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

Abstract

Objectives To establish the reliability and validity of a measure to assess pain in individuals with advanced dementia. Design 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. Setting Four different long-term care facilities, three skilled nursing facilities, and a locked dementia assisted-living facility. Participants 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. Measurements For Study 1, the PADE was administered; for Study 2, the PADE and the Cohen-Mansfield Agitation Inventory (CMAI) were administered. Results 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. Conclusion The PADE is a reliable and valid tool to assess pain in dementing elderly residents of long-term care facilities. To establish the reliability and validity of a measure to assess pain in individuals with advanced dementia. 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. Four different long-term care facilities, three skilled nursing facilities, and a locked dementia assisted-living facility. 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. For Study 1, the PADE was administered; for Study 2, the PADE and the Cohen-Mansfield Agitation Inventory (CMAI) were administered. 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. The PADE is a reliable and valid tool to assess pain in dementing elderly residents of long-term care facilities.