Pain Assessment in Older Inpatients across Geriatric Wards at King George Hospital: A Clinical Audit

Background: Accurate pain assessment is fundamental to effective pain management in older adults. Unrecognised pain is associated with adverse outcomes, including delirium, prolonged hospital stay and reduced quality of life. Although self-report remains the gold standard, some older adults may be unable to reliably report their pain because of cognitive impairment or communication difficulties, making pain more difficult to identify. In these situations, accurate pain assessment depends on healthcare professionals’ knowledge of pain assessment principles and the appropriate use of validated pain assessment tools. 

Aim: To evaluate multidisciplinary healthcare professionals’ knowledge and confidence regarding pain assessment in older adults admitted to geriatric wards at King George Hospital, BHRUT.  

Methods: This baseline clinical audit was conducted in May 2026 among multidisciplinary healthcare professionals working across geriatric wards at King George Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust. Knowledge and confidence regarding pain assessment in older adults were evaluated using a structured questionnaire based on national guidance. A Pareto analysis was performed to identify the knowledge domains contributing most to incorrect responses and inform targeted educational interventions. 

Results: Forty-eight healthcare professionals completed the questionnaire, of whom 37% reported receiving formal pain assessment training within the previous two years. Five participants (10%) correctly identified all validated pain assessment tools. Knowledge relating to validated pain assessment tools and pain assessment in older people living with cognitive impairment accounted for 77% of all incorrect responses. Self-reported confidence was lowest for assessing pain in patients living with dementia or cognitive impairment (mean 3.23/5).

Conclusion: This audit identified clear educational priorities relating to pain assessment in older adults, particularly the use of validated pain assessment tools and pain assessment in people living with cognitive impairment. These findings provide a baseline for targeted educational interventions and future re-audit to evaluate improvements in knowledge and confidence.