Assessment of pain in adults with cognitive impairment: A review of the tools

Abstract

The aim of this paper is to discuss the results of a review into the literature related to chronic pain and the older adult. Several themes within the review have been identified and reported elsewhere and the final report has been published by the University of Sheffield in the form of an annotated bibliography. This report focuses upon the findings of the in relation to the assessment of pain in the adult with cognitive impairment. Issues surrounding assessment in the non-cognitively impaired older adult have also been reported elsewhere. For this paper nine studies will be discussed which report the development and testing of pain assessment scales the focus of which is upon behavioural indicators of pain. Some scales have been omitted from the review and the rationale for this decision will be discussed. Each of the selected scales will be discussed and the authors will make recommendations for both clinical practice and for future research based upon the validity, reliability and user friendliness of the scales.From the paper it can be concluded that the Abbey, DOLOPLUS-2 and PACSLAC appear to be the most reliable and valid and in terms of the "user friendliness" would be appropriate to explore further. Recommendations are made for further multi-centre evaluation of these scales.

Pain in Older Adults: Epidemiology, Impact and Barriers to Management

“…Furthermore, the qualitative literature suggests that older people link ageing to physical decline and being in pain, therefore they may be reluctant to seek help. This has also been found in the nursing home setting where, because older people believed their pain to be intractable, they often did not complain to staff (7). Some authors describe a process of normalisation where older women learn to 'get on with it' and develop their own management strategies.…”

“…Attitudes of staff to pain in elderly people and effects upon management (7,16) Attitudes of staff Effects upon pain management…”

Perceptions of death among adults with intellectual disability and awareness of their own mortality

“…Works concerning their end of life are rare in French, although developed by English-speaking researchers (8,9), with studies about specific tools for the assessment of pain (10). Specialized gerontology for people with intellectual disability (ID) is also expanding, even though adapted practices are only at their beginning in France (6,11).…”

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

“…We identified 23 reviews as being potentially eligible for inclusion, of which 13 were excluded as they did not provide data on the psychometric properties of the tools. The remaining set included 10 records reporting data from eight reviews (the Schofield et al 2005 72 review was reported in three separate studies; [72][73][74] we have combined the results of this) ( Figure 3). The tables of included and excluded reviews are listed in Appendix 2.…”

“…The overall conclusion was that there is a need for further psychometric testing of each tool. 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.…”