Pain Assessment In Older Adults Research Articles

Pain Assessment in Older Adults After Traumatic Injury

This cross-sectional study analyzes how pain assessment frequency and pain score magnitude and variability differ by age among trauma patients admitted in hospitals.

Pain assessment for cognitively impaired older adults: Do items of available observer tools reflect pain-specific responses?

A number of observational tools are available to assess pain in cognitively impaired older adults, however, none of them can yet be regarded as a "gold standard". An international research initiative has created a meta-tool compiling the facial, vocalization and body movement items of the majority of available tools. Objective of this study was to investigate the pain specificity and the validity of these items. N=34 older adults with or without cognitive impairment were videotaped in three different conditions (one reference, two painful conditions) in their nursing homes. They were further asked to self-report their pain in each condition. The occurrence of non-verbal behaviours was coded as present or absent using the items of the meta-tool. The majority of non-verbal behaviours was not pain sensitive as they occurred less than three times across participants and conditions. Of the remaining items, two facial items ("pained expression" and "raising upper lip"), one vocalization item ("using pain-related words") and one body movement item ("guarding") were found to be pain specific and valid. One additional item, the vocalization item "gasping", was pain specific, but not associated with pain self-report, and three additional items, the facial items "frowning" and "narrowing eyes" and the vocalization item "mumbling" were correlated with pain self-report but did not help to separate pain from non-pain conditions. Systematic evaluation of items of existing observational pain assessment tools under naturalistic conditions seems a promising approach in the process of further investigating and improving tools. Only few items stemming from observational pain assessment tools were found to be pain sensitive and specific as well as valid in this study. The investigation of existing tools not only on tool but additionally on item-level can provide helpful insights and thereby can help to improve the original tools and establish a gold standard for nonverbal pain assessment in older adults with cognitive impairments.

Validation of Pain Assessment Checklist for Seniors with Limited Ability to Communicate-II (PACSLAC-II) in Iranian older adults with dementia living in nursing homes.

Some dementia patients can self-report pain although the reports are not valid in severe dementia. Observational scales have been developed for pain assessment in these patients. This study aimed to assess the psychometric properties of the Persian version of Pain Assessment Checklist for Seniors with Limited Ability to Communicate-II (PACSLAC-II). This validation study was conducted on 138 older adults with dementia suffering from chronic pain who lived in nursing homes. The PACSLAC-II Persian version was applied through observations during activity and rest. Reliability of the PACSLAC-II was evaluated by Cronbach's alpha and intra-class correlation coefficients. Construct validity was determined by confirmatory factor analysis, divergent and convergent validity. The Spearman's rank correlation between PACSLAC-II scores and Faces Pain Scale was calculated for concurrent validity. Known-group validity during activity and rest was calculated by Wilcoxon signed ranks test. Cronbach's alpha coefficient for facial expression (0.82), verbalisation (0.72), and body movement (0.84) subscales indicated good internal consistency. The intra-class correlation coefficients between two raters was 0.76 and in three times evaluation, the value was 0.76. Convergent validity with Iranian Brief Pain Inventory and divergent validity with 15-item Geriatric Depression Scale confirmed the construct validity of PACSLAC-II. Three factors structure of PACSLAC-II was approved, and most of the variance was explained by facial expressions. The PACSLAC-II can discriminate between pain and non-pain events and has a moderate correlation with Faces Pain Scale (r = 0.33). PACSLAC-II Persian version is a valid and reliable scale for pain assessment in older adults with dementia.

Purposeful Pain Assessment in Older Adults with Delirium Can Improve Outcomes

Assessment of the cognitively impaired older adult can improve cognition, pain behaviors and length of stay in acute care settings. Older adults in the hospital diagnosed with dementia were evaluated using the PAINAD scale and purposeful discussion with caretakers regarding past medical history and cognitive and functional status. A videotaped vignette of one of the patients was created to illustrate this complex assessment. Health care providers were educated on how the use of non-opiates, consistency, caregiver discussion and the PAINAD scale were able to reverse the patient's delirium and return her to a heightened cognitive level in five days.

Usability Testing of the iPhone App to Improve Pain Assessment for Older Adults with Cognitive Impairment (Prehospital Setting): A Qualitative Study.

