Pain Assessment in Advanced Dementia - Pain Resource Center

More documents

Recommendations

Info

presence of pain.Scoring of the breathing indicator seems unrelated to pain severity.Breathing does not seem to be a key indicator of pain. However, the tooldevelopers argue that one of the known areas believed to cause negativefeelings for persons with dementia is the aversive symptoms associated withintercurrent respiratory infections and that pneumonia is a the proximal causeof death for many demented persons. Thus, they included the breathing item.We perceive consolablity as a response to an intervention, not a behavioralmanifestation of pain. However, the relationship between consolability andpain may be an area for future research in this population.The validity for the scoring of items according to pain severity or separationof behaviors within each major category is not established, (eg. Breathing isscored: Normal=0, Occasional labored breathing/Short period ofhyperventilation =1, Noisy labored breathing/Long period ofhyperventilation/Cheyne-Stokes respirations=2). However the tool appears toidentify higher and lower levels of pain in an individual.Although the PAINAD does not adequately sample the content area ofbehavioral indicators for pain in elders with dementia who are unable tocommunicate, studies have demonstrated that the tool measures pain. It maynot detect pain in patients that demonstrate pain with behaviors other thanthose included in the tool.SubjectsPanel rating: 1Revised: 3Subjects Study 1 (Warden et al., 2003)Long term care VA Dementia Special Care Unit (96 patient unit).Subjects: 19 veterans, all CaucasianAverage age: 78.1 years (±5), Range 66-85 yearsGender: Female: 0, Male: 100%The subjects had dementia for 8.7 years on average (±4.7), Range 1-20.Length of time in residence: 16.5 months average (±13.5), Range 1-50months.MMSE: 2.8 ±4.5, Range 0-16.Bedford Alzheimer Nursing Severity Subscale: average 16.4 ±4.4, Range 9-23.Study 2 Lane et al., 2003)QI study – charts of 25 patients were used.No demographic data or disease characteristics are available for thesesubjects.Study 3 (Costardi et al., 2006)Geriatric Evaluation and Rehabilitation Unit, Northern Italy (n=1)Subjects: 20 with chronic pain and dementiaAverage age: 82 (SD=5.9) years; Range: 73-93 yearsGender: Female 80% Male: 20%MMSE: 16.4 + 3.8, range 10-22Study 4 (Hutchison et al., 2006)Acute care hospital, US (n=1)Subjects: 53 control and 27 PAINAD with acute postop painReviewed 04/04Revised 06/082
Average Age: 85.2 control and 88 PAINADGender: 85% female in control and 78% female in PAINADMMSE: control: 0% with less than 25 in control and 100% diagnoseddementiaPAINAD group: 23.6% with MMSE less than 25 and 76.4% diagnoseddementiaStudy 5 (Leong et al., 2006)Nursing Home in Singapore (n=1)Subjects: 88 with moderate and severe dementiaAverage Age: 79.6 (SD=8.3)Gender: 61.4% female; 38.6% maleMMSE: Not reportedStudy 6 (van Iersel et al., 2006)Palliative care patients in NH setting (n=17)Patients who could not express painSubjects: 157 patientsAverage Age: 85 years; range 22-100Gender: 78% female; 22% maleMMSE: Not reportedStudy 7 (Zwakhalen et al., 2006)Nursing Homes in Netherlands (n=3)Subjects: 128 patients with dementia; both acute and chronic painAverage Age: 82.4 (SD=6.8) years; range 60-96Gender: 78.1% female; 21.9% maleMMSE: Not reported; Cognitive Performance Scale: 21.9% mild, 28.1%moderate, 47.7% severeStudy 8 (Schuler et al., 2007)Nursing Homes in Germany (n=8)Subjects: 99 residents with dementiaAverage Age: 84.9 (SD=7.5)Gender: 80% female; 20% maleMMSE: Mean 12.1 (SD=9.7)Study 9 (Cohen-Mansfield & Lipson, 2008)Nursing homes in US (n=4)Subjects: 121 with dementiaAverage Age: 88 (range 59-101)Gender: 81.8% femaleMMSE: Mean 6.3 (range 0-20)Study 10 (DeWaters et al., 2008)Orthopedic unit in US hospital (n=1)Subjects: 25 verbal older persons, includes 13 cognitively intact and 12cognitively impaired personsAverage age: 81.24 (range 65-95)Gender: 84% femaleMMSE: 20.52 (range 9-30) plus diagnosis of dementia or confusion-Panel Commentary The PAINAD has received considerable attention internationally and 7additional studies have been conducted that provide additional psychometricdata on this tool. The PAINAD was translated and tested in Singapore,Belgium, Italy, Netherlands, and Germany, as well as two studies in the US.The majority of additional study has been conducted in NHs, however testingReviewed 04/04Revised 06/083
Page 1: Tool:The Assessment in Advanced Dem
Page 5 and 6: Scoring procedures are clearly desc
Page 7 and 8: Concurrent validity was reported ba
Page 9 and 10: number of patients with behaviors r
Page 11: Revision completed 06/08 by:K. Herr

Pain Assessment in Advanced Dementia - Pain Resource Center

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?