Common Pain Behaviours in Cognitively-Impaired Elderly Persons

As care providers, we must ensure that our assessment skills are top notch, especially for those adults unable to speak their pain. For persons suffering with dementia, aphasia, or other conditions preventing an oral report, pain expression sometimes takes on less obvious forms, such as confusion, social withdrawal, aggression or subtle changes in behaviors ….which are not always typical manifestations of pain.


Facial Expressions Verbalizations Vocalization Body Movements Changes in Interpersonal Interactions Changes in Interpersonal Activity Patterns or Routines Mental Status Changes
Slight frown

Sad face

Frightened face


Wrinkled forehead

Closed or tightened eyes

Any distorted expression

Rapid blinking






Calling out

Noisy breathing

Asking for help

Verbally abusive

Rigid posture

Tense body posture



Increased pacing

Increased rocking

Restricted movement

Gait or mobility changes



Resisting care

Decreased social interactions

Socially inappropriate behaviours

Disruptive behaviours

Acting withdrawn

Refusing food

Appetite changes

Increase in rest periods

Changes in sleep & rest patterns

Sudden cessation of common routines

Increased wandering

Crying or tears

Increased confusion

Irritability or distress

Consider utilizing a tool to assist with assessment! 

The PAINAD Scale or The Abbey Pain Scale

Download Tip of the Month

PDF – Common Pain Behaviours in Cognitively-Impaired Elderly Persons


Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the pain assessment in advanced dementia (PAINAD) scale. J Am Med Dir Assoc. 2003;4:9-15.

Herr, K., Coyne, P., McCaffrey, M., Manwarren, R. & Merkel, S. (2011). Pain Assessment in the Patient Unable to Self-Report. American Society for Pain Management Nursing