title: A comparative investigation of observational pain assessment tools for older adults with dementia.
abstract: OBJECTIVE
  Pain assessment in patients with dementia and severe limitations in ability to communicate can be challenging. The American Geriatrics Society (AGS) encourages the incorporation of 6 behavioral domains (ie, facial expressions, verbalizations/vocalizations, body movements, changes in interpersonal interactions, changes in activity patterns/routines and mental status changes) when conducting pain assessments among seniors with dementia. We investigated 6 observational pain assessment measures (differing with respect to the extent that they cover the AGS-recommended domains) under 2 different pain conditions (ie, influenza vaccination and movement-exacerbated pain) in a sample of long-term care residents with cognitive impairments. Given that a criticism of pain assessment scales is that many of the pain behaviors assessed are highly overlapping with symptoms of delirium, we also investigated the impact of the elimination of delirium-related items.
  
  
  RESULTS
  Consistent with expectations, all measures were able to differentiate between pain and baseline conditions. Reliability and validity varied across measures. Most measures continued to differentiate between pain and baseline states after items that overlap with delirium were eliminated.
  
  
  CONCLUSIONS
  Our results provide much needed psychometric information regarding newly developed pain assessments measures for seniors with dementia. The measures differed with respect to ability to differentiate pain-related from non-pain-related states. Moreover, our findings support the utility of comprehensive coverage of the AGS-recommended pain assessment domains.
authors: Department of Clinical Health Psychology, University of Manitoba.
authors: Amanda C
authors: AC
authors: Lints-Martindale
authors: Thomas
authors: T
authors: Hadjistavropoulos
authors: Lisa M
authors: LM
authors: Lix
authors: Lilian
authors: L
authors: Thorpe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology; D003704:Dementia / Q000150:complications* / Q000523:psychology; D004185:Disability Evaluation; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D009483:Neuropsychological Tests; D019370:Observation; D010146:Pain / Q000175:diagnosis* / Q000209:etiology*; D010147:Pain Measurement / Q000379:methods*; D015203:Reproducibility of Results; D057566:Self Report