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Cancer pain, Elderly, Pain intensity assessment instruments



  1. Chang, Hsien-Chen MSN, RN
  2. Lai, Yeur-Hur PhD, RN
  3. Lin, Kuan-Chia PhD
  4. Lee, Tzu-Ying PhD, RN
  5. Lin, Hung-Ru PhD, RN


Background: Effective pain management requires careful assessment of pain. Auditory, visual, cognitive, and motor impairments in elderly people may affect their ability to use pain assessment tools.


Objective: The aim of this study was to evaluate the reliability, validity, and no-response rate of pain scales among elderly patients with cancer pain, as well as patient preference for the scales.


Methods: A cross-sectional correlational design was used with a convenience sample of 73 elderly cancer patients recruited at a cancer-based hospital in southern Taiwan. Participants were asked to rate their pain by using a numeric rating scale (NRS-11), a facial pain scale (FPS), a verbal descriptor scale (VDS), and a mixed scale (consisting of NRS-11, FPS, and VDS) on 2 consecutive days.


Results: Test-retest reliability, as indicated by Spearman rank correlation coefficients for the 24-hour interval pain ratings, ranged from 0.426 to 0.683. The criterion-related validity of the scales was supported by significant Spearman rank-order correlation. The time taken to respond to the scales ranged from 40.3 to 16.2 seconds. The no-response rates for the scales decreased in the order NRS-11 > FPS > mixed scale > VDS. Patient preference for the scales decreased in the order mixed scale > VDS > NRS-11 > FPS.


Conclusions: All 4 scales were reliable and valid for assessing cancer pain among elderly patients.


Implications for Practice: Because the no-response rates for the scales depended on educational level and cognitive function, nurses should exercise good judgment in choosing pain intensity assessment tools for use with elderly patients.