The Abbey pain scale: a 1-minute numerical indicator for people with end-stage dementia

Abstract

The need for a specialized clinical regimen for patients with dementia who require palliative care has only recently been recognized. Structured approaches to palliative care are not well developed. The recognition and treatment of pain is an important part of this management risk. However, pain is consistently underdiagnosed and undertreated in this population. A factor contributing to this has been a lack of appropriate tools to help recognize and document pain. This study sought to develop and validate an easy-to-use pain scale for use in residential aged care homes. The tool was developed with residents with end- or late-stage dementia who were unable to articulate their needs, identified by the registered nurses who knew them. Results showed that following pain-relief intervention the average pain score recorded using the scale fell by more than half. A paired Student's t-test showed the reduction to be highly significant (P<0.001). Validity and internal reliability, assessed by calculating Gamma and Cronbach's alpha, were found to be satisfactory. Qualitative evidence gathered from users of the scale indicated that it was considered a useful clinical device that could be completed within one minute. Further analysis of the use of the scale in clinical settings, testing of inter-rater reliability and examination of the limitations found in this study will commence early in 2004.

End of life care for community dwelling older people with dementia: an integrated review

“…at home care and hospice care). Six studies included direct evidence from people with dementia (The Anne Mei, 2002;Allen, 2003;Abbey et al, 2004;Shega et al, 2004;Magaziner et al, 2005;Abbey, 2006) as opposed to relying on family carers' and health professionals' accounts and/or records of the care. Most studies had purposive or convenience samples.…”

“…Nonpharmaceutical interventions were effective in reducing discomfort for 62% of participants, and analgesics effective for 75% of participants The study demonstrated more effective use of analgesia and less discomfort in the intervention group. This work, and that of Abbey et al (2004), highlighted the importance of structured ways of working that combine educational support for care workers with the development of interventions that are specific for end-of-life care for people with dementia. These studies were based in nursing homes and relied on effective cross-disciplinary working.…”

“…Research on the assessment of pain for people with end stage dementia is limited and has focused on the ability of carers to predict pain (Shega et al, 2004) and the validity and perceived usefulness of different pain assessment tools for end-of-life care (Abbey et al, 2004). Van Lersel et al (2006) asked 185 care providers to compare two pain assessment tools (Abbey and PAINAD) with 157 older people who could not verbally express their experience of pain.…”

Pharmacological Management of Pain in Older People

“…The APS recommended Abbey Pain Scale is a 4-point scale that is used to rate six domains of observation: vocalisations, facial expressions, body language, behavioural changes, physiological changes and physical changes. 24 This and other pain measures appropriate for this population are published in Pain in Residential Aged Care Facilities: Management Strategies. 18 …”

Cultural adaptation of the scale Pain Assessment in Advanced Dementia – PAINAD to Brazil

“…In the global literature, 12 instruments were found proposing the evaluation of pain in people with severe dementia published until 2013, being those: Abbey Pain Scale (8) ; CNPI -Checklist of Nonverbal Pain Behaviors (9) , CPAT -Certified Nursing Assistant Pain Assessment Tool (10) ; DOLOPLUS-2 (11) ; MPS -Mahoney Pain Scale (12) ; MOBIDMobilization-Observation-Behavior-Intensity-Dementia Pain Scale (13) e MOBID-2 (14) ; NOPPAIN -Non-communicative Patient's Pain Assessment Instrument (15) ; PACS-LAC -Pain Assessment Checklist for Seniors With Limited Ability to Communicate (16); PADE -Pain Assessment for the Dementing Elderly (17) ; PAINAD -Pain Assessment in Advanced Dementia (18) , PAINE -Pain Assessment in Non communicative Elderly Persons (19) and ADD -Assessment of Discomfort in Dementia (20) .…”