The prevalence of chronic pain in older persons is higher than it is in other age groups.  Although prevalence estimates vary from study to study depending on method used and population under investigation, chronic pain has been estimated to affect as many as 76% of older persons who live independently and as many as 93% of those who reside in long-term care facilities (Abdulla et al., 2013). Despite its high prevalence, pain is often undertreated in older adults and such undertreatment is especially significant among older persons with dementia (e.g., Balfour and O’Rourke, 2003; de Souto Barreto et al., 2013; Presley et al., 2018; Schneider et al., 2020).

There are several factors that contribute to the undertreatment of pain in older persons. Older adults, for example, may be more stoic when it comes to reporting pain (Yong et al., 2001). Moreover, it has been suggested that societal beliefs and attitudes contribute to pain undertreatment (e.g., Makris et al., 2015).  That is, many consider pain to be “a normal part of growing old.” Viewing pain as a normal part of aging may lead health professionals to be less likely to treat pain thoroughly in older patients and older patients may be less likely to seek pain management than are their younger counterparts.  But pain is not a normal part of the aging process. As such, pain should be treated irrespective of a person’s age.  Further, among seniors with severe dementia, there is the added difficulty that there can be serious limitations in ability to self-report pain related to the cognitive and language impairments that accompany the dementing condition. As such, pain problems often go undetected in this population. In fact, among patients with dementia, behavioral disturbance due to pain can be misattributed to a psychiatric problem and is often treated with psychotropic rather than analgesic medication (e.g., Balfour & O’Rourke, 2003; Cipher et al., 2006).  This is unfortunate because use of psychotropic medications may hasten death in this population (e.g., Ballard et al., 2009).

Hadjistavropoulos et al. (2007) provide detailed recommendations for the pain assessment of the older adult (see also Hadjistavropoulos, 2015). In summary, a thorough pain assessment is a comprehensive process that should not be limited to evaluations of pain intensity. Instead, patient emotional/personality/social functioning and coping resources should also be evaluated along with reported functional limitations as well as cognitive and behavioural responses to pain. Psychological assessment results should be integrated with a complete clinical history and the findings of medical and functional examinations. As with any type of psychological assessment of older persons, it is important to select clinical tools that have been appropriately validated with this population. For clinicians, interested in a brief screening battery suitable for cognitively intact older persons, Hadjistavropoulos et al. (2007) recommended use of the Brief Pain Inventory (Cleeland et al., 1994) combined with the short form of the McGill Pain Questionnaire (Melzack, 1975). The combination of these two tools would allow for an evaluation of pain intensity, self-reported interference with function, pain location, medication use, perceived relief and measurement of the sensory and affective qualities of the pain experience.

Given the serious communication limitations of people with severe dementia, psychometric testing is often unfeasible and recent research has led to a proliferation of observational pain assessment tools, some of which have strong psychometric properties (see Chan et al., 2014; Hadjistavropoulos, Herr, et al., 2014; Herr et al., 2019). Research has demonstrated that regular observational pain assessments of seniors with dementia can have considerable clinical benefits (Fuchs-Lacelle et al., 2008; Hadjistavropoulos, Kaasalainen, et al., 2014).  For more specific recommendations for the patient with dementia, the reader is referred to Hadjistavropoulos (2017) and Hadjistavropoulos (2015).

Generally speaking, it is widely recognized that the best approach to managing chronic pain is interdisciplinary.  In fact, older adults are especially likely to benefit from interdisciplinary pain management (Morrison et al., 2009) because they are prone to frequent comorbidities (McGuire et al., 2014). When psychological treatment is integrated in interdisciplinary pain management, it tends to have a cognitive behavioral orientation. From a psychological standpoint, cognitive behavioral therapy (CBT) procedures  have been used with some success in the chronic pain management of the older adult but positive findings are sometimes limited to specific domains of functioning such as beliefs about pain (e.g., Green et al., 2009; Waters et al., 2005). In a meta-analytic investigation focusing on CBT for older persons with pain, Lunde et al., (2009) found a moderate overall effect size and demonstrated benefits on self-reported pain but not on depression, medication use and physical function. More recently, Niknejad et al. (2018) concluded, based on a systematic review and meta-analysis that was largely focused on CBT, that psychological interventions for chronic pain result in small but significant effects on pain catastrophizing beliefs and self-efficacy about pain management. Still, more research investigating the longer-term efficacy of CBT with this population is needed.  In recent years, some promising findings are beginning to emerge with mindfulness-based (e.g., Morone, Greco, et al., 2008; Morone, Lynch, et al., 2008; Turner et al., 2016) as well as with acceptance and commitment approaches to pain management (Hann and McCracken, 2014; McCracken and Jones, 2012).

