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Emergency clinicians’ knowledge and practice of pain assessment for older adults with cognitive impairment: A cross-sectional study

Year: 2026

Type: article

Abstract: BACKGROUND: Older adults with cognitive impairment frequently present to emergency departments and often experience poor pain management. Patients' impaired self-reporting, limited clinician training, inconsistent use of behavioural tools, and environmental pressures have been reported challenges. This study examined emergency clinicians' knowledge and practices in assessing pain for this population. METHODS: A descriptive cross-sectional survey was conducted across two emergency departments in Australia. An 86-item survey collected clinicians' pain assessment knowledge and practices. Quantitative data were analysed using descriptive statistics, and qualitative responses were thematically analysed. RESULTS: 148 clinicians (110 nurses, 21 doctors, 17 allied health staff) responded to the survey (response rate =13.9 %). Whilst 80.9 % of respondents agreed observational tools were important, 44.6 % routinely used observational tools and perceived importance of these varied across clinical groups (p = 0.001). A self-report tool, the Numerical Rating Scale, was most used (78.3 %). The top barrier for pain assessment was patients' inability to communicate and top enabler was viewing pain as a priority. CONCLUSIONS: Clinicians recognised the importance of assessing pain in cognitively impaired older adults, yet practice was inconsistent and often relied on self-report and subjective observation. Targeted training, accessible observational assessment tools, and clear guidelines are needed to improve pain assessment and management.

Source: Australasian Emergency Care

DOI: 10.1016/j.auec.2025.12.001