Pain and agitation in long-term care residents with dementia: use of the Pittsburgh Agitation Scale.
OBJECTIVE
to explore the relationship between total and sub-scores of the Pittsburgh Agitation Scale (PAS) and five proxy measures of pain in long-term care (LTC) residents.


METHODS
descriptive correlational design.


METHODS
58 residents in three LTC facilities in rural Western Canada with moderate to severe cognitive impairment took part in the study. Six full-time registered nurses working in the facilities and three palliative care nurse consultants provided pain and agitation assessments.


METHODS
registered nurses used PAS to assess agitation. The five proxy measures of pain were the Discomfort Scale for Dementia of the Alzheimer's Type (DS-DAT), number of pain diagnoses, use of analgesic medications, and pain ratings by both facility nurses and palliative care nurse consultants.


RESULTS
there was a moderately strong relationship between total PAS agitation scores and total DS-DAT pain scores (r=0.51, P<0.01). The PAS sub-score "resisting care" was significantly correlated with total DS-DAT scores (r=0.46, P<0.01), and pain ratings by both facility nurses (r=0.48, P<0.01) and palliative care nurse consultants (r=0.51, P<0.01).


CONCLUSIONS
for certain residents with dementia, PAS may allow assessment of both agitation and uncommunicated pain. It is possible that the PAS form of agitation "resistance to care" may indicate pain that individual cannot otherwise communicate. One possible response to such resistance would be to trial pain medication and reassess agitation. Nursing staff in LTC facilities may need additional training in pain assessment of residents with dementia.
Zieber
Colin G
CG
Palliative Care, Chinook Health Region, c/o Lethbridge Regional Hospital, 960 19th St South, Lethbridge, Alberta T1J 1W5, Canada.
Hagen
Brad
B
Armstrong-Esther
Chris
C
Aho
Morgan
M
D000368:Aged; D000544:Alzheimer Disease / Q000523:psychology*; D006801:Humans; D008134:Long-Term Care; D010146:Pain / Q000175:diagnosis*; D011569:Psychiatric Status Rating Scales; D011581:Psychological Tests; D011594:Psychometrics; D011595:Psychomotor Agitation / Q000175:diagnosis*