Accurate assessments of pain help healthcare professionals to identify its source and manage it appropriately. Pain in cognitively impaired older adults is difficult to assess and this can result in poor management and outcomes. In response to the vulnerability of this patient group, researchers have produced a variety of tools for pain assessment in cognitively impaired older adults. Replication research is recommended to validate further and generalize results, although there is enough evidence to support the use of direct observation of behaviour in identifying pain in this group of patients.