the highest prevalence of (very) severe pain (20%)”. According to studies, in Austrian retirement and nursing homes around two thirds of residents suffer from pain. This does not surprise anyone who shares the widespread belief that pain is part of ageing. Doctors, however, contradict this and emphasise that pain management is inadequate and that the training of both doctors and nurses leaves much to be desired. Pain has very different causes and can occur in many different forms. It can be either chronic or acute and the presence of pain can differ greatly in its subjective severity. This sensation is difficult to grasp objectively. If pain remains untreated, this results in very severe impairment of the quality of life. Long-lasting pain has drastic consequences for body and mind. People lose their appetite, lose weight, lose their drive or become aggressive and the danger of suicide grows. Untreated pain In order to be able to treat pain, it must be recognised in a timely manner and precisely diagnosed in a pain assessment. A comprehensive evaluation of pain requires compliance with numerous criteria: how does the pain manifest, where it is localised, when does it occur, how long does it last, how intense is it, what is the quality of the pain and which symptoms accompany the pain. The use of welltested scales, with which the persons affected can better gauge their sensation of pain, are helpful. Assessing pain in nursing home residents with severe dementia is difficult because of limited communication possibilities. The danger that their suffering is not adequately assessed, but is trivialised, is significant. Persons with advanced dementia can no longer express their pain adequately. The increasing loss of independence and self-determination leads to a high degree of dependence on nursing staff. The nursing staff has the responsibility to keep their eye on possible pain in the most literal sense of the word. The basis for assessing pain by a third party is continuing and systematic observation of changes in behaviour, such as facial expression, language or physical movements during all nursing tasks. As is the case in self-assessment, scales can be helpful in an assessment by a third party as well. In this area most particularly, a cooperative partnership between attending physicians, nurses and relatives is especially important. Pain assessment Unfortunately, pain assessments are not seamlessly customary in retirement and nursing homes. During their visits, the commissions have found repeatedly that pain assessments are either not yet customary or that the documentation of pain perception and of the corresponding medication-based or non-medication-based measures is very deficient. If pain in the elderly would be routinely evaluated with the same priority as blood pressure, pulse, breathing and temperature, a significant amount of unnecessary suffering, stress and fear could be avoided. Pain prevention is inadequate 42