integration of regular assessment due to its multiple benefits. However, there are certain challenges comply with the implication of pain assessment mechanism within aged care settings. It is important to analyse these barriers so that accurate decisions could be considered and consistent support to aged individual s can be ensured. Atee et al, (2022) revealed that staff shortage and extreme pressure on nurses reduce the efficacy of assessment, in aged care settings nurses are overburdened with varied clinical tasks, they have to look upon patient day to day requirements. Thereby they prioritise these tasks over pain assessment, particularly during busy shift.
As a result, nurses neglect pain-based complexities of patient; this leads to create drastically impact on patient outcomes. This shows that it is important to take significant measures related to staff shortage issues and accordingly, appropriate allocation of roles and responsibilities should be done. Nurses play important role in decision-making process, specifically for older adults in aged care settings; they are responsible for assessing the needs and requirements of patients and subsequently, relevant decision should be taken.
However, Smith et al, (2023) stated that lack of training programme limits nurse’s professional competencies and creates issues while undertaking pain assessment. In order to use PAINAD tool nurses must have expertise in this context so they can effectively assess non-verbal cues of patients and accordingly, appropriate actions are implemented. This proves that in aged care settings consistent training programmes should be implied so that nurses can gain insights and expertise for conducting pain assessment. Knowledge deficit and incorrect beliefs among nurses related to pain assessment identified as an important barrier; nurses often misunderstood pain as normal sign of ageing and misinterpret it as a psychological or behavioural issue. This result in neglecting chronic pain and further develops severe risks for patient; therefore, it is important improve nurse knowledge so they can understand the pain-based complexities of patient and timely action could be taken.
In the study of Mast et al, (2021) it has been evident that using PAINAD tool requires expertise and competence and if nurses are not trained in this area then this leads to create persistent complexities while using this tool. Settings that have integrated these routine assessment systems focuses on organising consistent training programmes for nurses so they can gain expertise and develops competence. Nevertheless, there is need to implement quality improvement project making nurses aware about standardised protocols. This results in improving compliance and assessment accuracy for improving patient outcomes to greater extent.
Hsu, Chen and Belcastro (2022) depicted that integration of quality improvement project supports in managing all these barriers and improve nursing practices and subsequently, patient outcomes could be improved to greater extent. Organizational factors such as-lack of support to staff members and lack of resources also creates complexities in implication of routine nurse-led pain assessment. It is important to overcome these barriers by integrating systemic changes within setting. Specific focus needs to be integrated on organising staff training, allocating roles and responsibilities to staff members appropriately and providing consistent support to nurses.
Implication Within Nursing Area and Policy Contexts
Policy-driven strategies are important for implementing standardized protocols that supports regular nurse-led pain assessment within aged care setting. In accordance with “The National Strategic Action Plan for Pain Management” it is important to address the needs and requirement of people suffering from dementia; there are more than 60% people are living with dementia; older patients with dementia suffers from chronic pain which are often not addressed within settings due to multiple barriers (The Australian Pain Society, 2025).
The Australia Pain Society effectively focusing on scheduling pain assessment for individuals suffering from cognitive impairments; the vision complies with implementing multidisciplinary association that undertaken advance pain management techniques through education, advocacy and transformational improvement within clinical area (The Australian Pain Society, 2025). These are essential aspects on-to which focus should be integrated. This multidisciplinary approach must be integrated in setting and training requires to be organised for improving nursing knowledge and practices in this area.
However, Chary et al, (2025) depicted that rigid policies often neglect patient needs; for instance- nurses are told to use pain assessment tools however, if no monitoring is done then nurses would not be aware about their mistakes and further they would not be able to improve their practices. Thus, implication of standards or policies must be done in such way that promotes nurses engagement and improves their practices related to pain assessment. Hence, effective policy implementation must comply with integrating assessment tools within daily practices.
The findings of literature should be imply in nursing practices by organising training and development programmes for nurses so they can learn about the ways in which tools should be used for pain assessment (Pu et al, 2025). Furthermore, nurse leader should allocate roles and responsibilities in such manner that does not create extreme work pressure on nurses. Conducting regular nurse-led-pain assessment is crucial and this should be implied in nursing practices for assessing the pain of patients suffering from dementia. Persistent training enables nurses in identifying non-verbal cues of patient and subsequently, they would be able to assess the severity of pain. Moreover, incorporation of multidisciplinary association is important for undertaking advanced pain management techniques within setting.
