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Pain in aged care: how common, and why it is missed

Residents & families Aged care staff 6 min read

By Dr Josh Hatch, FRACGP

Pain is one of the most common problems in residential aged care, and one of the easiest to miss. Studies of nursing home residents report current pain in anywhere from about a fifth to more than four-fifths of residents, depending on how pain was measured and who was asked 2.

Numbers in the text link to the 7 sources listed at the foot of this page.

What the studies show

22% to 85%

of nursing home residents had current pain across 26 studies published from 2010 to 2020. The range is wide because the studies measured pain in different ways 2.

22% to 29%

was the range in studies that took pain from the medical chart, against 32% to 79% in studies that asked residents themselves. Charts recorded less pain than residents reported 2.

9% to 80%

of nursing home residents living with dementia had pain across 25 observational studies, with higher figures towards the end of life 3.

74%

of 550 residents in 12 South Australian nursing homes in 2019 were taking a regular oral analgesic: paracetamol, an anti-inflammatory or an opioid 4.

Why pain is missed

Pain is under-detected and poorly managed in people living with dementia, in residential care and in hospital 6. A person who cannot describe pain may still show it through behaviour, which is what observational pain tools are designed to pick up 78. The next page describes those tools.

An older hospital study shows how large the gap can be. Among older people with a hip fracture, those with advanced dementia received about a third of the opioid dose given to people without cognitive impairment, for the same injury. This was an observational study in one US hospital 9.

Pain can also sit behind other problems. In the review of nursing home studies, pain was most strongly associated with depression, difficulty with daily activities, arthritis, dementia and cognitive impairment 2. When a resident’s mood, mobility or behaviour changes, pain is one of the things to look for.

What families and staff can look out for

None of these proves that a person is in pain. Each is a reason to ask about it.

  • A change from usual. Moving less, staying in bed, eating less, sleeping poorly, or no longer joining in.

  • Pain at particular times. Wincing or resisting during showering, dressing, transfers, wound care or turning in bed.

  • Other words for pain. Some people say they are sore, stiff, aching or uncomfortable but will not use the word pain.

  • Behaviour that is new. Calling out, restlessness, guarding a limb, pushing staff away or becoming withdrawn.

Related pages on this site

Sources cited on this page

  1. 2 Cole CS, Carpenter JS, Chen CX, et al. Prevalence and factors associated with pain in nursing home residents: a systematic review of the literature. J Am Med Dir Assoc. 2022;23(12):1916–25. (Systematic review of 26 descriptive studies, 2010–2020.) View source
  2. 3 Helvik AS, Bergh S, Tevik K. A systematic review of prevalence of pain in nursing home residents with dementia. BMC Geriatr. 2023;23:641. (Systematic review of 25 observational studies.) View source
  3. 4 Dowd LA, Hamada S, Hattori Y, et al. A mixed-methods study on the pharmacological management of pain in Australian and Japanese nursing homes. Age Ageing. 2024;53(2):afae024. (Cross-sectional; 550 residents of 12 South Australian nursing homes, 2019.) View source
  4. 6 Lichtner V, Dowding D, Esterhuizen P, et al. Pain assessment for people with dementia: a systematic review of systematic reviews of pain assessment tools. BMC Geriatr. 2014;14:138. View source
  5. 7 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(1):9–15. (Instrument development study, 19 residents.) View source
  6. 8 Abbey J, Piller N, De Bellis A, et al. The Abbey pain scale: a 1-minute numerical indicator for people with end-stage dementia. Int J Palliat Nurs. 2004;10(1):6–13. (Validation study in Australian residential aged care.) View source
  7. 9 Morrison RS, Siu AL. A comparison of pain and its treatment in advanced dementia and cognitively intact patients with hip fracture. J Pain Symptom Manage. 2000;19(4):240–8. (Prospective cohort, one US academic hospital; observational.) View source

See every source cited across the pain section →

Written by Dr Josh Hatch, FRACGP. General information only, reflecting his reading of the published evidence as at November 2026. It is not individual medical advice, does not create a doctor–patient relationship, and must not be used to start, stop or change any treatment. It gives no doses, and it does not recommend any procedure, clinic or practitioner. Evidence and Australian regulatory and PBS arrangements change — always confirm current advice with the treating GP, pharmacist or specialist.

This is general education, not a clinical protocol. The doctors who practise with Umbrella Aged Care are independent general practitioners, and each makes their own clinical decisions with the resident and family. Your GP’s advice for an individual may differ from what is written here. If it does, please ask them to talk it through with you.

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