The checklist of nonverbal pain indicators (CNPI)

Feldt, Karen S.

doi:10.1053/jpmn.2000.5831

Cited by 326 publications

(208 citation statements)

References 18 publications

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“…[34] The tool addresses the unique needs of the demented population and shows preliminary validity and modest reliability with cognitively impaired older adults in the acute care setting; however, additional refinement and evaluation with larger samples in diverse settings is needed to determine its utility with the demented older adult in acute and chronic pain.…”

Section: Observational Methodsmentioning

confidence: 99%

“…Even when evaluated for use among cognitively impaired elderly patients, the VDS demonstrates a 73% completion rate. [34] The present pain inventory (PPI) is another VDS, which uses the adjectives none, mild, discomforting, distressing, horrible, and excruciating to describe pain. [86] The PPI demonstrates good validity and is feasible for older patients, including those with mild to moderate cognitive impairment, with completion rates up to 65% [39] [99] [121] [127]; however, some researchers note more difficulty with its use by cognitively impaired persons when compared with a descriptor scale with simpler vocabulary.…”

Section: Verbal Descriptor Scalementioning

confidence: 99%

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Assessment and measurement of pain in older adults

Herr

Garand

2001

Clinics in Geriatric Medicine

342

251

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Although the empirical base is still limited when providing clear directions for pain assessment and management in older adults, it is possible to identify recommendations for guiding practice based on consensus and a developing scientific base to support best practice activities. This article offers a brief overview of the epidemiology and consequences of pain, followed by a summary of issues and approaches relevant to pain assessment in older adults. Cohort specific recommendations for comprehensive pain assessment and measurement are then addressed. Prevalence and Consequences of Pain in Older AdultsOlder individuals frequently suffer from both acute and chronic painful diseases, have multiple diseases, and take numerous pain medications, [2] although relatively little investigative or clinical attention has been paid to the assessment of pain in the geriatric population, compared with the general population. This is surprising because populationbased figures indicate that the prevalence of pain is twofold higher in those over age 60 (250 per thousand), compared with those under age 60 (125 per thousand). [24] [79] [108] Further, prevalence estimates suggest that approximately 60% of community-dwelling older adults and up to 80% of elderly long-term care facility residents experience substantial pain.[24] [79] [108] Because pain is often remediable, [2] [25] it is thought that the high prevalence estimates of unrelieved pain in elderly persons may result from underrecognition, which in turn results in undertreatment. [65] [91] [120] The consequences of untreated pain can profoundly impact the older person's quality of life. In addition to physiologic risks associated with untreated pain (e.g., cough suppression with subsequent retention of pulmonary secretions), depression, [58] [39] [90] Therefore, it is imperative that health care professionals' knowledge and skills related to pain assessment in older adults be improved, and aggressive approaches to comprehensive pain assessment be adopted, to ensure and improve the quality of life of our senior citizens. Approaches to Pain Assessment with Older Adults Clinical AssessmentIn the clinical setting, accurate assessment of pain is critical for the identification of appropriate interventions and for evaluating the effectiveness of such interventions. Patients should be assessed regularly for the presence of pain and for improvement, deterioration, or complications attributable to pain treatment.[2] The frequency of the follow-up should be a function of the severity of the pain and the potential for adverse effects of treatment. Documentation of pain assessment formalizes the pain assessment process and is essential in the provision of individualized care from both a legal and professional perspective. [17] Inherent in the assessment of pain among older adults is the understanding of its potentially remediable components. For example, if a patient has acute pain, assessment should focus on the underlying pathology responsible for the pain stimulus. If th...

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Section: Observational Methodsmentioning

confidence: 99%

Section: Verbal Descriptor Scalementioning

confidence: 99%

Assessment and measurement of pain in older adults

Herr

Garand

2001

Clinics in Geriatric Medicine

342

251

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“…To develop items for the Pain Behaviors for the Osteoarthritis Instrument for Cognitively Impaired Elders (PBOICIE), the first author compiled pain behaviors from other observational instruments (Dirks et al, 1993;Feldt, 2000;Kerns et al, 1991;Richards et al, 1982) and OA pain assessment instruments (Keefe et al, 1987), as well as pain behaviors suggested by the American Geriatrics Society panel (AGS Panel on Persistent Pain in Older Persons, 2002) and past studies (Weiner et al, 1999). Six content experts in long-term care, orthopedic care, and pain research used a 5-point scale (0=definitely not a pain behavior to 4=definitely a pain behavior) to rate each item's relevance to pain in severely CI elders with OA of the knee or hip.…”

