Pragmatic evaluation of an observational pain assessment scale in the emergency department: The Pain Assessment in Advanced Dementia (PAINAD) scale

Abstract

BackgroundPain assessment is challenging in older people with cognitive impairment who present to the emergency department and may result in suboptimal management. Therefore, the usefulness of the Pain Assessment in Advanced Dementia (PAINAD) tool for older people with cognitive impairment presenting with a painful injury was evaluated. MethodsIn this multi-centre observational sub-study, older people (≥65 years) suspected of a long bone fracture were screened for cognitive impairment using the Six Item Screening (SIS) tool. Patients with SIS≤4 were assessed using the PAINAD. Descriptive and correlation statistical analyses were performed. Cronbach's alpha was used to estimate the reliability of the PAINAD. ResultsThis predominantly female (63%) sample had a mean age of 85.5±7.5 years and a moderately urgent Australian Triage code (mode: 3). Median pain intensity was low (numerical reporting scale: 5.5 [3.0–8.0]). Median PAINAD score was ‘mild’ (1.0 [0.0–3.2]) with wide variability (range: 0–9). The PAINAD demonstrated good reliability (Cronbach's α=0.80). Most PAINAD items appeared worthy of retention. ConclusionsThe PAINAD has potential as an effective pain assessment tool for older people with cognitive impairment in emergency departments. Strategies such as partnering with carers and family to collaboratively assess pain require further investigation in this setting.