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

Abstract

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.

Towards improved decision support in the assessment and management of pain for people with dementia in hospital: a systematic meta-review and observational study

“…Much of the literature concerned with the assessment and management of pain for people with cognitive impairment has focused on the development and validation of observational instruments designed for the purpose of assessment. 54 A number of studies have shown that these tools are not often used in clinical practice, a finding that was supported in our data. This may be because the tools do not facilitate the rapid creation of the 'overall picture of pain' and, therefore, do not assist clinicians with their decision-making about pain in this vulnerable group of patients.…”

“…It presents a thorough synthesis of current systematic review literature concerning the psychometric properties and clinical utility of pain assessment tools for the assessment of pain in adults with dementia, and provides a detailed picture of the state of the field in the complex task of assessing pain. 54 For ease of reference, in this report we refer to our systematic review of systematic reviews as a 'meta-review'. We call the systematic reviews considered for inclusion in the meta-review 'reviews', and refer to publications included in the reviews as 'studies'.…”

Using sense-making theory to aid understanding of the recognition, assessment and management of pain in patients with dementia in acute hospital settings

“…In order to assist with the assessment process a number of assessment tools have been developed. These include simple rating scales for self-reporting of pain as well as tools to structure the observation of behavioural cues as a method for identifying the presence of (and changes in) pain in patients with dementia and other cognitive impairments (Corbett et al, 2012, Lichtner et al, 2014. Despite the abundance of such tools (Lichtner et al, 2014), many studies have highlighted that nurses do not use them in practice, preferring to rely on simple questioning (Manias, 2012) and their (Parke, 1998) or that a patient may be experiencing pain (Parke, 1998)[p26].…”

End-Stage Care of Persons with Alzheimer’s Disease

“…15 Interestingly, observational pain assessments utilize six domains of behavioral interpretation of pain, highlighted by American Geriatric Society, specifically body language, alterations in mental status, activity variation, facial expression, interactions with others, and negative vocalization. 16 Similarly, painful indicators can include grimacing, moaning, wandering, agitation, inappropriate speech, aggression, restlessness are often useful.…”