Section: Methodsmentioning

confidence: 99%

“…These provide indications of whether the elder is experiencing OA knee or hip pain. Current methods for assessing CI elders, however, do not address these indicators of OA (Feldt, 2000;Simons & Malabar, 1995;Snow et al, 2003;Weiner et al, 1999).While an observational tool is available to identify OA pain in the general population, including elders (Keefe et al, 1987), there is no such instrument for CI elders with OA. Current measurement tools for osteoarthritic pain have not been tested with CI elders and no one has systematically studied pain behaviors in CI elders with OA of the knee or hip.…”

mentioning

confidence: 99%

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The Pain Behaviors for Osteoarthritis Instrument for Cognitively Impaired Elders (PBOICIE)

Tsai¹,

Beck²,

Richards³

et al. 2008

Research in Gerontological Nursing

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Severely cognitively impaired (CI) elders have trouble responding to questions about their osteoarthritis knee or hip pain, making pain management difficult. Thus, the Pain Behaviors for Osteoarthritis Instrument for Cognitively Impaired Elders (PBOICIE) was developed as an alternative. This article reports the development and psychometric testing of the PBOICIE in three studies.The 6-item PBOICIE was not associated with the Verbal Descriptor Scale, but was significantly associated with Keefe's method for observing pain behaviors in patients with knee or hip osteoarthritis, with r=.36-.55, indicating good concurrent validity. The 6-item PBOICIE was able to discriminate elders' pain behaviors before and after analgesic administration (2.9 ± 1.89 vs. 1.97 ± 1.98; p<.001).This study has shown that multifaceted pain assessments are needed in elders with osteoarthritis knee or hip pain since the observed behaviors did not parallel, but added information to verbal report. Osteoarthritis (OA) of the knee or hip is the leading cause of disability in elders (Campbell et al., 1994) and is a significant source of pain and suffering in cognitively impaired (CI) elders. It is estimated that 48% to 65% of CI elders have OA (Marzinski, 1991; The Canadian Study of Health and Aging, 1994). Without proper treatment of their pain, these elders may forego physical activities to avoid aggravating the pain, thus further impairing their physical and cognitive function and increasing their need for assistance. Other consequences of unrelieved pain include depression, sleep disturbances, withdrawal, falls and fall-related injuries, and malnutrition (Ferrell & Ferrell, 1990;Rubenstein & Josephson, 2002). Overall, unrelieved pain decreases quality of life for CI elders, adds to caregiver burden, and increases health care costs (Ferrell & Ferrell, 1990). KeywordsAccurate assessment of pain is critical for treating CI elders with OA and evaluating the outcomes of treatment. Verbal self-report of pain, representing the individual's subjective perception of pain, is the gold standard for measuring an individual's pain, and treatment decisions are generally based upon this self-report ( . Given the high prevalence of OA in CI elders and its adverse consequences, an alternative to verbal report of pain is urgently needed for these elders.One alternative to verbal report is assessment of the verbal or non-verbal behaviors demonstrated by patients who communicate to others that they are experiencing pain (Fordyce, 1976). Activities involving the lower extremities, such as standing, walking, rising from a bed or chair, and climbing stairs, put extra pressure on the affected knee or hip joint, aggravating the pain in patients with OA. In response, elders with OA exhibit subtle but specific non-verbal behaviors indicating knee or hip pain, but these are not included on generic pain observational tools. Elders show disturbed ambulation and gestures such as moving slowly with stiffness, rubbing or holding the affected site, shifting body weig...

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The Physician's Role in Patients' Nursing Home Care

Zweig¹,

Popejoy²,

Parker-Oliver³

et al. 2011

JAMA

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More than 1.5 million adults live in US nursing homes, and approximately 30% of individuals in the United States will die with a nursing home as their last place of residence. Physicians play a pivotal role in the rehabilitation, complex medical care, and end-of-life care of this frail and vulnerable population. The reasons for admission are multifactorial and a comprehensive care plan based on the Minimum Data Set guides the multidisciplinary nursing home team in the care of the patient and provides assessments of the quality of care provided. Using the cases of 2 patients with different experiences, we describe the physician's role in planning for admission, participating as a team member in the ongoing assessment and care in the nursing home, and guiding care at the end of life. The increasing population of older adults has also promoted community-based and residential alternatives to traditional nursing homes. The future of long-term care will include additional challenges and rich innovations in services and options for older adults.

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The checklist of nonverbal pain indicators (CNPI)

Cited by 326 publications

References 18 publications

Assessment and measurement of pain in older adults

Assessment and measurement of pain in older adults

The Pain Behaviors for Osteoarthritis Instrument for Cognitively Impaired Elders (PBOICIE)

The Physician's Role in Patients' Nursing Home Care

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