Pain Assessment in Advanced Dementia Scale (PAINAD)
What It Measures
The PAINAD is for people who can no longer say they are in pain. In advanced dementia, distress often gets read as agitation or behaviour rather than as a symptom with a cause — so the scale replaces asking with structured watching.
Five behaviours are observed and each scored 0, 1, or 2. Breathing, from normal through occasional laboured breathing to noisy laboured breathing or Cheyne-Stokes respirations. Negative vocalization, from none through occasional moaning to repeated troubled calling out. Facial expression, from smiling or inexpressive to grimacing. Body language, from relaxed to rigid, fists clenched, pulling away. And consolability, from no need to console to unable to console at all. Totals run 0 to 10.
Further Reading
Additional Notes
Licensing Notes: The scale is distributed free through geriatricpain.org, the Hartford Institute for Geriatric Nursing, and health systems worldwide, and is endorsed by the American Medical Directors Association.
Learn More: The Treatment threshold is low: bands of 1–3 mild, 4–6 moderate, and 7–10 severe are commonly cited, but many institutions treat a score of 2 or above as the point that triggers intervention, since a nonverbal person scoring 2 may be experiencing considerably more than the number suggests.