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

Abstract

<h3>Objectives</h3> To establish the reliability and validity of a measure to assess pain in individuals with advanced dementia. <h3>Design</h3> Sixty-five residents of long-term care facilities were assessed using a new rating tool, the Pain Assessment for the Dementing Elderly (PADE), in two separate studies: (1) Residents were assessed simultaneously by two different raters, at Time 1 and 2, to establish interrater reliability, stability, and internal consistency. (2) Validity was established by assessing the correlation between an agitation scale and the PADE; by comparing groups with pain as a significant clinical factor (as assessed by an independent rater) versus not a significant factor, and by assessing individuals receiving versus not receiving psychoactive medications. <h3>Setting</h3> Four different long-term care facilities, three skilled nursing facilities, and a locked dementia assisted-living facility. <h3>Participants</h3> Twenty-five residents of long-term care facilities with advanced levels of dementia in Study 1, and 40 residents with similar level of dementia in Study 2; 42% of the total sample were rated as having significant painful conditions. <h3>Measurements</h3> For Study 1, the PADE was administered; for Study 2, the PADE and the Cohen-Mansfield Agitation Inventory (CMAI) were administered. <h3>Results</h3> Reliability coefficients were adequate (interrater = 0.54–0.95; stability=0.70–0.98; and internal consistency=0.24–0.88). Validity coefficients were likewise encouraging, with the PADE demonstrating the expected relationship with a measure of agitation. The PADE also differentiated between groups that were independently judged to suffer clinically problematic pain versus those who were not. <h3>Conclusion</h3> The PADE is a reliable and valid tool to assess pain in dementing elderly residents of long-term care facilities.