PAIN ASSESSMENT IN PERSONS WITH DEMENTIA

Pain Assessment in Persons with Dementia

Pain Assessment in Persons with Dementia

Introduction

Pain in elderly is often undertreated, and may be especially true in elderly patients with severe dementia. Changes in patient's ability to communicate verbally present special challenges in treatment of pain and pain does not improve can have serious consequences, including reduced physical function and decreased appetite. Pain assessment in advanced dementia (PAIN) scale was designed to assess pain in this population to observe five specific indicators: breathing, vocalization, facial expression, body language, and ability to console. A nurse or other health professional can use scale in less than five minutes of observation. (Lacelle 2004)

e.g., despite the similar prevalence of pain under treatment such conditions. pain is due in part to difficulties in assessing pain in this public.5 In particular, cognitive functions deteriorate, patients are less likely to self-report pain6 although no convincing evidence of clinically significant reductions in suffering related pain. (Gagliese Fuchs 2001)

In last decade there has been significant progress in field of pain assessment in patients with dementia. In first case, it is important to note that older people with mild to moderate dementia tend to be able to provide answers to their one-dimensional self-report measures of pain, like box of 21 points and scale8 numerical rating scales. However, as cognitive functions deteriorate, self-report of pain becomes less reliable. As the rule, on basis of literature may suggest that patients with Mini Mental Status Examination (MMSE) 14 accounts 18 or more tend to provide valid responses to certain one-dimensional self-report tools (e.g. box scale of 21 points, 8 analog scale15 colors). (Chibnall 2001)

However, patients with an MMSE mean score of 12 at times capable of providing valid self-reports of pain as well.16 In considering self-report measures for elderly should be noted that some researchers17 have expressed reservations about using Traditional visual analog scales with this population because of concerns about the high number of responses may qualify. (Closs 2004)

Given limitations of self-report in face of deteriorating cognitive abilities, several observational tools have been developed specifically for older people with dementia, for example, ,18-20. We urge clinicians and researchers to read recent systematic literature reviews21, 22 (including French language review23) and comparative studies instruments24 evaluation to select one or more of these assessment tools. In addition, relevant clinical guidelines are available.25, 26 it should be noted, however, that most of available observation instruments used with caution until proven additional validation is available. (Taylor 2003)

In general, as recommended elsewhere, 25 steps should always be followed by clinicians who are evaluating pain among elderly:

Dimensional self-report measures must always be treated with older people with dementia than those with mild to moderate cognitive impairment are often able to provide valid self-reports.12, 13 patients with more severe dementia can sometimes give valid self-reports well. Examples of specific tools that you can try include (but not necessarily limited to) table of 21-point scale, numerical rating scales 8, 9, 10 verbal rating ...