An Interdisciplinary Expert Consensus Statement on Assessment of Pain in Older Persons (original) (raw)

Assessment and measurement of pain in older adults

Clinics in Geriatric Medicine, 2001

Although the empirical base is still limited when providing clear directions for pain assessment and management in older adults, it is possible to identify recommendations for guiding practice based on consensus and a developing scientific base to support best practice activities. This article offers a brief overview of the epidemiology and consequences of pain, followed by a summary of issues and approaches relevant to pain assessment in older adults. Cohort specific recommendations for comprehensive pain assessment and measurement are then addressed.

Assessing Pain in Older Adults

International Psychogeriatrics, 2000

In recent years, pain control has become a topic of increased interest in the United States. Although the interest originated in professional societies (the American Pain Society has called for pain to be treated as a “fifth vital sign”), regulatory agencies have now picked up on the issue. For example, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), probably the most important of the regulatory agencies, has established standards for pain assessment to be implemented by the upcoming year (JCAHO, 2000).

Pain assessment in the elderly: A psychometric evaluation of self-report and behavioral methods

2002

Limited research has been done that examines appropriate and reliable methods to assess for pain in the elderly population. For the cognitively impaired elderly, pain assessment is further complicated by their limited communication abilities. Reliable and clinically feasible methods are desperately needed to assess pain so that it can be managed appropriately. ^ The purpose of this study was to

A comparison of pain-assessment tools for use with elderly long-term-care residents

The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières, 2003

The purpose of this study was to examine the psychometric properties (test-retest and interrater reliability, criterion concurrent validity) of 3 verbal pain-assessment tools (Faces Pain Scale, Numerical Rating Scale, Present Pain Intensity Scale) and a behavioural pain-assessment scale for use with an elderly population. The study used a repeated-measures design to examine the reliability and validity of the tools across 4 groups of participants with varying levels of cognitive impairment using a non-random stratified sample of 130 elderly long-term-care residents. The findings support the test-retest and interrater reliability of the behavioural pain-assessment tool across all levels of cognitive impairment, whereas the same measures of reliability for the verbal-report tools decreased with increasing cognitive impairment; however, the majority of elderly with mild to moderate cognitive impairment were able to complete at least 1 of these tools. The findings are discussed in relat...

Pain assessment in older people with dementia: literature review

Journal of Advanced Nursing, 2009

Title. Pain assessment in older people with dementia: literature review. Aim. This paper is a report of a literature review conducted to identify barriers to successful pain assessment in older adults with dementia and possible strategies to overcome such barriers. Background. Pain is frequently undetected, misinterpreted, or inaccurately assessed in older adults with cognitive impairment. These people are often unable to articulate or convey how they feel and are often perceived as incapable of experiencing or recalling pain. Data sources. Searches were conducted of CINAHL, Medline and other databases for the period 1993-2007 using the search terms pain, dementia, assess*, barrier* and obstacle*. Methods. Studies were critically appraised by two independent reviewers. Data were extracted using instruments specifically developed for the review. Studies were categorized according to levels of evidence defined by the Australian National Health and Medical Research Council and Joanna Briggs Institute. Results. Perceived barriers to successful pain assessment in people with dementia included lack of recognition of pain, lack of sufficient education and/or training, misdiagnosis or late diagnosis, and non-use of assessment tools. Barriers related to people with dementia included insufficient evidence, the possibility of a 'no pain' subset of people with dementia, type of pain, and stoical attitudes. Strategies proposed as means of overcoming these barriers included knowing the person, knowing by diversity/intuitive perception, education and training, and use of adequate tools. Conclusion. More extensive education and training about the relationship between pain and dementia are urgently needed, as is the development and implementation of an effective pain assessment tool specifically designed to detect and measure pain in older adults with all stages of dementia.

Pain Assessment for the Dementing Elderly (PADE): Reliability and Validity of a New Measure

Journal of the American Medical Directors Association, 2003

To establish the reliability and validity of a measure to assess pain in individuals with advanced dementia. Design: Sixty-five residents of long-term care facilities were assessed using a new rating tool, the Pain Assessment for the Dementing Elderly (PADE), in two separate studies: (1) Residents were assessed simultaneously by two different raters, at Time 1 and 2, to establish interrater reliability, stability, and internal consistency. (2) Validity was established by assessing the correlation between an agitation scale and the PADE; by comparing groups with pain as a significant clinical factor (as assessed by an independent rater) versus not a significant factor, and by assessing individuals receiving versus not receiving psychoactive medications. Setting: Four different long-term care facilities, three skilled nursing facilities, and a locked dementia assisted-living facility. Participants: Twenty-five residents of long-term care facilities with advanced levels of dementia in Study 1, and 40 residents with similar level of dementia in Study 2; 42% of the total sample were rated as having significant painful conditions. Measurements: For Study 1, the PADE was administered; for Study 2, the PADE and the Cohen-Mansfield Agitation Inventory (CMAI) were administered. Results: Reliability coefficients were adequate (interrater ϭ 0.54-0.95; stability ϭ 0.70-0.98; and internal consistency ϭ 0.24-0.88). Validity coefficients were likewise encouraging, with the PADE demonstrating the expected relationship with a measure of agitation. The PADE also differentiated between groups that were independently judged to suffer clinically problematic pain versus those who were not. Conclusion: The PADE is a reliable and valid tool to assess pain in dementing elderly residents of longterm care facilities.