The CNA-generated PPQ was a more sensitive measure of pain than the MDS for this sample. Although the MDS represents an important step toward systematic and standardized assessment of pain, more emphasis should be placed on multimodal assessment, including CNAs' perceptions and observations about pain experienced by cognitively impaired nursing home residents.

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Nursing staff can be trained to improve and maintain communication skills during care without increasing the amount of time delivering care. The methodological advantages of including measures to assess treatment implementation are discussed.

Self-evaluation of memory performance, one aspect of metamemory, may be an important indicator of concurrent, retrospective, or future decline in memory functioning. The relationships among self-evaluations, cognition, and outcome were investigated in the OCTO study, a longitudinal, population-based panel of the oldest old. Using concurrent data, results indicated that overall cognitive ability, depression, gender, and education were associated with self-reports of memory for the entire sample. The relation of perception of decline to actual decline was also examined. Self-reported decline over a 2-year period was associated with actual decline in performance on three tests of memory. Finally, self-reported memory function was investigated as an indicator of future cognitive decline and diagnosis of dementia. These self-evaluations predicted decline on specific tests of memory over 2 years and subsequent diagnosis of dementia after 2 and 4 years. The amount of variance accounted for by self-evaluations, however, was relatively small, suggesting that complaints reflect different processes, only one of which is the pathological decline involved in dementia.

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