Nurses and relatives routinely fail to detect the severity of chronic pain among nursing home residents, especially those with cognitive impairments, according to a new study.

The five-year study from The Netherlands followed 174 nursing home residents at six different facilities. A total of 171 nurses and 122 relatives also took part in the study. Researchers conducted interviews with the non-cognitively impaired residents to determine how much, if any, pain they had reported in the week prior to the interview. Researchers found that 89% of nurses and 67% of relatives were aware of the pain. Those who were aware of the pain often assessed it at the same level, on a scale of one to 10, as the residents did.

Nurses and relatives were less apt to know about resident pain if that resident was at rest, and often assessed that pain at zero out of 10, while residents rated their pain at around four, according to researchers. The full report appears in the September issue of The Journal of Clinical Nursing.