This pain behavior tool is used to assess pain in older adults who have dementia or other cognitive impairment and are unable to reliably communicate their pain. It can be used by a nurse or by a CNA to screen for pain-related behaviors.  PAINAD Tool.

It should be used at the following time points:

1. At admission to the Nursing Home to establish an initial baseline level of behaviors that may be related to pain
   
2. At each quarterly nursing review
   
3. Every shift - in older adults with behaviors suggesting pain is not controlled
   
4. Any time a change in pain status is reported
   
5. Following a pain intervention to evaluate treatment effectiveness (within 1-2 hours)

Observe the older adult for 3-5 minutes during activity/with movement (such as bathing, turning, transferring).

For each item included in the PAINAD, select the score (0, 1, 2) that reflects the current state of the behavior.

Add the score for each item to achieve a total score. Total scores range from 0 to 10 (based on a scale of 0 to 2 for five items), with a higher score suggesting more severe pain (0= “no pain” to 10= “severe pain”).

After each use, compare the total score to the previous score received. An increased score suggests an increase in pain, while a lower score suggests pain is decreased.

CNA should report any changes or scores to the nurse for follow-up assessment.

See “How To Try This Video: Pain Assessment in Older Adults” for training staff.

Document/record all scores in a location that is readily accessible by other health care providers.

Behavior observation scores should be considered alongside knowledge of existing painful conditions and reports from someone who knows the older adult (like a family member or nursing assistant) and their pain behaviors. Remember some older adults may not demonstrate obvious pain behaviors or cues.