Pain assessment in older adults with cognitive impairment is often challenging, and paramedics are not given sufficient tools/training to assess pain. The development of a mobile app may improve pain assessment and management in this vulnerable population. We conducted usability testing of a newly developed iPhone pain assessment application with potential users, in this case as a tool for clinical paramedic practice to improve pain assessment of older adults with cognitive impairment. We conducted usability testing with paramedic students and a Delphi panel of qualified paramedics. Participants studied the app and paper-based algorithm from which the app was developed. The potential use for the app was discussed. Usability testing focus groups were recorded, transcribed verbatim, and analyzed using a thematic approach. Proposed recommendations were disseminated to the Delphi panel that reviewed and confirmed them. Twenty-four paramedic students from two UK ambulance services participated in the focus groups. Usability of the app and its potential were viewed positively. Four major themes were identified: 1) overall opinion of the app for use in paramedic services; 2) incorporating technological applications into the health care setting; 3) improving knowledge and governance; and 4) alternative uses for the app. Subthemes were identified and are presented. Our results indicate that the pain assessment app constitutes a potentially useful tool in the prehospital setting. By providing access to a tool specifically developed to help identify/assess pain in a user-friendly format, paramedics are likely to have increased knowledge and confidence in assessing pain in patients with dementia.

Pain Assessment in Older Adults with Dementia: An Exploratory Pilot Study of Paramedic Students’ Perceptions of the Utility of Two Validated Assessment Tools

Introduction This paper presents findings from an exploratory study in which undergraduate paramedic students’ trialled the use of two pain assessment tools as part of an interprofessional learning experience in residential aged care facilities. The research sought to identify the potential utility of the Abbey Pain Scale and PAINAD tools for use by paramedics with people with advanced dementia who have limited ability to communicate. Methods Thirty-one final year undergraduate paramedic students completed a 5-day clinical placement in in four residential aged care facilities in Tasmania, Australia. While on placement students used the two tools to assess pain in residents with known pain issues, under the supervision of nursing staff and paramedic tutors. A mixed methods approach, utilising a quantitative survey and a qualitative open-ended questionnaire, was adopted to ascertain students’ views on the potential for the tools to be used in paramedic practice. Results The research found both tools had potential for use in paramedic practice. Feedback from students indicated both pain assessment tools had strengths and weaknesses. Recommendations were made for how each of the tools could be adapted to make them suitable for use by paramedics. Conclusion Forecast increases in the number of people living with dementia, and the changing nature of paramedic practice, means that paramedics are more likely to be called on to assess pain in this population in community settings. Further research is needed to inform the development of pain assessment tools specifically for use by paramedics in these settings.

Management of cancer pain: ESMO Clinical Practice Guidelines

Management of cancer pain: ESMO Clinical Practice Guidelines

Pain in the Older Adult: An Imperative Across All Health Care Settings

Across all care settings for older patients, pain is often ineffectively managed. A gap still exists between best-practice recommendations for pain assessment/treatment and current clinical practice, despite the availability of guidelines. Using a validated pain scale is critical to objectively evaluate pain intensity. Assessing pain in patients with cognitive impairment can be particularly challenging, but using pain behaviors and specifically designed, reliable, and valid tools can assist the process. Other guiding principles when selecting pain assessment tools, such as clinical usability and potential limitations, are discussed. Once pain is identified, the goals of care for older patients center on positively affecting function. Pain undertreatment is a particularly important phenomenon to address, because unrelieved persistent pain can significantly affect older individuals. Approaches tailored to an individual's needs and supported by the best available evidence should be implemented to improve patient outcomes and to increase the consistency with which care is delivered to the growing population of older Americans. The goal of this paper was to provide current evidence-based strategies and tools for pain assessment in older adults, including those with cognitive impairment.

Pain assessment in older people with dementia: literature review

This paper is a report of a literature review conducted to identify barriers to successful pain assessment in older adults with dementia and possible strategies to overcome such barriers. Pain is frequently undetected, misinterpreted, or inaccurately assessed in older adults with cognitive impairment. These people are often unable to articulate or convey how they feel and are often perceived as incapable of experiencing or recalling pain. Searches were conducted of CINAHL, Medline and other databases for the period 1993-2007 using the search terms pain, dementia, assess*, barrier* and obstacle*. Studies were critically appraised by two independent reviewers. Data were extracted using instruments specifically developed for the review. Studies were categorized according to levels of evidence defined by the Australian National Health and Medical Research Council and Joanna Briggs Institute. Perceived barriers to successful pain assessment in people with dementia included lack of recognition of pain, lack of sufficient education and/or training, misdiagnosis or late diagnosis, and non-use of assessment tools. Barriers related to people with dementia included insufficient evidence, the possibility of a 'no pain' subset of people with dementia, type of pain, and stoical attitudes. Strategies proposed as means of overcoming these barriers included knowing the person, knowing by diversity/intuitive perception, education and training, and use of adequate tools. More extensive education and training about the relationship between pain and dementia are urgently needed, as is the development and implementation of an effective pain assessment tool specifically designed to detect and measure pain in older adults with all stages of dementia.

