National Preventive Mechanism 5.1.4 Introduction of care standards in relation to pain Facilities often do not notice that elderly persons suffer for extended periods of time from severe pain resulting from both immobility and physical stress. However, it is incorrect to assume that pain is simply part of old age. Pain impairs quality of life, increases the risk of falls and leads to more rapid physical decline and confinement to bed. Pain must not be accepted as simply part of old age A study published in 2015 concerning pain in long-term care facilities in Austria shows that around two thirds of the residents of retirement and nursing homes suffer from pain and simply accept this situation as due to their old age. Pain is kept secret in most cases (64%) in order not to be a burden for nursing staff. Around one third of residents had concerns regarding side effects or had recently received painkillers (19%). 18% of elderly persons did not have any reference care person and 16% were concerned about becoming addicted to medication (source: Schreier et al.: “Pain and assessment of pain in retirement and nursing homes. Results of the OSiA study” (“Schmerz und Schmerzerfassung in Altenpflegeheimen. Ergebnisse der OSiA-Studie”), in: Der Schmerz, April 2015, volume 29, issue 2, pp. 203-210). The result of this study has also been confirmed by commission visits. Although a nursing diagnosis of “pain” had been made for a large number of very elderly persons, no further measures had been incorporated into nursing schedules. Regular questioning concerning the intensity of pain in situations of immobility and physical stress was not carried out either. Elderly persons at one facility in Salzburg reported to Commission 2 that they did not speak to staff about pain as the staff were already overworked. Residents at a facility in Carinthia described that, despite receiving medical treatment for pain, they still suffered from pain and could hardly move as a result. However, no additional interventions were carried out and no therapeutic support was provided. Pain and dementia often arise in parallel 110 In many cases commissions reported that they observed reactions indicative of pain from persons with severe dementia who were no longer capable of expressing themselves, such as twisted faces or defensive movements against the care measures. None of this was apparent from the documentation. Also medical histories prior to admission in the homes have proved to be largely incomplete regarding this matter. In addition to information concerning previous illnesses, it would also be important to know whether painkillers have been taken, and if so, since when and which ones. Here it is above all relatives who are questioned, as they are often better informed regarding the consumption of painkillers than the attending physician, especially if overthe-counter medicines obtainable without medical consultation have been used. The likelihood of dementia and pain emerging in parallel is very high. Nevertheless, persons with dementia are given painkillers much less frequently, and with lower doses, than patients without dementia of the same age. This