Pain assessement in the elderly should follow specific guidelines (AGS Guidelines JAGS 50:S205-S224, 2002), by using the usual pain measures, i.e. numerical rating scale or verbal rating scales, keeping in mind that compliance in completing visual analogue scales is poor in the elderly. The elderly without cognitive compromise can use same methods used for all patients. In case of cognitive compromise, multidimensional evaluations including non-verbal pain behaviours, activity scales and proxy pain ratings have been considered. Several behavioural scales and facial expressions scale have been studied among which the DS-DAT, PADE, PAINAD, CNPI, DOLOPLUS, PATCOA. The Facial expression coding system and the pain behaviour observation system by Keefe et al. have been developed by psychosocial scientists. The relevance of these methods to evaluate patients with cognitive impairment in the advanced phase of palliative care will be discussed.