Hence, there is no doubt in depicting that regular nurse-led pain assessment are important for supporting older patient however; there is need to address concerns related to training, staff shortage, lack of resources and lack of support complexities so that consistent support can be assured to nurses.
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Conclusion
Conclusively; this can be said that regular nurse-led assessments are important for implementing effective pain management practices among elderly people. The literature revealed that pain assessment supports in identifying severity of pain, undertakes early detection, reduces agitation and improves quality of life. Early detection of pain enable nurses in taking timely intervention that improves patient outcomes. However, there is need to focus on challenges comprising with staff training, organizational barriers and workload on nurses; these complexities has been acting as a barrier and further limiting the implication of pain assessment tool.
Findings demonstrate that standardized assessment protocol should be implied in setting and there is need to invest in staff education training. Supportive policies such as integration of multidisciplinary association are important for improving pain management outcomes.The implication of findings should be done in clinical practice by organising training programmes for nurses. Furthermore, multidisciplinary approach that comprises with policy support, staff education and staff engagement proves to be essential in addressing issues related to pain assessment. Integration of regular nurse-led pain assessment supports nurses in early detection of pain and accordingly, severe risks for older individuals can be reduced. Hence, it is pivotal to assure focus on this area and accordingly, appropriate steps must be integrated by nurses for improving patient outcomes.
REFERENCES
- Achterberg, W. P., Erdal, A., Husebo, B. S., Kunz, M., & Lautenbacher, S. (2021). Are chronic pain patients with dementia being undermedicated?. Journal of Pain Research, 431-439.
- Atee, M., Hoti, K., Chivers, P., & Hughes, J. D. (2022). Faces of pain in dementia: learnings from a real-world study using a technology-enabled pain assessment tool. Frontiers in Pain Research, 3, 827551.
- Atee, M., Morris, T., Macfarlane, S., & Cunningham, C. (2021). Pain in dementia: prevalence and association with neuropsychiatric behaviors. Journal of Pain and Symptom Management, 61(6), 1215-1226.
- Chary, A. N., Suh, M., Bhananker, A., Hernandez, N., Rivera, A. P., Boyer, E., ... & Kennedy, M. (2025). Experiences of the emergency department environment: a qualitative study with caregivers of people with dementia. Internal and Emergency Medicine, 20(5), 1565-1574.
- Felton, N., Lewis, J. S., Cockburn, S. J., Hodgson, M., & Dawson, S. (2021). Pain assessment for individuals with advanced dementia in care homes: a systematic review. Geriatrics, 6(4), 101.
- Hsu, H. F., Chen, K. M., & Belcastro, F. (2022). The effect of music interventions on chronic pain experienced by older adults: A systematic review. Journal of Nursing Scholarship, 54(1), 64-71.
- Jonsdottir, T., & Gunnarsson, E. C. (2021). Understanding nurses’ knowledge and attitudes toward pain assessment in dementia: A literature review. Pain Management Nursing, 22(3), 281-292.
- Mast, B. T., Molony, S. L., Nicholson, N., Kate Keefe, C., & DiGasbarro, D. (2021). Person‐centered assessment of people living with dementia: review of existing measures. Alzheimer's & Dementia: Translational Research & Clinical Interventions, 7(1), e12138.
- Minaya‐Freire, A., Subirana‐Casacuberta, M., Puigoriol‐Juvanteny, E., & Ramon‐Aribau, A. (2021). Pain management nursing practice assessment in older adults with dementia. Nursing open, 8(6), 3349-3357.
- Pu, L., Barton, M., Kodagoda Gamage, M., Okada, M., Todorovic, M., & Moyle, W. (2025). Pain Assessment and Management in Dementia Care: Qualitative Perspectives of People With Dementia, Their Families, and Healthcare Professionals. Journal of Clinical Nursing.
- Smith, T. O., Lockey, D., Johnson, H., Rice, L., Heard, J., & Irving, L. (2023). Pain management for people with dementia: a cross-setting systematic review and meta-ethnography. British Journal of Pain, 17(1), 6-22.
- Tsai, Y. I. P., Browne, G., & Inder, K. J. (2021). The effectiveness of interventions to improve pain assessment and management in people living with dementia: A systematic review and meta‐analyses. Journal of advanced nursing, 77(3), 1127-1140.
- The Australian Pain Society, 2025. Online. Available through < https://www.apsoc.org.au/>
