Pain assessment and cognitive impairment: part 1

Davies, Elizabeth; Male, Margaret; Reimer, Valerie; Turner, Margaret; Wylie, James

doi:10.7748/ns.19.12.39.s54

Cited by 14 publications

(12 citation statements)

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“…Plusieurs outils semblent moins applicables en milieu de soins, soit parce que la durée de la formation requise pour l'observateur est inapplicable dans un contexte de soins (DS-DAT [53]), soit parce que le protocole d'observation nécessaire est long et fatigant pour le résidant, ce qui ne convient pas dans le contexte d'un suivi systématique du niveau de douleur (PBM 64). Ce phénomène semble être une difficulté inhérente aux instruments visant à évaluer la douleur.…”

Section: Méthodologie Description De La Recherche Bibliographiqueunclassified

“…De plus, tous les instruments, sauf le FACS (56-58), incluent les vocalisations et verbalisations et les mouvements du corps. Cependant, seulement la moitié des instruments comprennent des énoncés relatifs aux changements dans les interactions sociales, les formes d'activités ou l'état mental.Quelques instruments, soit le PADE (61), le NOPPAIN (62) et l'échelle de Davies et coll (63,64),. intègrent, en plus de l'observation comportementale du patient, une évaluation globale du niveau de douleur perçue par l'observateur.…”

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“…intègrent, en plus de l'observation comportementale du patient, une évaluation globale du niveau de douleur perçue par l'observateur. Le NOPPAIN (62) et l'échelle de Davies et coll (63,64). incluent une autoévaluation par le patient.…”

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The Systematic Evaluation of Instruments Designed to Assess Pain in Persons with Limited Ability to Communicate*

Aubin

Giguère

Hadjistavropoulos

et al. 2007

Pain Research and Management

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Chronic pain is often underdetected and undertreated in long-term care facilities. The use of self-report measures of pain (such as the visual analogue scale) is often problematic for older adults residing in long-term care because of the high prevalence of visual and auditory deficits and severe cognitive impairment. Observational measures of pain have been developed to address this concern. A systematic grid designed to assess the properties of existing observational measures of pain was used for seniors with dementia. The grid focused on the evaluation of content validity (12 items), construct validity (12 items), reliability (13 items) and clinical utility (10 items). Among the 24 instruments that were evaluated, several were deemed to be promising in the assessment of pain among older persons with severe dementia. Nonetheless, additional research is needed before their routine integration in the practices of long-term care settings.

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The Systematic Evaluation of Instruments Designed to Assess Pain in Persons with Limited Ability to Communicate*

Aubin

Giguère

Hadjistavropoulos

et al. 2007

Pain Research and Management

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“…There is evidence that observation of pain behaviour should be integrated in pain assessment instruments (17,23,24), and proxy ratings are recommended, although considered complicated (25). In response to a strong need to improve pain management in severe dementia, several observational pain behaviour instruments have been developed (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). As discussed in review studies (25,(38)(39)(40), some tools are considered promising, although the psychometric properties are not yet convincingly investigated.…”

Section: Introductionmentioning

confidence: 99%

Pain behaviour and pain intensity in older persons with severe dementia: reliability of the MOBID Pain Scale by video uptake

Husebø

Strand

Moe‐Nilssen

et al. 2009

Scandinavian Caring Sciences

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Advancing age is associated with high prevalence of dementia, often combined with under-diagnosed and under-treated pain. A nurse-administered assessment tool has been developed to unmask pain during standardised, guided movements, called Mobilisation-Observation-Behaviour-Intensity-Dementia (MOBID) Pain Scale. The aim was to examine intra- and inter-rater reliability of pain behaviour indicators, inferred pain intensity, and the overall MOBID Pain Score. Twenty-six nursing home patients with severe dementia and chronic pain, 11 primary caregivers and three external raters at the Red Cross Nursing Home, Bergen were included. During video uptake the patients were guided by their primary caregivers to standardised movements of different body parts. Pain behaviour indicators (pain noises, facial expression and defence) were registered for each movement with subsequent rating of pain intensity by external raters, who assessed and scored the videos concurrently and independently at day 1, 4 and 8. Facial expression was most commonly observed, followed by pain noises and defence. Repeated assessments increased the number of observed pain behaviours, but did not improve reliability. Inter-rater reliability was highest for noises, followed by defence and facial expression (kappa = 0.44-0.92, kappa = 0.10-0.76 and kappa = 0.05-0.76 respectively, at day 8). Mobilisation of arms and legs were rated most painful. Intra- and inter-rater reliability of overall pain were very good [intraclass correlation coefficient (1,1) ranging 0.92-0.97 and 0.94-0.96 respectively, at day 8]. Reliability of pain intensity scores tended to increase by repeated assessment. Using video uptake, MOBID Pain Scale was shown to be sufficiently reliable to assess pain in older persons with severe dementia.

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“…Individuals display many different behavioral cues, making it difficult for the clinician to comprehend the nursing home resident’s needs. Research indicates specific verbal, behavioral, and facial expressions as being representative of pain 10,11. Because pain is an individual subjective experience, the complexity of assessing and determining patient pain may increase with cognitive decline.…”

Section: Introductionmentioning

confidence: 99%

Behavioral cues to expand a pain model of the cognitively impaired elderly in long-term care

Burfield¹,

Wan²,

Sole³

et al. 2012

CIA

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BackgroundThe purpose of this study was to determine the relationship between hypothesized pain behaviors in the elderly and a measurement model of pain derived from the Minimum Data Set-Resident Assessment Instrument (MDS-RAI) 2.0 items.MethodsThis work included a longitudinal cohort recruited from Medicare-certified longterm care facilities across the United States. MDS data were collected from 52,996 residents (mean age 83.7 years). Structural equation modeling was used to build a measurement model of pain to test correlations between indicators and the fit of the model by cognitive status. The model evaluates the theoretical constructs of pain to improve how pain is assessed and detected within cognitive levels.ResultsUsing pain frequency and intensity as the only indicators of pain, the overall prevalence of pain was 31.2%; however, analysis by cognitive status showed that 47.7% of the intact group was in pain, while only 18.2% of the severely, 29.4% of the moderately, and 39.6% of the mildly cognitively impaired groups were experiencing pain. This finding supports previous research indicating that pain is potentially under-reported in severely cognitively impaired elderly nursing home residents. With adjustments to the measurement model, a revised format containing affective, behavioral, and inferred pain indicates a better fit of the data to include these domains, as a more complete measure of the pain construct.ConclusionPain has a significant effect on quality of life and long-term health outcomes in nursing home residents. Patients most at risk are those with mild to severe cognitive decline, or those unable to report pain verbally. Nursing homes are under great scrutiny to maintain standards of care and provide uniform high-quality care outcomes. Existing data from federally required resident surveys can serve as a valuable tool to identify indicators of pain and trends in care. Great responsibility lies in ensuring pain is included and monitored as a quality measure in long-term care, especially for residents unable to communicate their pain verbally.

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Pain assessment and cognitive impairment: part 1

Cited by 14 publications

References 0 publications

The Systematic Evaluation of Instruments Designed to Assess Pain in Persons with Limited Ability to Communicate*

The Systematic Evaluation of Instruments Designed to Assess Pain in Persons with Limited Ability to Communicate*

Pain behaviour and pain intensity in older persons with severe dementia: reliability of the MOBID Pain Scale by video uptake

Behavioral cues to expand a pain model of the cognitively impaired elderly in long-term care

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