The MOBID-2 Pain Scale | Use In Dementia Patients
Written By Kobi Nathan, Pharm.D., M.Ed., CDP, BCGP, AGSF
Sleep Disorders
July 10, 2023

How do you assess pain in patients with dementia?

As a healthcare professional, you understand the importance of assessing and managing pain in older persons.

However, this can be particularly challenging for older persons with severe dementia, who may not be able to communicate their pain in a traditional manner.

This is where the Mobilization-Observation-Behavior-Intensity-Dementia  (MOBID-2 Pain Scale) comes in – a standardized tool designed to assess pain intensity in older persons with severe dementia.

The MOBID Pain Scale is a comprehensive pain assessment tool that considers physical, behavioral, and psychological symptoms the older adult is experiencing.

It provides a more holistic approach to the assessment of pain in individuals with dementia, allowing you to understand better and address their pain.

In this article, we will explore the components of the MOBID-2 and how you can use the pain scale in a clinical setting, assisted living facilities, and nursing homes to enhance patient care.

To help you visualize what the scale looks like, see the screenshots below, used with permission from the primary creator of the assessment tool, Dr. Bettina Husebo:

MOBID-2 Pain Scale Page 1

MOBID-2 Pain Scale page 2


If you want to print out the pain scale, you can download the pdf here.

Key Takeaways

  • The MOBID-2 Pain Scale is a reliable and valid tool for assessing pain in individuals with dementia.
  • Pain assessment is important in elderly care, particularly in dementia care, and the MOBID-2 Pain Scale takes into account physical, behavioral, and psychological symptoms.
  • Non-pharmacological pain relief methods should also be considered, and pain education is an essential component of pain management.
  • Caregiver training is crucial to ensure that all staff members are familiar with the tool and how to use it properly, and incorporating pain assessment tools into healthcare protocols can improve the quality of life for elderly patients.

Understanding the Importance of Pain Assessment in Elderly Patients

If you want to provide the best care for your elderly loved ones, it’s crucial to understand the importance of pain assessment.

Pain management is a critical component of elder care, particularly since the elderly population is more prone to chronic pain due to various medical conditions.

Therefore, healthcare providers should use pain assessment tools to determine the severity of pain experienced by their patients.

Pain assessment is especially important in dementia care, where nonverbal patients may be unable to express their pain.

Effective nursing interventions can improve the quality of life for these patients.

Pain assessment is also critical in palliative care, where a holistic approach to pain management can improve the overall quality of life for patients.

By understanding the importance of pain assessment, caregivers can provide their elderly loved ones with the best possible care.

What is the MOBID-2 Pain Scale

The MOBID-2 Pain Scale is an observational tool to assess discomfort in patients with severe dementia in which observers rate pain intensity on a 0-10 scale, when the patient is at rest and again after five standardized movements.

The scale was developed by Dr. Husebo BS and colleagues to address the challenges of accurately evaluating pain in people with dementia, who may be unable to communicate their symptoms effectively.

The MOBID-2 Pain Scale has become widely used in clinical settings due to its reliability and validity in assessing pain intensity in older persons.

Research findings from Norwegian nursing homes have shown that the MOBID-2 Pain Scale effectively detects pain in individuals with dementia and is comparable to other pain assessment tools.

Test-retest reliability and validity testing have also been conducted to ensure that the scale measures what it is intended to measure.

Cultural considerations should also be considered when using the MOBID-2 Pain Scale, as different cultures may express pain differently.

Patient education and caregiver training are also important aspects of clinical implementation to ensure the proper use of the tool in pain management.

How to Administer the MOBID-2 Pain Scale

Administering the MOBID-2 Pain Scale requires careful observation of various pain assessment techniques.

This is especially important for individuals with cognitive impairments who may have difficulty communicating pain.

However, it’s essential to note that pain management strategies shouldn’t rely solely on the MOBID-2 Pain Scale.

The tool is meant to supplement patient communication and other pain monitoring techniques.

During the pain assessment process, it’s crucial to observe the patient’s facial expressions, body movements, vocalizations, and changes in activity level.

This helps to evaluate discomfort and identify the pain level accurately.

To administer the pain assessment using the MOBID scale, you can do the following:

Observe your patient before beginning (are they ready to proceed?).

Explain clearly what is going to happen to your patient.