Pain Measurement: Present Concerns and Future Directions

Over the past 15 years, researchers have worked to establish reliability and validity of several pain measures used to assess pain in older adults. A recent state of the science consensus statement cited slightly more than 400 references focusing on the various aspects of pain assessment in older adults [1] that identify some of the unique concerns of this population. Accurate, valid, reliable pain measures are essential in assisting clinicians as they quantify, track, and evaluate treatments to reduce pain. Although some researchers have focused on development of comprehensive pain measures for older adults, many researchers have been testing instruments that focus on the single characteristic of pain severity. This issue of Pain Medicine reports two articles on instruments that measure pain severity. Herr, Spratt, Garand, and Li report their work evaluating the sensitivity and utility of the Iowa Pain Thermometer (IPT) and four other pain severity measures [2]. This article is another in a series of the works by Herr, whose career focus has been to establish sensitivity, reliability, validity, ease of use, and preference of pain severity instruments in older adult populations. In early work, Herr and Mobily established that older adults most preferred the Verbal Descriptor Scale (VDS) when compared with other pain measures [3]. In recent years, Herr et al. have modified the VDS into the IPT, which gives a visual image of a pain thermometer and allows subjects to select levels of severity that fall between the words offered. Herr et al. confirm relatively higher failure rates in both younger and older populations of the visual analogue scale (VAS), a scale preferred by …

Pain Assessment in Older Adults With Dementia: Using Behavioral Observation Methods in Clinical Practice

Pain assessment in older adults with dementia recently has received considerable attention from both researchers and clinicians as evidenced by a surge of published behavioral observation tools for pain assessment in this vulnerable population. These behavioral observation methods offer a promising strategy to improve pain assessment in older adults who are not able to communicate their pain verbally. However, some concerns exist related to the interpretation and clinical utility of these methods for decision making related to pain management interventions. This article provides an overview of the general state of knowledge on the use of behavioral observation methods in older adults and discusses the use of such methods to guide decision making in clinical settings.

Observation Scales for Pain Assessment in Older Adults With Cognitive Impairments or Communication Difficulties

Several pain observation scales have been developed to accurately assess and manage pain in older adults with severe cognitive impairments, communication difficulties, or both. To review relevant pain observation scales and the psychometric qualities of these scales. The literature was searched for articles reporting the use of a pain observation scale in an empirical study and describing psychometric properties in older adults with cognitive impairments, communication difficulties, or both. Thirteen pain observation scales were included. Scales differed in numbers of items, types of categories, and psychometric properties. Facial expression, vocalization, motor behavior, and social behavior or mood are categories present in most of the scales. In terms of reliability and validity, however, most studies are too limited or incomplete to allow definite conclusions to be drawn about usefulness in daily practice. As different methods of evaluating reliability and validity were used, and different aims (e.g., type of pain) were pursued, the available scales cannot be compared easily. Nevertheless, a few are promising, given preliminary results. These should be examined further on psychometric properties and usefulness in different populations because optimal pain assessment is necessary for efficient and effective pain treatment.

Chronic pain in the older patient: management strategies. 2.

This is the second of a two-part series, which highlights issues and strategies related to pain assessment in older adults and current problems of pain management in older adults and analgesic regimens pertinent to this population. The complexities of assessing pain in older adults and assessment techniques for accomplishing a careful evaluation of pain were presented in the first part of this series, which was published in the January issue of the Journal of Gerontological Nursing (Vol. 28, No. 1). This article addresses issues and strategies related to management of pain, particularly analgesic use, in this challenging population.

Chronic pain: challenges and assessment strategies.

Older adults are a rapidly growing segment of the world population, and long-term care will continue to be a major concern for most health care institutions in this century. Pain management remains at the forefront of long-term care issues, with older patients more subject than younger patients to chronic disease states that predispose them to pain. Assessment and management of chronic pain, however, are impeded by a lack of patient and caregiver education regarding pain, widespread misconceptions about pain in older patients, and special concerns and cautions for appropriate analgesic use in this population. This is the first of a two-part series highlighting issues and strategies related to pain assessment in older adults.

Assessment and measurement of pain in older adults

Although the empiric base is still limited when providing clear directions for pain assessment and management in older adults, it is possible to identify recommendations for guiding practice based on consensus and a developing scientific base to support best practice activities. A brief overview of the epidemiology and consequences of pain is offered, followed by a summary of issues and approaches relevant to pain assessment in older adults. Cohort-specific recommendations for comprehensive pain assessment and measurement based on current evidence are then addressed, including strategies for assessment of pain in cognitively impaired older adults.