EXAMINING PAIN in Aggressive Cognitively Impaired Older Adults

Abstract

Few studies have explored the phenomenon of pain in people with severe cognitive impairment. Pain assessment, which depends primarily on people's ability to describe dimensions of pain, becomes problematic when clients' cognitive impairment is so severe they cannot respond to pain assessment tools. The purpose of this study was to describe the phenomenon of pain for a subgroup of aggressive cognitively impaired nursing home residents who were enrolled in a larger study of aggressive behavior. To determine if pain was a possible factor influencing aggression, information was sought from five sources: family members, nursing assistant (NA) caregivers, medical record listings of pain-related diagnoses, use of analgesics, and observations of aggressive behaviors. Families reported pain in 44% of subjects, while NAs reported pain in 66% of subjects. Seventy-six percent of subjects had one or more pain-causing diagnoses. Sixty-four percent of subjects whose family members thought they may have pain were being treated with analgesics, compared to 44% of subjects whose NA reported they may be experiencing pain. Aggression scores were significantly higher in subjects who had two or more pain-related diagnoses and in subjects with arthritis. Nurses who are aware of a history of pain, reports of pain by families and caregivers, presence of pain-related medical diagnoses, and who realize pain may be a trigger for aggressive behavior may be more likely to recognize pain in cognitively impaired older adults. Better pain assessment should lead to improved treatment of pain in this population.

Psychometric properties of pain intensity scales comparing among postoperative adult patients, elderly patients without and with mild cognitive impairment in China

“…In general, the elderly with CI received significantly less analgesics than the elderly without CI (Dawson, 1998). A study of nursing home residents found that 78% of the nursing home residents who had CI had a pain-causing diagnosis, but fewer than 40% of them received analgesics (Feldt, Warne, & Ryden, 1998).…”

Pain and combat injuries in soldiers returning from Operations Enduring Freedom and Iraqi Freedom: Implications for research and practice

“…For example, Stolee and colleagues reviewed 39 recent instruments and reported that none met contemporary validity and reliability standards [29]. Behavioral observations alone are not sufficient despite associations between pain and aggression [30] or agitation [31] in those with cognitive impairment because behavioral observations cannot discriminate between the multiple possible etiologies. Because studies comparing the reliability of self-reported pain scores across levels of cognitive impairment have found that approximately one-third of older adults with severe cognitive impairment could provide useful and valid pain ratings [32][33], providers should first attempt to elicit self-reports of pain using simple pain scales (e.g., the Faces Scale) for all responsive polytrauma patients.…”

Cognitive impairment and pain management: Review of issues and challenges

“…Pain is an internal, subjective experience that cannot be directly assessed. In persons with limited capacity for self-report, indications of pain are typically manifested through behaviors that overlap widely with those indicative of other conditions, such as hunger, thirst, too little or too much stimulation, anxiety, or depression [22,[25][26][27]. Therefore, the existing pain-assessment observational scales are probably not specific to pain [28][29].…”