Pain is likely to be a different problem in the old-old and the frail elderly compared to the young-old. Little attention has been paid to date to the impact of pain on quality of life in dementia patients, in postfracture patients, or in nondemented nursing home residents. It is likely that pain is a major source of depression and suffering in these individuals. Although currently available pain assessment tools are appropriate for the young-old, their usefulness in the old-old has not yet been evaluated. Additional pain assessment tools are needed for uncommunicative patients. The effectiveness of pain relief treatments in such patients cannot be evaluated without appropriate assessment. Such assessment may depend upon well-developed behavioral and observational techniques, particularly in individuals with later-life dementias such as dementia of the Alzheimer's type-a condition responsible for in excess of 60% of nursing home residents.