Age Differences in Decoding Pain from the Facial Expression of Healthy Individuals and Patients with Dementia

Objective. Patients with dementia, whose ability to provide self-report of pain is often impaired, are in crucial need of observers who can detect the patients' pain-indicative behaviors appropriately, to initiate treatment. The facial display of pain promises to be especially informative for that purpose. The age of the observer has been shown to have a critical influence on observational emotion recognition (with age-related decrements in facial emotion recognition) but has not yet been studied as such for pain recognition.

Methods. For that purpose, 24 young (mean age: 24 years) and 22 older (mean age: 70 years) observers watched 120 video clips, showing facial expressions of young and old individuals with and without dementia during slight and moderate noxious stimulation. After each clip, observers were asked to rate how much pain the observed individual might have experienced.

Results. Young observers were superior in grading different levels of pain in the observed individuals; furthermore, their ratings corresponded better with the self-ratings of the observed individuals. However, the performance of the older observers was still sufficient as regards the differentiation of different pain levels and prediction of self-report in others.

Conclusions. Age does not only lead to a decline in recognition of facial expressions of emotions but age also affects the quality of observational pain recognition in others. However, given that older observers' performance was only slightly reduced, clearly suggests that older caregivers are surely not at risk of becoming visual agnostic for the pain in others.