Pain Assessment for the Dementing Elderly (PADE): Reliability and Validity of a New Measure

Villanueva, Michael R.; Smith, Tricia L.; Erickson, Janelle; Lee, Angela C.; Singer, Clifford

doi:10.1097/00130535-200301000-00001

Cited by 32 publications

(49 citation statements)

References 50 publications

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“…Studies investigating informant ratings of pain included in this review used self‐report instruments (such as the VDS and EQ 5D) to compare informant and self‐reports of pain. Tools created specifically for caregiver informant‐use (eg, Pain Assessment for the Dementing Elderly, PADE; Pain Assessment in Noncommunicative Elderly Persons, PAINE; Abbey Pain Scale) are yet to be tested or validated within community‐dwelling people with dementia.…”

Section: Discussionmentioning

confidence: 99%

“…Due to these complexities, regular and structured medication reviews are needed to assess the use, efficacy, and side‐effects of analgesic prescriptions, especially so as changes to cognitive ability are evident over the course of the disease. Care is particularly needed when new medications, such as transdermal analgesics are initiated to balance the risk of adverse drug reactions against the ease of transdermal patch administration of opioids . In conjunction with pharmacological strategies, prescribing clinicians should consider the use of non‐pharmacological strategies to minimise drug‐related adverse events.…”

Section: Discussionmentioning

confidence: 99%

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Pain assessment and pain treatment for community‐dwelling people with dementia: A systematic review and narrative synthesis

Bullock

Bedson

Jordan

et al. 2019

Int J Geriat Psychiatry

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Objectives:To describe the current literature on pain assessment and pain treatment for community-dwelling people with dementia. Method:A comprehensive systematic search of the literature with narrative synthesis was conducted. Eight major bibliographic databases were searched in October 2018. Titles, abstracts, and full-text articles were sequentially screened. Standardised data extraction and quality appraisal exercises were conducted. Results:Thirty-two studies were included in the review, 11 reporting findings on pain assessment tools or methods and 27 reporting findings on treatments for pain.In regard to pain assessment, a large proportion of people with moderate to severe dementia were unable to complete a self-report pain instrument. Pain was more commonly reported by informal caregivers than the person with dementia themselves.Limited evidence was available for pain-focused behavioural observation assessment.In regard to pain treatment, paracetamol use was more common in communitydwelling people with dementia compared with people without dementia. However, non-steroidal anti-inflammatory drugs (NSAIDs) were used less. For stronger analgesics, community-dwelling people with dementia were more likely to receive strong opioids (eg, fentanyl) than people without dementia. Conclusion:This review identifies a dearth of high-quality studies exploring pain assessment and/or treatment for community-dwelling people with dementia, not least into non-pharmacological interventions. The consequences of this lack of evidence, given the current and projected prevalence of the disease, are very serious and require urgent redress. In the meantime, clinicians should adopt a patient-and caregiver-centred, multi-dimensional, longitudinal approach to pain assessment and pain treatment for this population.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pain assessment and pain treatment for community‐dwelling people with dementia: A systematic review and narrative synthesis

Bullock

Bedson

Jordan

et al. 2019

Int J Geriat Psychiatry

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“…However, the operationalization of what is a pain-indicative facial expression differs immensely between scales. In Table 1, a summary is presented of the facial items used in observational tools to assess pain in dementia [20][21][22][23][24][25][26][27][28][29][30][31][32]. A detailed overview of the most common pain observation tools mentioned in previous reviews, together with a detailed description of the included facial pain expression items, can be found in the online supplementary Table. Most pain tools use one categorical item that is usually referred to as 'Facial expression(s)'.…”

Section: Available Observation Scalesmentioning

confidence: 99%

“…Within the domain of behavioral pain indicators, facial expressions of pain may be particularly useful, as they are currently regarded to be very reliable indicators of pain experience [7][8][9]. Studies have for example demonstrated that, amongst different behavioral observation domains (e.g., bodily posture, vocalizations), facial expression is the most reliable and most discriminate pain indicator in the first few months of life [10,11].…”

Section: Introductionmentioning

confidence: 99%

The Use of Facial Expressions for Pain Assessment Purposes in Dementia: A Narrative Review

Oosterman

Zwakhalen

Sampson

et al. 2016

Neurodegener. Dis. Manag.

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Facial expressions convey reliable nonverbal signals about pain and thus are very useful for assessing pain in patients with limited communicative ability, such as patients with dementia. In this review, we present an overview of the available pain observation tools and how they make use of facial expressions. Utility and reliability of facial expressions to measure pain in dementia are discussed, together with the effect of dementia severity on these facial expressions. Next, we present how behavioral alterations may overlap with facial expressions of pain, and may even influence the extent to which pain is facially expressed. The main focus is on disinhibition, apathy and emotional changes. Finally, an overview of theoretical considerations and practical implications is presented for assessing pain using facial expressions in clinical settings.

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“…However, obtaining detailed self-reports in both patients with cognitive impairment and the elderly can prove to be a major challenge and, therefore, requires the use of pain assessment tools that are relatively easy and adequately describe the pain experience 31. For cognitively sound older adults, the VRS, NRS or FPS may be easy and reliable to use (A), whereas in elderly with symptoms of dementia or cognitive impairment,32 the Abbey’s Pain Scale, Pain Assessment in Advanced Dementia Scale (PAINAD) and Pain Assessment for the Dementing Elderly (PADE) have demonstrated reliability (A) 33–35…”

Section: Supplementary Materialsmentioning

confidence: 99%

Evidence and consensus recommendations for the pharmacological management of pain in India

Dureja¹,

Iyer

Das

et al. 2017

JPR

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Despite enormous progress in the field of pain management over the recent years, pain continues to be a highly prevalent medical condition worldwide. In the developing countries, pain is often an undertreated and neglected aspect of treatment. Awareness issues and several misconceptions associated with the use of analgesics, fear of adverse events – particularly with opioids and surgical methods of analgesia – are major factors contributing to suboptimal treatment of pain. Untreated pain, as a consequence, is associated with disability, loss of income, unemployment and considerable mortality; besides contributing majorly to the economic burden on the society and the health care system in general. Available guidelines suggest that a strategic treatment approach may be helpful for physicians in managing pain in real-world settings. The aim of this manuscript is to propose treatment recommendations for the management of different types of pain, based on the available evidence. Evidence search was performed by using MEDLINE (by PubMed) and Cochrane databases. The types of articles included in this review were based on randomized control studies, case–control or cohort studies, prospective and retrospective studies, systematic reviews, meta-analyses, clinical practice guidelines and evidence-based consensus recommendations. Articles were reviewed by a multidisciplinary expert panel and recommendations were developed. A stepwise treatment algorithm-based approach based on a careful diagnosis and evaluation of the underlying disease, associated comorbidities and type/duration of pain is proposed to assist general practitioners, physicians and pain specialists in clinical decision making.

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Pain Assessment for the Dementing Elderly (PADE): Reliability and Validity of a New Measure

Abstract: The PADE is a reliable and valid tool to assess pain in dementing elderly residents of long-term care facilities.

Cited by 32 publications

References 50 publications

Pain assessment and pain treatment for community‐dwelling people with dementia: A systematic review and narrative synthesis

Pain assessment and pain treatment for community‐dwelling people with dementia: A systematic review and narrative synthesis

The Use of Facial Expressions for Pain Assessment Purposes in Dementia: A Narrative Review

Evidence and consensus recommendations for the pharmacological management of pain in India

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