Observational pain assessment scales for people with dementia: a review

While, Christine; Angus, Jocelyn

doi:10.12968/bjcn.2009.14.10.44496

Cited by 22 publications

(14 citation statements)

References 10 publications

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“…They are very specific in their aims, i.e. to identify pain assessment tools for cognitively impaired adults recommended for use by paramedics [ 38 ] and district nurses [ 39 ]. They identified two and four reviews respectively, which were amongst those we also retrieved.…”

Section: Resultsmentioning

confidence: 99%

Pain assessment for people with dementia: a systematic review of systematic reviews of pain assessment tools

et al. 2014

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BackgroundThere is evidence of under-detection and poor management of pain in patients with dementia, in both long-term and acute care. Accurate assessment of pain in people with dementia is challenging and pain assessment tools have received considerable attention over the years, with an increasing number of tools made available. Systematic reviews on the evidence of their validity and utility mostly compare different sets of tools. This review of systematic reviews analyses and summarises evidence concerning the psychometric properties and clinical utility of pain assessment tools in adults with dementia or cognitive impairment.MethodsWe searched for systematic reviews of pain assessment tools providing evidence of reliability, validity and clinical utility. Two reviewers independently assessed each review and extracted data from them, with a third reviewer mediating when consensus was not reached. Analysis of the data was carried out collaboratively. The reviews were synthesised using a narrative synthesis approach.ResultsWe retrieved 441 potentially eligible reviews, 23 met the criteria for inclusion and 8 provided data for extraction. Each review evaluated between 8 and 13 tools, in aggregate providing evidence on a total of 28 tools. The quality of the reviews varied and the reporting often lacked sufficient methodological detail for quality assessment. The 28 tools appear to have been studied in a variety of settings and with varied types of patients. The reviews identified several methodological limitations across the original studies. The lack of a ‘gold standard’ significantly hinders the evaluation of tools’ validity. Most importantly, the samples were small providing limited evidence for use of any of the tools across settings or populations.ConclusionsThere are a considerable number of pain assessment tools available for use with the elderly cognitive impaired population. However there is limited evidence about their reliability, validity and clinical utility. On the basis of this review no one tool can be recommended given the existing evidence.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2318-14-138) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Pain assessment for people with dementia: a systematic review of systematic reviews of pain assessment tools

et al. 2014

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“…The range of the MMSE is from 0 to 30, with higher scores signifying better cognitive function. A cutoff score of 10 was used to indicate severe cognitive impairment (Feldt et al, 1998;Ferrell, 1995;Husebo et al, 2007Husebo et al, , 2009Husebo et al, , 2010While & Jocelyn, 2009). Exclusion criteria were an ability to reliably self-report pain, cognitive impairment due to injury, trauma, or cerebral vascular accident, using prescribed seizure medications, or physical aggression/combativeness.…”

Section: Setting and Samplementioning

confidence: 99%

A Comparison of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC) and Pain Assessment in Advanced Dementia Scale (PAINAD)

Natavio

McQuillen

Dietrich

et al. 2020

Pain Management Nursing

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Background: There is currently no gold standard instrument for assessing pain in severely cognitively impaired adults who are unable to provide self-report. Aims: To determine interrater reliability of the PACSLAC and PAINAD in assessing pain behaviors in patients with the same pain stimulus, determine the consistency of the reliable changes between and within the instruments and assess nurse preference for either instrument. Design: A single-group, within-subjects repeated-measures design was implemented. Setting: The study took place in a small suburban hospital. Participants/Subjects: Pain levels were observed at 24, 48, and 72 hours postsurgery using two instruments: Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC) and Pain Assessment in Advanced Dementia Scale (PAINAD). These instruments were selected because they are among the most commonly recommended tools for clinical use. Interrater reliability was analyzed along with reliable changes in pain for each period, and the study concluded with the nurse raters completing a preference survey. Methods: A convenience sample of 30 patients was used with a diagnosis of severe dementia rendering the patient unable to reliably express pain, 60þ years of age, recovering from hip fracture surgery. Results: Greater interrater reliability was found for the PACSLAC, with reliable change potentially affected by the type and level of pain medication. The nurses' preference for the tool was split. Conclusions: The results of this study indicate that the PACSLAC may be the more reliable tool over the PAINAD; however, rater training and familiarity with the tool is critical.

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“…Families or carers of patients with cognitive impairment including dementia are familiar with them, their history, idiosyncrasies and needs (Buffum andHaberfelde 2007, McAuliffe et al 2012). They could therefore be a valuable resource for determining pain and an individual's preferred strategies for pain relief (Schofield 2008, While andJocelyn 2009). However, there is a lack of research that supports involving family carers and informal caregivers in pain assessment and management.…”

Section: Observational Assessmentmentioning

confidence: 99%

The complexity of pain assessment in older people

Gregory¹

2015

Nursing Older People

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Pain is common in older people and its assessment is an important part of the nurse's role. Asking people about their pain is considered the most accurate and reliable assessment because of the subjective nature of pain. A number of simple and easy-to-administer self-rating scales are available to measure pain intensity. To rate their pain, however, people need to understand the request, as well as recall and interpret the painful signal. Observing specific behaviours associated with pain is advocated when communication and cognitive function are impaired, for example, in people with advanced dementia. A number of pain assessment tools have been developed that involve observation of some or all of the behaviours. The aim of this article is to highlight the importance of pain assessment, discuss the various pain assessment scales and tools available and identify some of the factors that can make comprehensive assessment of pain in older people and those with cognitive impairment complex.

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Observational pain assessment scales for people with dementia: a review

Cited by 22 publications

References 10 publications

Pain assessment for people with dementia: a systematic review of systematic reviews of pain assessment tools

Pain assessment for people with dementia: a systematic review of systematic reviews of pain assessment tools

A Comparison of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC) and Pain Assessment in Advanced Dementia Scale (PAINAD)

The complexity of pain assessment in older people

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