Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC-II)©


The PACSLAC II Checklist is used to screen for pain in older adults who have dementia or other cognitive impairment with a limited ability to communicate. The tool should be used by a professional nurse.

When to use:

It should be used at the following time points:

  • Upon admission to establish initial baseline level of behaviors that may be related to pain
  • At each quarterly nursing review
  • Weekly for older adults with a trigger for pain or problem with pain
  • Any time a change in behavior is reported that might be related to pain
  • Reassess as appropriate to determine if treatment goals are met

How to use:

Complete the PACSLAC-II checklist based on observations of the older adult during activity or movement (such as transferring out of bed or walking) after a day-long shift of observation. Many underlying pain problems are easier to identify during periods of movement than during rest. It would be best to adopt an individualized approach using the PACSLAC-II regularly (under similar conditions) with each older adult. You would then examine for significant changes or fluctuations in the older adult's pattern of scores.

Determine presence or absence of each behavior on the checklist and add for a total score. Compare the total score after each use to the previous score obtained.

An increased score suggests that an increase in pain is likely. On the other hand, a lower score suggests that pain has decreased.


Document/record all scores in a location that is readily accessible by other health care providers.

Note: The PACSLAC is a screening tool and not a definitive indicator of pain. Behavior observation scores should be considered alongside knowledge of existing painful conditions and reports from someone who knows the older adult (like a family member or nursing assistant) and their pain behaviors. Remember some older adults may not demonstrate obvious pain behaviors or cues. The authors of this tool wish you to note that the research on the validation and evaluation of the PACSLAC-II is not complete. As such, if you choose to use it, you must do so with caution.


Chan, S., Hadjistavropoulos, T., Williams, J., Lints-Martindales, A., (2014). Evidence-based development and initial validation of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate-II (PACSLAC-II). The Clinical Journal of Pain, Vol.30(9), p.816-824