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

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.