Effective pain management of the older adult begins with pain assessment using the proper tools. Understanding the complexities of the older adult in the ICU is the first step; this can be done by integrating the evidence-based practice guidelines provided by the American Geriatrics Society, the Joint Commission on Accreditation of Health Care Organizations (JCAHO pain standards: www.jcaho.org/standard/pm_hap.html), and the Society of Critical Care Medicine into physicians' and nurses' practice. Joint Commission on Accreditation of Health Care Organizations now recommends considering pain as the "fifth vital sign" (JCAHO pain standards: www.jcaho.org/standard/pm_hap.html). In summary, Park et al highlight key concepts that must be considered for all effective treatment plans: "anticipation, recognition, quantification, treatment and reassessment of the needs of the patient." Only then can we anticipate the impacts of chronic and critical illnesses and realize reliable and superior comfort for the elderly.