Abstract
BackgroundPain is a common and major problem among nursing home residents. The prevalence of pain in elderly nursing home people is 40–80%, showing that they are at great risk of experiencing pain. Since assessment of pain is an important step towards the treatment of pain, there is a need for manageable, valid and reliable tools to assess pain in elderly people with dementia.MethodsThis systematic review identifies pain assessment scales for elderly people with severe dementia and evaluates the psychometric properties and clinical utility of these instruments. Relevant publications in English, German, French or Dutch, from 1988 to 2005, were identified by means of an extensive search strategy in Medline, Psychinfo and CINAHL, supplemented by screening citations and references. Quality judgement criteria were formulated and used to evaluate the psychometric aspects of the scales.ResultsTwenty-nine publications reporting on behavioural pain assessment instruments were selected for this review. Twelve observational pain assessment scales (DOLOPLUS2; ECPA; ECS; Observational Pain Behavior Tool; CNPI; PACSLAC; PAINAD; PADE; RaPID; Abbey Pain Scale; NOPPAIN; Pain assessment scale for use with cognitively impaired adults) were identified. Findings indicate that most observational scales are under development and show moderate psychometric qualities.ConclusionBased on the psychometric qualities and criteria regarding sensitivity and clinical utility, we conclude that PACSLAC and DOLOPLUS2 are the most appropriate scales currently available. Further research should focus on improving these scales by further testing their validity, reliability and clinical utility.
Highlights
Pain is a common and major problem among nursing home residents
The prevalence of pain in elderly nursing home residents is 40–80% [49], showing that they are at great risk of experiencing pain
We reviewed the relevant publications based on an extensive search strategy, involving computer searches of Medline, Psychinfo and Cumulative Index to Nursing and allied Health Literature (CINAHL) to identify the literature
Summary
Pain is a common and major problem among nursing home residents. The prevalence of pain in elderly nursing home people is 40–80%, showing that they are at great risk of experiencing pain. More than 50% of US nursing home residents have substantial cognitive impairment or dementia [6] This situation is comparable to that in European countries like Austria and the UK, where dementia has been found to occur in over 60% of the institutionalised population [11,12] and in the Netherlands, where more than half of the nursing home residents have been diagnosed with dementia [13]. This demographic data suggests that the volume of nursing home care required will increase and pain assessment will be a major challenge
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