Limited Australian clinical guidelines for pain assessment in hospitalized older adults with cognitive impairment: implications for safe and quality care.

Introduction: Pain assessment remains challenging in healthcare settings in patients who are unable to self-report their pain. More than 50% of individuals with dementia and other forms of cognitive impairment (CI) experience pain daily. However, pain is frequently overlooked and inadequately assessed by healthcare professionals due to their lack of knowledge and guidelines to inform pain assessment. Pain is also a leading cause of hospital presentation and inappropriate pain assessment can impact on pain management and compromise safe and quality care. Evidence-based guidelines that inform appropriate pain assessment and management are therefore essential. This scoping review aimed to explore pain assessment guidelines for patients with CI in hospital through an Australian focused search to inform pain assessment practice within our local context and subsequent research. The objectives were to identify accessible pain assessment guidelines for hospitalized older adults with CI and summarize and describe their characteristics. Methods: A scoping review was conducted, using the Joanna Briggs Institute methodology and reported in accordance with the PRISMA-ScR reporting framework. The search strategy was guided by the Population, Concept, and Context frameworks, focusing on older adults with CI, pain assessment guidelines, and hospital or acute care setting. The search was conducted in March 2026, using CINHAL, MEDLINE, Embase, Web of Science, Google, Yahoo Search, and Bing. Results: No Australian guidelines were located in the database search. Of 56 guidelines identified through internet searches, nine met the inclusion criteria and were included in data extraction. All nine included pain assessment indication; however, two provided no practical guidance, and the remaining seven offered only brief narrative descriptions of pain assessment steps. The most frequently recommended pain assessment tools in the guidelines for patients with CI were the Pain Assessment in Advanced Dementia and the Abbey Pain Scale. Discussion: By systematically mapping the extent, characteristics, and variability of guidelines for pain assessment of patients with CI guidelines, it is an important first step in driving innovation in pain assessment for older adults in Australia. It provides transferable insights that can inform the development and adaptation of international clinical guidelines. Scoping Review Registration (OSF):https://doi.org/10.17605/OSF.IO/HJSMZ.