The American Geriatrics Society (2009) has outlined specific recommendations regarding the pharmacological pain management of the older adult.  The interested reader is referred to the American Geriatrics Society Pharmacological Management of Persistent Pain in Older Persons for more information.

Written by Thomas Hadjistavropoulos, Ph.D., ABPP, University of Regina, Canada

GENERAL

Backman, C.L. (2006). Psychosocial aspects in the management of arthritis pain. Arthritis Research & Therapy, 8, 221-228. Available online.

Backman, C.L. (2006). Psychosocial aspects in the management of arthritis pain. Arthritis Research & Therapy, 8, 221-228.  Available online.

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Balfour, J. E., & O’Rourke, N. (2003). Older adults with Alzheimer Disease, comorbid arthritis and prescription of psychotropic medications. Pain Research and Management, 8(4), 198-204.

Balfour, J. E., & O’Rourke, N. (2003). Older adults with Alzheimer Disease, comorbid arthritis and prescription of psychotropic medications. Pain Research and Management, 8(4), 198-204.

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Balfour, J. E., & O’Rourke, N. (2003). Older Adults with Alzheimer’s Disease, Comorbid Arthritis and Prescription of Psychotropic Medications. Pain Research and Management, 8(4), 198–204. https://doi.org/10.1155/2003/105459

Balfour, J. E., & O’Rourke, N. (2003). Older Adults with Alzheimer’s Disease, Comorbid Arthritis and Prescription of Psychotropic Medications. Pain Research and Management, 8(4), 198–204. https://doi.org/10.1155/2003/105459

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Cipher, D. J., Clifford, P. A., & Roper, K. D. (2006). Behavioral manifestations of pain in the demented elderly. Journal of the American Medical Directors Association, 7(6), 355-365. doi: 10.1016/j.jamda.2005.11.012

Cipher, D. J., Clifford, P. A., & Roper, K. D. (2006). Behavioral manifestations of pain in the demented elderly. Journal of the American Medical Directors Association, 7(6), 355-365. doi: 10.1016/j.jamda.2005.11.012

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Cipher, D. J., Clifford, P. A., & Roper, K. D. (2006). Behavioral Manifestations of Pain in the Demented Elderly. Journal of the American Medical Directors Association, 7(6), 355–365. https://doi.org/10.1016/j.jamda.2005.11.012

Cipher, D. J., Clifford, P. A., & Roper, K. D. (2006). Behavioral Manifestations of Pain in the Demented Elderly. Journal of the American Medical Directors Association, 7(6), 355–365. https://doi.org/10.1016/j.jamda.2005.11.012

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Deane, G., & Smith, H.S. (2008). Overview of Pain Management in Older Persons. Clinics in Geriatric Medicine, 24(2), 185–201.

Deane, G., & Smith, H.S. (2008). Overview of Pain Management in Older Persons. Clinics in Geriatric Medicine, 24(2), 185–201.

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Deane, G., & Smith, H.S. (2008). Overview of Pain Management in Older Persons. Clinics in Geriatric Medicine, 24(2), 185–201.

Deane, G., & Smith, H.S. (2008). Overview of Pain Management in Older Persons. Clinics in Geriatric Medicine, 24(2), 185–201.

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Hadjistavropoulos, T. & Hadjistavropoulos, H.D. (Editors) (2019). Fundamentals of health psychology (2nd edition). Toronto: Oxford University Press.

Hadjistavropoulos, T. & Hadjistavropoulos, H.D. (Editors) (2019). Fundamentals of health psychology (2nd edition). Toronto: Oxford University Press.

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Herr, K. (2010). Pain in the Older Adult: An Imperative Across All Health Care Settings. Pain Management Nursing, 11(2) Supplement, S1–S10.

Herr, K. (2010). Pain in the Older Adult: An Imperative Across All Health Care Settings. Pain Management Nursing,  11(2) Supplement, S1–S10.

