Other: Pain assessment in the cognitively intact and cognitively impaired elderly

Abstract

Elderly hospitalized patients often appear unable to reliably report their pain experience due to cognitive impairments, most commonly due to dementia. Previous geriatric pain research has generally found that the elderly become less able to reliably self-report pain intensity at greater levels of cognitive impairment. In this study, we examined the relationships among pain scores on three self-report pain intensity measures by cognitive group (intact vs. impaired), as well as the dispersal of self-report scores by cognitive domain. Subjects were twenty-seven elderly patients, aged 65 to 92 years, admitted to hospital due to an acute hip fracture or compression fracture of the spine. Cognitive functioning was assessed using the Cognistat, a psychological test battery that evaluates a number of cognitive domains: attention, comprehension, repetition, naming, construction, memory, calculation, similarities, and judgement. Three self-report pain measures were used: the Numerical Rating Scale, the Colored Analogue Scale, and the Faces Pain Scale (modified Bieri version). Consent was obtained for each patient to undertake a cognitive and pain assessment session. Pain ratings using each scale were obtained at baseline and immediately after the performance of four physical activities (lying, sitting, standing, and walking). An averaged z-score of -1 on the Cognistat was used to determine cognitive group membership. For both the intact and impaired groups, a marked positive relationship was found between all three pain measures. There was no relationship between total dispersal scores on the three self-report measures and any of the cognitive domains. The study results, although preliminary and exploratory in nature, suggest that a fairly wide range of cognitively impaired elderly retain the ability to reliably self-report their pain. Using interscale agreement as a criterion, the three pain measures appear equally useful in obtaining self-reported pain intensity ratings in an elderly population.