Ethnic Differences in Nonverbal Pain Behaviors Observed in Older Adults with Dementia

Culturally Conscientious Pain Measurement in Older African Americans

“…Metrics. One recent study examining ethnic differences in pain behaviors found that older African Americans with dementia used fewer pain words and displayed more pain-related facial expressions and noises, but the African American sample was quite small which limits reliability and generalizability (Ford et al, 2015). Older African Americans' use of non-verbal communication of pain is consistent with other literature (Booker et al, 2015).…”

“…However, many of the tools developed to detect pain through observation of behaviors have not been validated in older African Americans with dementia, which is unfortunate given their higher prevalence of dementia and chronic pain. Therefore, little evidence exists on cultural differences in pain behaviors between older racial populations (Ford, Snow, Herr, & Tripp-Reimer, 2015) or on which pain assessment tools should be used in African American older adults with dementia or who are noncommunicative. Some studies validating observational pain-behavior tools do not even report the race or ethnicity of their sample (e.g., Feldt, 2000) or have extremely small African American samples (e.g., Ersek, Herr, Neradilek, Buck, & Black, 2010), which makes it difficult to discern for which ethnic populations such tools are valid, reliable, and practical.…”

Pain in Hospice Patients With Dementia

“…Training initiatives need to also address the issue of culture, which affects both the actual assessment of pain-related cues among patients and also caregivers' attitudes and beliefs about pain management at the end of life. 27 Zborowski introduced in the early 1950s the notion that pain is not only a neurological and physiological but also a cultural experience highlighting how culture impacts the emotional, linguistic, and behavioral responses to pain. 28 Riley et al found increased expression of nonverbal pain behaviors in cognitively intact African Americans when compared to white counterparts.…”

Ethnic Differences Identified by Pain Sensitivity Questionnaire Correlate With Clinical Pain Responses

“…One review article found that numerous studies have reported ethnic differences causing barriers to treatment (both seeking and receiving). 7 In fact, Ford et al 15 found that adequate pain management was less likely in minority populations likely due to unknown differences in pain sensitivity. In addition, Kwok and Bhuvanakrishna 7 found AAs more likely to have unrecorded pain issues as compared with NHWs and a much higher chance of being undertreated for their pain needs.…”

“…12 These 2 subscores were identified in the previous study 18 by factor analysis, each including 7 items that on average were rated as moderately painful (mean rating 4-6 on the 11-point scale, PSQ moderate) or as causing minor pain (mean rating <4, PSQ minor). The PSQ total score was calculated as the average rating of items 1, 2, 3, 4, 6,7,8,10,11,12,14,15,16, and 17 (all but the 3 nonpainful items); the PSQ minor score was calculated as the average rating of items 3, 6, 7, 10, 11, 12, and 14; and the PSQ moderate score was calculated as the average rating of items 1, 2, 4, 8, 15, 16, and 17. 18 The original version of the PSQ has been shown to be significantly correlated to a variety of experimentally produced pain intensity ratings, both in control subjects and in patients with chronic pain.…”