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Makris, U. E., Higashi, R. T., Marks, E. G., Fraenkel, L., Sale, J. E. M., Gill, T. M., & Reid, M. C. (2015). Ageism, negative attitudes, and competing co-morbidities – why older adults may not seek care for restricting back pain: A qualitative study. BMC Geriatrics, 15(1), 39. https://doi.org/10.1186/s12877-015-0042-z

Makris, U. E., Higashi, R. T., Marks, E. G., Fraenkel, L., Sale, J. E. M., Gill, T. M., & Reid, M. C. (2015). Ageism, negative attitudes, and competing co-morbidities – why older adults may not seek care for restricting back pain: A qualitative study. BMC Geriatrics, 15(1), 39. https://doi.org/10.1186/s12877-015-0042-z

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ASSESSMENT

Look at the extensive assessment database of geriatric measures from the University of Alabama’s Alabama Research Institute on Aging! Register for access to the database HERE.

Bjoro, K., & Herr, K. (2008). Assessment of Pain in the Nonverbal or Cognitively Impaired Older Adult. Clinics in Geriatric Medicine, 24(2), 237–262.

Bjoro, K., & Herr, K. (2008). Assessment of Pain in the Nonverbal or Cognitively Impaired Older Adult.  Clinics in Geriatric Medicine,  24(2), 237–262.

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Chan, S., Hadjistavropoulos, T., Williams, J., & Lints-Martindale, A. (2014). Evidence-based Development and Initial Validation of the Pain Assessment Checklist for Seniors With Limited Ability to Communicate-II (PACSLAC-II). The Clinical Journal of Pain, 30(9), 816–824. https://doi.org/10.1097/AJP.0000000000000039

Chan, S., Hadjistavropoulos, T., Williams, J., & Lints-Martindale, A. (2014). Evidence-based Development and Initial Validation of the Pain Assessment Checklist for Seniors With Limited Ability to Communicate-II (PACSLAC-II). The Clinical Journal of Pain, 30(9), 816–824. https://doi.org/10.1097/AJP.0000000000000039

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Ferrell, B.A., Stein, W.M., & Beck, J.C. (2000). The Geriatric Pain Measure: Validity, Reliability and Factor Analysis. Journal of the American Geriatrics Society, 48(2), 1669-73.

Ferrell, B.A., Stein, W.M., & Beck, J.C. (2000). The Geriatric Pain Measure: Validity, Reliability and Factor Analysis. Journal of the American Geriatrics Society, 48(2), 1669-73.

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Fuchs-Lacelle, S. & Hadjistavropoulos, T. (2004). Development and preliminary validation of the pain assessment checklist for seniors with limited ability to communicate (PACSLAC). Pain Management Nursing, 5(1), 37-49. Click here for the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PASLAC).

Fuchs-Lacelle, S. & Hadjistavropoulos, T. (2004). Development and preliminary validation of the pain assessment checklist for seniors with limited ability to communicate (PACSLAC). Pain Management Nursing, 5(1), 37-49.  Click here for the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PASLAC).

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Fuchs-Lacelle, S., Hadjistavropoulos, T., & Lix, L. (2008). Pain assessment as intervention: A study of older adults with severe dementia. Clinical Journal of Pain, 24(8), 697-707.

Fuchs-Lacelle, S., Hadjistavropoulos, T., & Lix, L. (2008). Pain assessment as intervention: A study of older adults with severe dementia. Clinical Journal of Pain, 24(8), 697-707.

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Hadjistavropoulos, T. (2015). Pain assessment and management in older adults. In P. A. Lichtenberg and B. T. Mast (Eds). APA Handbook of Clinical Geropsychology (Vol. 2)(pp. 413-439). Washington: APA Press.

Hadjistavropoulos, T. (2015). Pain assessment and management in older adults. In P. A. Lichtenberg and B. T. Mast (Eds). APA Handbook of Clinical Geropsychology (Vol. 2)(pp. 413-439). Washington: APA Press.

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Hadjistavropoulos, T. (2017). Guidelines and practical approaches for the effective pain assessment of the patient with dementia. In S. Gibson & S. Lautenbacher (Eds.), Pain in dementia (pp. 177–191). Wolters Kluwer.

Hadjistavropoulos, T. (2017). Guidelines and practical approaches for the effective pain assessment of the patient with dementia. In S. Gibson & S. Lautenbacher (Eds.), Pain in dementia (pp. 177–191). Wolters Kluwer.

