Abstract
BackgroundThere is evidence of under-detection and poor management of pain in patients with dementia, in both long-term and acute care. Accurate assessment of pain in people with dementia is challenging and pain assessment tools have received considerable attention over the years, with an increasing number of tools made available. Systematic reviews on the evidence of their validity and utility mostly compare different sets of tools. This review of systematic reviews analyses and summarises evidence concerning the psychometric properties and clinical utility of pain assessment tools in adults with dementia or cognitive impairment.MethodsWe searched for systematic reviews of pain assessment tools providing evidence of reliability, validity and clinical utility. Two reviewers independently assessed each review and extracted data from them, with a third reviewer mediating when consensus was not reached. Analysis of the data was carried out collaboratively. The reviews were synthesised using a narrative synthesis approach.ResultsWe retrieved 441 potentially eligible reviews, 23 met the criteria for inclusion and 8 provided data for extraction. Each review evaluated between 8 and 13 tools, in aggregate providing evidence on a total of 28 tools. The quality of the reviews varied and the reporting often lacked sufficient methodological detail for quality assessment. The 28 tools appear to have been studied in a variety of settings and with varied types of patients. The reviews identified several methodological limitations across the original studies. The lack of a ‘gold standard’ significantly hinders the evaluation of tools’ validity. Most importantly, the samples were small providing limited evidence for use of any of the tools across settings or populations.ConclusionsThere are a considerable number of pain assessment tools available for use with the elderly cognitive impaired population. However there is limited evidence about their reliability, validity and clinical utility. On the basis of this review no one tool can be recommended given the existing evidence.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2318-14-138) contains supplementary material, which is available to authorized users.
Highlights
There is evidence of under-detection and poor management of pain in patients with dementia, in both long-term and acute care
Behavioural and psychological symptoms of dementia such as agitation and aggression often arise as a result of underlying pain, presenting a considerable challenge for treatment and care that may lead to institutionalisation or prescriptions of antipsychotic medications that carry serious safety concerns [6]
For ease of reference, in this paper we refer to our systematic review of systematic reviews as a meta-review; we call the systematic reviews considered for inclusion in the meta-review reviews and refer to publications included in the reviews as studies; we use the term records to refer to the bibliographic data of publications of reviews; the terms scales, tools and instruments are used interchangeably
Summary
There is evidence of under-detection and poor management of pain in patients with dementia, in both long-term and acute care. This review of systematic reviews analyses and summarises evidence concerning the psychometric properties and clinical utility of pain assessment tools in adults with dementia or cognitive impairment. While people with mild to moderate dementia are often able to report their pain verbally or use simple visual or numerical pain intensity assessment tools, these options are not feasible for use with people with later stage dementia in whom communication ability is severely impaired [7,8]. As a result previous work has shown that pain is frequently under-detected and poorly managed in people with dementia, in both long-term and acute care [9,10,11,12]
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