Pain Assessment in Persons with Dementia: Relationship Between Self‐Report and Behavioral Observation

Abstract

OBJECTIVES-To investigate the relationship between self-report and behavioral indicators of pain in cognitively impaired and intact older adults. DESIGN-Quasi-experimental, correlational study of older adults.SETTING-Data were collected from residents of nursing homes, assisted living, and retirement apartments in North/Central Florida. PARTICIPANTS-126 adults, mean age 83 years; 92 cognitively intact, 24 cognitively impaired.MEASUREMENTS-Pain interviews (pain presence, intensity, locations, duration), pain behavior measure, MMSE, analgesic medications, and demographic characteristics. Participants completed an activity-based protocol to exacerbate pain. RESULTS-86%self-reported regular pain. Controlling for analgesics, cognitively impaired participants reported less pain after movement, but not at rest. Behavioral pain indicators did not differ between cognitively intact and impaired elders. Total number of pain behaviors was significantly related to self-reported pain intensity (Beta = .40, p = .000) in intact elders. CONCLUSION-Self-reported pain is diminished in cognitively impaired elders relative to intact elders, independent of analgesics, but only when assessed following movement. Behavioral pain indicators do not differ between groups. The relationship between self-report and pain behaviors supports the validity of behavioral assessments in this population. Findings support multidimensional pain assessment in persons with dementia.

Cultural adaptation of the scale Pain Assessment in Advanced Dementia – PAINAD to Brazil

“…The difficulties to assess pain is believed to come from subjective characteristics of the painful phenomenon, specifically in situations with cognitive alterations, once an adequate assessment requires the individual to remember and share situations of pain already experienced, requiring preserved cognitive functions to verbalize, for example, the pain location, intensity and other characteristics (2) .…”

“…In many situations they are not able to remember their pain or they are not capable to verbally communicate it to their caregivers, which makes it harder to detect and measure, characterizing its evaluation as a problem to be considered for those patients (1)(2)(3) .…”

Pain Experience and Expression in Patients with Dementia

“…We can divide them into observational scales, basing on others' perceptions concerning a patient, and methods basing on a patient's self-report. Herr et al (2006;Horgas et al, 2009) made a review of the fourteen scales and stated that these tools were still in an early stage of development, and required more precise psychometric elaboration before they would be able to be recommended to wider clinical employment. Similar conclusions are made by Cook et al (1999).…”

“…Teno et al (2001) speaks about a range of 40% -46% of residents experiencing pain and according to Snow's et al (2004) estimates -67,4%. Horgas et al (2009) pertaining to elderly population in general states that pain is an experience shared by 50% -86% of them. 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.…”

“…Horgas et al (2009) pertaining to elderly population in general states that pain is an experience shared by 50% -86% of them. 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).…”