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Hadjistavropoulos, T., Dever Fitzgerald, T., & Marchildon, G. (2010). Practice guidelines for assessing pain in older persons who reside in long-term care facilities. Physiotherapy Canada, 62(2), 104-113. doi:10.3138/physio.62.2.104

Hadjistavropoulos, T., Dever Fitzgerald, T., & Marchildon, G. (2010). Practice guidelines for assessing pain in older persons who reside in long-term care facilities. Physiotherapy Canada, 62(2), 104-113. doi:10.3138/physio.62.2.104

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Hadjistavropoulos, T., Herr, K., Prkachin, K. M., Craig, K. D., Gibson, S. J., Lukas, A., & Smith, J. H. (2014). Pain assessment in elderly adults with dementia. The Lancet Neurology, 13(12), 1216–1227. https://doi.org/10.1016/S1474-4422(14)70103-6

Hadjistavropoulos, T., Herr, K., Prkachin, K. M., Craig, K. D., Gibson, S. J., Lukas, A., & Smith, J. H. (2014). Pain assessment in elderly adults with dementia. The Lancet Neurology, 13(12), 1216–1227. https://doi.org/10.1016/S1474-4422(14)70103-6

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Hadjistavropoulos, T., Herr, K., Turk, D.C., Fine, P.G., Dworkin, R.H., Helme, R., Jackson, K., Parmelee, P.A., Rudy, T.E., Beattie, B. L. Chibnall, J. T., Craig, K.D., Ferrell, B., Ferrell, B., Fillingim, R. B., Gagliese, L., Gallagher, R., Gibson, S. G., Harisson, L., Katz, B. Keefe, F., Lieber, S. J., Lussier, D., Schmader, K.E., Tait, R.C., Weiner, D.K., Williams, J. (2007). An interdisciplinary expert consensus statement on assessment of pain in older persons. Clinical Journal of Pain, 23, S1-S43.

Hadjistavropoulos, T., Herr, K., Turk, D.C., Fine, P.G., Dworkin, R.H., Helme, R., Jackson, K., Parmelee, P.A., Rudy, T.E., Beattie, B. L. Chibnall, J. T., Craig, K.D., Ferrell, B., Ferrell, B., Fillingim, R. B., Gagliese, L., Gallagher, R., Gibson, S. G., Harisson, L., Katz, B. Keefe, F., Lieber, S. J., Lussier, D., Schmader, K.E., Tait, R.C., Weiner, D.K., Williams, J. (2007). An interdisciplinary expert consensus statement on assessment of pain in older persons. Clinical Journal of Pain, 23, S1-S43.

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Hadjistavropoulos, T., Kaasalainen, S., Williams, J., & Zacharias, R. (2014). Improving Pain Assessment Practices and Outcomes in Long-Term Care Facilities: A Mixed Methods Investigation. Pain Management Nursing, 15(4), 748–759. https://doi.org/10.1016/j.pmn.2013.07.009

Hadjistavropoulos, T., Kaasalainen, S., Williams, J., & Zacharias, R. (2014). Improving Pain Assessment Practices and Outcomes in Long-Term Care Facilities: A Mixed Methods Investigation. Pain Management Nursing, 15(4), 748–759. https://doi.org/10.1016/j.pmn.2013.07.009

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Herr, K., & Garand, L. (2001). Assessment and measurement of pain in older adults. Clinics in Geriatric Medicine, 17(3), 457-478. doi: 10.1016/S0749-0690(05)70080-X

Herr, K., & Garand, L. (2001). Assessment and measurement of pain in older adults. Clinics in Geriatric Medicine, 17(3), 457-478. doi: 10.1016/S0749-0690(05)70080-X

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Herr, K., Coyne, P. J., Ely, E., Gélinas, C., & Manworren, R. C. B. (2019). Pain Assessment in the Patient Unable to Self-Report: Clinical Practice Recommendations in Support of the ASPMN 2019 Position Statement. Pain Management Nursing, 20(5), 404–417. https://doi.org/10.1016/j.pmn.2019.07.005

Herr, K., Coyne, P. J., Ely, E., Gélinas, C., & Manworren, R. C. B. (2019). Pain Assessment in the Patient Unable to Self-Report: Clinical Practice Recommendations in Support of the ASPMN 2019 Position Statement. Pain Management Nursing, 20(5), 404–417. https://doi.org/10.1016/j.pmn.2019.07.005

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Lichtenberg, P.A. (Ed.) (2010). Handbook of assessment in clinical gerontology (2nd edition). Burlington, MA: Academic Press.