Guide your patient sequentially through steps 1 to 10, marking the boxes on the pain scale appropriately for pain noises, facial expressions, and defense behaviors:

  • Pain noises: “Ouch!”, groaning, screaming, gasping
  • Facial expression: Frowning, grimacing, tightening of mouth, closing eyes.
  • Defensive behaviors: Freezing, pushing, guarding, crouching.
  • As you move through each step, mark the pain intensity on the scale according to your assessment of how much pain your patient is experiencing.
  • Based on your observation of steps 1 to 10, rate your patient’s overall pain intensity in the bottom of the pain assessment.

Additionally, pain documentation is necessary to track progress and adjust pain medication administration as needed.

Management of pain

Non-pharmacological pain relief methods, such as massage therapy and relaxation techniques, should also be considered to complement pain medication.

If pain medications must be used, opioids should be avoided as much as possible to prevent further exacerbation of your patient’s cognitive impairment and to prevent falls and injuries.

A good option would be non-opioid pain medication such as acetaminophen or NSAIDs, where appropriate and after careful consideration by your patient’s physician.

In certain cases, older adults may achieve satisfactory pain relief by taking acetaminophen and ibuprofen together.

Pain education is also an essential component of pain management, as it can help patients understand the importance of pain monitoring and management in their overall health and well-being.

A word of caution – in the later stages, there are certain signs death is near for dementia patients.

These signs can overlap with those you may typically see in older adults who are merely experiencing pain without impending death.

As a nursing staff member, it will be up to you to expertly and confidently assess your patient in an accurate manner.

As I mentioned earlier, proper training will help you achieve mastery over your assessment skills.

Benefits of Using the MOBID-2 Pain Scale

Using this tool can greatly improve the quality of life for elderly patients, ensuring that their pain is properly managed and reducing their discomfort and possible agitation.

The MOBID-2 Pain Scale has several benefits that make it a valuable tool in pain management.

Here are some of the benefits that can be achieved by using this scale:

  1. Improved communication: The MOBID-2 Pain Scale allows your patients to communicate their pain level to healthcare providers accurately. This, in turn, helps providers to make more informed decisions about pain management.
  2. Early intervention: With the MOBID-2 Pain Scale, healthcare providers can detect pain early and intervene before it becomes severe. This can lead to better pain management and improved patient outcomes.
  3. Patient satisfaction: Using a pain scale to manage pain can increase patient satisfaction, as patients feel their pain is being taken seriously and managed appropriately.
  4. Reduced medication errors: By using the MOBID-2 Pain Scale, healthcare providers can ensure that the correct medication and dosage are given to patients, reducing the risk of medication errors.

Other pain assessments

I have written a detailed article about the PAINAD scale, another trusted assessment method you can use to rate pain in older adults with dementia.

I highly recommend you read it to learn more.

To rate pain in patients who are NOT cognitively impaired, I suggest reading my article on the PQRST pain assessment method.

Pain management: Are NSAIDs safe for older adults?

In general, taking NSAIDs consistently can put anyone, regardless of age, at risk for thrombotic events, gastrointestinal bleeding, worsening of high blood pressure and heart failure, and kidney damage.

In older adults, the risk of experiencing these adverse events is compounded. To learn why, read my article here.

These OTC medications may seem rather benign, but they can also interact with your existing medications or medical problems and cause great harm.

Always consult your doctor first before taking NSAIDs.


In conclusion, utilizing a specialized pain assessment tool, such as the MOBID-2 Pain Scale, is crucial in caring for elderly patients with dementia.

Traditional pain assessments may overlook important behavioral and psychological symptoms that indicate pain in this population.

The MOBID-2 Pain Scale considers these additional indicators, providing a more comprehensive approach to pain management.

Administering the MOBID-2 Pain Scale may require extra training for healthcare providers, but the benefits of using such a tool are numerous.

By accurately assessing and addressing pain in individuals with dementia, healthcare providers can improve the overall quality of life and reduce the use of unnecessary medications or treatments.

Additionally, a specialized pain assessment tool can enhance communication between healthcare providers, caregivers, and patients, leading to a more collaborative and effective approach to pain management.

Overall, incorporating the MOBID-2 Pain Scale into clinical practice can improve the care and well-being of elderly patients with dementia.

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