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Effective pain management requires careful assessment of pain. Auditory, visual, cognitive, and motor impairments in elderly people may affect their ability to use pain assessment tools.The aim of this study was to evaluate the reliability, validity, and no-response rate of pain scales among elderly patients with cancer pain, as well as patient preference for the scales.A cross-sectional correlational design was used with a convenience sample of 73 elderly cancer patients recruited at a cancer-based hospital in southern Taiwan. Participants were asked to rate their pain by using a numeric rating scale (NRS-11), a facial pain scale (FPS), a verbal descriptor scale (VDS), and a mixed scale (consisting of NRS-11, FPS, and VDS) on 2 consecutive days.Test-retest reliability, as indicated by Spearman rank correlation coefficients for the 24-hour interval pain ratings, ranged from 0.426 to 0.683. The criterion-related validity of the scales was supported by significant Spearman rank-order correlation. The time taken to respond to the scales ranged from 40.3 to 16.2 seconds. The no-response rates for the scales decreased in the order NRS-11 > FPS > mixed scale > VDS. Patient preference for the scales decreased in the order mixed scale > VDS > NRS-11 > FPS.All 4 scales were reliable and valid for assessing cancer pain among elderly patients.Because the no-response rates for the scales depended on educational level and cognitive function, nurses should exercise good judgment in choosing pain intensity assessment tools for use with elderly patients.