Lichtenberg, P.A. (Ed.) (2010). Handbook of assessment in clinical gerontology (2nd edition). Burlington, MA: Academic Press.

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Lints-Martindale, A. C., Hadjistavropoulos, T., Lix, L. M., & Thorpe, L. (2012). A comparative investigation of observational pain assessment tools for older adults with dementia. Clinical Journal of Pain, 28(3), 226-237. doi:10.1097/AJP.0b013e3182290d90

Lints-Martindale, A. C., Hadjistavropoulos, T., Lix, L. M., & Thorpe, L. (2012). A comparative investigation of observational pain assessment tools for older adults with dementia. Clinical Journal of Pain, 28(3), 226-237. doi:10.1097/AJP.0b013e3182290d90

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Makris, U. E., Higashi, R. T., Marks, E. G., Fraenkel, L., Sale, J. E. M., Gill, T. M., & Reid, M. C. (2015). Ageism, negative attitudes, and competing co-morbidities – why older adults may not seek care for restricting back pain: A qualitative study. BMC Geriatrics, 15(1), 39. https://doi.org/10.1186/s12877-015-0042-z

Makris, U. E., Higashi, R. T., Marks, E. G., Fraenkel, L., Sale, J. E. M., Gill, T. M., & Reid, M. C. (2015). Ageism, negative attitudes, and competing co-morbidities – why older adults may not seek care for restricting back pain: A qualitative study. BMC Geriatrics, 15(1), 39. https://doi.org/10.1186/s12877-015-0042-z

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Melzack, R. (1975). The McGill Pain Questionnaire: Major properties and scoring methods. Pain, 1(3), 277-299. doi: 10.1016/0304-3959(75)90044-5

Melzack, R. (1975). The McGill Pain Questionnaire: Major properties and scoring methods. Pain, 1(3), 277-299. doi: 10.1016/0304-3959(75)90044-5

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Mezinski, P.M., Keller, A.W., & Luggen A.S. (2004). Assessment of pain in the cognitively impaired older adult in long-term care. Geriatric Nursing, 25(2), 107–112.

Mezinski, P.M., Keller, A.W., & Luggen A.S. (2004). Assessment of pain in the cognitively impaired older adult in long-term care.  Geriatric Nursing,  25(2), 107–112.

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Yong, H. H., Gibson, S. J., David, J. D. L., & Helme, R. D. (2001). Development of a pain attitudes questionnaire to assess stoicism and cautiousness for possible age differences. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 56B(5), P279-P284.

Yong, H. H., Gibson, S. J., David, J. D. L., & Helme, R. D. (2001). Development of a pain attitudes questionnaire to assess stoicism and cautiousness for possible age differences. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 56B(5), P279-P284.

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Zwakhalen, S. M. G., Hamers, J. P. H., Abu-Saad, H., & Berger, M. P. F. (2006). Pain in elderly people with severe dementia: A systematic review of behavioural pain assessment tools. BMC Geriatrics, 6(1), 3. doi:10.1186/1471-2318-6-3

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TREATMENT

Abdulla, A., Bone, M., Adams, N., Elliott, A. M., Jones, D., Knaggs, R., Martin, D., Sampson, E. L., & Schofield, P. (2013). Evidence-based clinical practice guidelines on management of pain in older people. Age and Ageing, 42(2), 151–153. https://doi.org/10.1093/ageing/afs199

Abdulla, A., Bone, M., Adams, N., Elliott, A. M., Jones, D., Knaggs, R., Martin, D., Sampson, E. L., & Schofield, P. (2013). Evidence-based clinical practice guidelines on management of pain in older people. Age and Ageing, 42(2), 151–153. https://doi.org/10.1093/ageing/afs199

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Abdulla, A., Bone, M., Adams, N., Elliott, A.M., Jones, D., Knaggs, R., Martin, D., Sampson, E.L., & Schofield, P. (2013). Evidence-based clinical practice guidelines on management of pain in older people. Age Ageing, 42 (2), 151-153. doi: 10.1093/ageing/afs199.

Abdulla, A., Bone, M., Adams, N., Elliott, A.M., Jones, D., Knaggs, R., Martin, D., Sampson, E.L., & Schofield, P. (2013).  Evidence-based clinical practice guidelines on management of pain in older people. Age Ageing, 42 (2), 151-153.  doi: 10.1093/ageing/afs199.

