title: Pain Assessment Using Self-reported, Nurse-reported, and Observational Pain Assessment Tools among Older Individuals with Cognitive Impairment.
abstract: Pain assessment in older individuals with cognitive impairment is challenging. Evidence on the performance of pain assessment tools in this population remains limited. The aim of this study was to evaluate the performance of self-reported pain, nurse-reported pain, and observational pain tools among older patients with cognitive impairment using a prospective observational design. In all, 152 older individuals admitted to the acute geriatric ward were recruited through convenience sampling. Three methods of pain assessment were compared: self-reported pain (SRP), observational pain using the Pain Assessment in Advanced Dementia (PAINAD) tool, and nurse-reported pain (NRP). Cognition and mood were assessed with the Mini-Mental State Examination (MMSE) and the 15-item Geriatric Depression Scale (GDS-15). There was moderate agreement between SRP and PAINAD (k = 0.438) and fair agreement between SRP and NRP (k = 0.263). There was statistically significant correlation between SRP and GDS-15 (r = 0.382, p < .001) but not between SRP and MMSE (r = 0.018, p = .824). These results suggest that the use of an observational pain scale would be helpful in pain assessment among older individuals when the ability to report pain is not possible. However, self-reported assessments should be attempted first for cognitively impaired patients.
authors.affiliation: Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. Electronic address: ahvia_ngu84@yahoo.com.
authors.forename: Sylvia S C
authors.initials: SS
authors.lastname: Ngu
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Ageing and Age-Associated Disorders Research Group, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Maw Pin
authors.initials: MP
authors.lastname: Tan
authors.affiliation: Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Ageing and Age-Associated Disorders Research Group, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Pathmawathi
authors.initials: P
authors.lastname: Subramanian
authors.affiliation: Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Rasnah
authors.initials: R
authors.lastname: Abdul Rahman
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Ageing and Age-Associated Disorders Research Group, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Shahrul
authors.initials: S
authors.lastname: Kamaruzzaman
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Ageing and Age-Associated Disorders Research Group, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Ai-Vyrn
authors.initials: AV
authors.lastname: Chin
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Ageing and Age-Associated Disorders Research Group, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Kit Mun
authors.initials: KM
authors.lastname: Tan
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Ageing and Age-Associated Disorders Research Group, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Philip J H
authors.initials: PJ
authors.lastname: Poi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000067289:Behavior Observation Techniques / Q000379:methods*; D060825:Cognitive Dysfunction / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D009730:Nursing Assessment / Q000379:methods*; D010146:Pain / Q000150:complications / Q000175:diagnosis*; D010147:Pain Measurement / Q000379:methods*; D019727:Proxy; D057566:Self Report