Assessment of Pain in Cognitively Impaired Older Adults: A Comparison of Pain Assessment Tools and Their Use by Nonprofessional Caregivers

Abstract

The mean age of the CI subjects was 83, and 83% were women. The mean Mini-Mental State Exam score was 15.7. One-third of the CI subjects were unable to complete any of the three pain assessment tools. Of the 104 subjects completing at least one tool, 13 (12.5%) reported no pain and 91 (87.5%) reported some pain. Sixteen (10%) of the subjects were depressed as measured with the GDS or Cornell instrument. In 70 of the 104 subjects (67%) able to complete any tool, the caregiver and CI subject agreed as to the level of pain experienced by the CI subject. The number of tools completed by the CI subjects decreased with increased cognitive impairment. The Pain Intensity Scale was the tool most likely to be completed by both CI subjects and caregivers. The means of test scores were not significantly different for the paired groups of CI subject and caregiver, and the nonparametric correlation of each tool was significant: "faces" (Spearman's rho (p) = .417); "line" (p = .420); and PIS (p = .452). The Hospice Approach Discomfort Scale did not correlate well with other tools. The Pain Intensity Scale seems to be more useful than other pain assessment tools in assessing pain in cognitively impaired patients and can be used by nonprofessional caregivers in a community-based care setting.

Symptom Control in Palliative Care—Part I: Oncology as a Paradigmatic Example

“…24 A recent study 25 of the available instruments for assessing pain in cognitively impaired individuals found good consistency between scores on five different pain assessment scales for those with moderate cognitive impairment. Another study showed that one third of patients, with a mean MMSE of 15.7, were not able to complete any of the three pain assessment tools studied, 26 and caregiver and patient agreement about pain intensity occurred in only 67%. In patients with severely impaired cognition, behavioral and verbal 27,28 cues have to be used for clinical assessment.…”

Pain management skills of regional nurses caring for older people with Dementia: A needs analysis

“…Managing pain is not simply the measurement of physiological discomfort. It is a holistic view of the physical, social, cultural, and spiritual dimensions of the pain experience and the way in which this affects the person's normal activities of daily living (Krulewitch et al 2000). Despite the availability of psychometrically sound rating scales to measure pain, a significant number of participants were either not aware of these or did not use them routinely to justify their pain management interventions -principally because they did not consider them useful.…”

“…Unfortunately, standardized pain rating scales require the person in pain to be able to process and interpret thoughts, generally relying on their ability to describe the pain experience verbally (Parke 1998). Approximately 33% of cognitively impaired people are unable to be usefully rated by way of these tools (Krulewitch et al 2000). This is complicated by their problems with memory and the concurrent use of the chemical and mechanical restraints that may mask their usual responses to pain (Parke 1998).…”

Pain Experience and Expression in Patients with Dementia

“…Individuals with dementia also often suffer from pain -according to Horgas et al (2009) this problem touches every day 32% to 53% of this group. Older research estimate prevalence of pain in the patients with dementia living in nursery homes at 60%-90% of the population (Krulewitch et al, 2000;Parmelee et al 1993;Ferrell et al, 1990;Ferrell et al, 1995;Shega et al, 2004). There are data quoted in the literature suggesting pain prevalence in 33% to 80% patients with dementia (Brummel-Smith et al, 2000).…”