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AGS Panel on Persistent Pain in Older Persons. (2002). The Management of Persistent Pain in Older Persons. Journal of the American Geriatrics Society, 50 (S6), S205–S224.

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American Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older Persons. (2009). Pharmacological Management of Persistent Pain in Older Persons: pharmacological management of persistent pain in older persons. Journal of the American Geriatrics Society, 57(8), 1331–1346. https://doi.org/10.1111/j.1532-5415.2009.02376.x

American Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older Persons. (2009). Pharmacological Management of Persistent Pain in Older Persons: pharmacological management of persistent pain in older persons. Journal of the American Geriatrics Society, 57(8), 1331–1346. https://doi.org/10.1111/j.1532-5415.2009.02376.x

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American Psychological Association (Producer). (2008). Adapting Psychotherapy for Working with Older Adults. [DVD]. http://www.apa.org/pubs/videos/4310856.aspx

American Psychological Association (Producer). (2008). Adapting Psychotherapy for Working with Older Adults. [DVD]. http://www.apa.org/pubs/videos/4310856.aspx

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Ballard, C., Hanney, M. L., Theodoulou, M., Douglas, S., McShane, R., Kossakowski, K . . . Yu, L. (2009). The dementia antipsychotic withdrawal trial (DART-AD): Long-term follow-up of a randomised placebo-controlled trial. The Lancet Neurology, 8(2), 151-157. doi: 0.1016/S1474-4422(08)70295-3

Ballard, C., Hanney, M. L., Theodoulou, M., Douglas, S., McShane, R., Kossakowski, K . . . Yu, L. (2009). The dementia antipsychotic withdrawal trial (DART-AD): Long-term follow-up of a randomised placebo-controlled trial. The Lancet Neurology, 8(2), 151-157. doi: 0.1016/S1474-4422(08)70295-3

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Bradford, A., Shrestha, S., Snow, A.L., Wilson, N, Hersch, G., Stanley, M.A., and Kunik, M.E. (2012). Managing pain to prevent aggression in people with dementia: A non-pharmacological Intervention. American Journal of Alzheimer’s Disease and other Dementias, 27(1):41-7. PMID: 22467413

Bradford, A., Shrestha, S., Snow, A.L., Wilson, N, Hersch, G., Stanley, M.A., and Kunik, M.E. (2012). Managing pain to prevent aggression in people with dementia: A non-pharmacological Intervention. American Journal of Alzheimer’s Disease and other Dementias, 27(1):41-7. PMID: 22467413

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Cleeland, C. S., Gonin, R., Hatfield, A. K., Edmonson, J. H., Blum, R. H., Stewart, J. A., & Pandya, K. J. (1994). Pain and its treatment in outpatients with metastatic cancer. New England Journal of Medicine, 330(9), 592-596. doi:10.1056/NEJM199403033300902

Cleeland, C. S., Gonin, R., Hatfield, A. K., Edmonson, J. H., Blum, R. H., Stewart, J. A., & Pandya, K. J. (1994). Pain and its treatment in outpatients with metastatic cancer. New England Journal of Medicine, 330(9), 592-596. doi:10.1056/NEJM199403033300902

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de Souto Barreto, P., Lapeyre-Mestre, M., Vellas, B., & Rolland, Y. (2013). Potential underuse of analgesics for recognized pain in nursing home residents with dementia: A cross-sectional study. PAIN, 154(11), 2427-2431.

de Souto Barreto, P., Lapeyre-Mestre, M., Vellas, B., & Rolland, Y. (2013). Potential underuse of analgesics for recognized pain in nursing home residents with dementia: A cross-sectional study. PAIN, 154(11), 2427-2431.

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Deane, G., & Smith, H.S. (2008). Overview of Pain Management in Older Persons. Clinics in Geriatric Medicine, 24(2), 185–201.

Deane, G., & Smith, H.S. (2008). Overview of Pain Management in Older Persons. Clinics in Geriatric Medicine, 24(2), 185–201.

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Deane, G., & Smith, H.S. (2008). Overview of Pain Management in Older Persons. Clinics in Geriatric Medicine, 24(2), 185–201.

Deane, G., & Smith, H.S. (2008). Overview of Pain Management in Older Persons. Clinics in Geriatric Medicine, 24(2), 185–201.

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