The nurse should be able to recognize these descriptors and consider them as potential indicators of pain and clarify them with further questions. According to Horgas & Miller (2008), older adults with cognitive or physical limitations have difficulty expressing details about their pain. These include pain location, duration, onset, type, precipitating factors, and pain-relieving factors. Pain is a subjective experience with no valid and reliable objective tests to measure it. The existence and intensity of pain are measured by the patient's self-report. Unfortunately, older populations with cognitive impairment may have difficulty expressing pain through verbal or body language. In some cases, it is surprising to know that pain in the elderly dementia population is very often undertreated. Therefore, variation in the patient's ability to communicate verbally can add an additional layer to effectively manage pain. When the pain problem is not resolved, it decreases the overall ability to perform daily activities and causes serious repercussions throughout most of one's life (Horgas & Miller, 2008). Similarly, the elderly population with cognitive impairment is even more limited in communicating pain symptoms. Therefore, particular attention should be paid to observing even the smallest reactions: body movement, changes in activity routines, changes in interpersonal interactions, facial expression, mental state changes, verbalizations, and vocalizations (Bruckenthal, Reid & Reisner, 2009 ). Additionally, some patients may have limited movement which makes it difficult for professionals to evaluate them. When pain is uncontrolled in patients with cognitive limitation, they express their pain by being violent, angry, or refusing routine care. There are patients who come more calmly and... in the center of the paper... for the management of persistent pain in elderly people. (2009). Journal of theAmerican Geriatrics Society, 57(8), 1331-1346.Reid, M., Bennett, D., Chen, W., Eldadah, B., Farrar, J., Ferrell, B., & ... Zacharoff , K. (2011). Improving pharmacological pain management in older adults: identifying research gaps and methods to address them. Pain Medicine, 12(9), 1336-1357. Somes, J., & Donatelli, N. (2013). Pain assessment in the cognitively impaired or demented elderly. Journal of Emergency Nursing, 39(2), 164-167. Wickremaratchi, M., & Llewelyn, J. (2006). Effects of aging on touch. Postgraduate MedicalJournal, 82(967), 301-304.Zwakhalen, S.G., Jenny T., S., & Najim, M.D. (2012). Which score most likely represents pain on the PAINAD observational pain scale for patients with dementia?. Journal of the American Medical Directors Association, 13(4), 384