A Review of Observational Pain Scales in Nonverbal Elderly With Cognitive Impairments

Abstract

Objective: Pain assessment for nonverbal older adults with cognitive impairments or dementia presents many challenges, and it is important to determine which scales are most useful in assessing pain among this population. Method: In this review 11 observational scales for assessment of pain in older adults with dementia or cognitive impairments are evaluated in four areas: pain indicators, reliability, validity, and clinical utility of the measure. Results: Results indicate that various scales are available for assessing pain in cognitively impaired or demented older adults who are unable to report their pain, but future research should focus on further psychometric evaluations. Conclusions: Implications include that social workers should be trained as raters of pain assessment methods.

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

“…However, in general, the reporting lacked detail. For example, as shown in Tables 4 and 5, the list of included/excluded studies was provided in only three reviews, 67,86,87 the explicit involvement of two or more independent reviewers (question 2) was reported in only one review, 86 only three reviews 67,82,86 explained the methods used to combine findings (question 9) and only one review 86 seemed to have assessed the likelihood of publication bias. This lack of detail in reporting may be because of restrictions on word limits in publications.…”

“…Three reviews 82,86,87 also explicitly aimed at an evaluation of the evidence, that is to critically evaluate the existing tools, or to identify key components and analyse the reported psychometric properties of tools. Two reviews 64,82 reported a systematic method for evaluation of the tools.…”

“…Two reviews recommended that the focus should be on studying existing scales rather than creating new ones, 64,72 although one review also suggested that there may be a need to revisit the tools' conceptual foundations. 82 Recommendations for further research and testing of the tools included the involvement of culturally diverse populations 64,82,87 and the provision of scoring methods and guidelines for interpretation in the evaluation of the scale. 87 Finally, a need for research emerged to link assessment with treatment algorithms.…”

“…82 Recommendations for further research and testing of the tools included the involvement of culturally diverse populations 64,82,87 and the provision of scoring methods and guidelines for interpretation in the evaluation of the scale. 87 Finally, a need for research emerged to link assessment with treatment algorithms.…”

“…87 Among the tools selected by the reviews as possible best candidates, albeit on limited evidence, were the DS-DAT, Doloplus-2, MPS, PACSLAC, PAINAD, Abbey Pain Scale, and ECPA. However, there was no clear consensus on the single best tool.…”