Pain in elderly people with severe dementia: A systematic review of behavioural pain assessment tools

This systematic review identifies pain assessment scales for elderly people with severe dementia and evaluates the psychometric properties and clinical utility of these instruments. Relevant publications in English, German, French or Dutch, from 1988 to 2005, were identified by means of an extensive search strategy in Medline, Psychinfo and CINAHL, supplemented by screening citations and references. Quality judgement criteria were formulated and used to evaluate the psychometric aspects of the scales.Twenty-nine publications reporting on behavioural pain assessment instruments were selected for this review. Twelve observational pain assessment scales (DOLOPLUS2; ECPA; ECS; Observational Pain Behavior Tool; CNPI; PACSLAC; PAINAD; PADE; RaPID; Abbey Pain Scale; NOPPAIN; Pain assessment scale for use with cognitively impaired adults) were identified. Findings indicate that most observational scales are under development and show moderate psychometric qualities.Based on the psychometric qualities and criteria regarding sensitivity and clinical utility, we conclude that PACSLAC and DOLOPLUS2 are the most appropriate scales currently available. Further research should focus on improving these scales by further testing their validity, reliability and clinical utility.In the last decade, there has been a growing interest in pain among elderly people. Pain among nursing home residents is a common and major problem. Statistics indicate that pain is twice as likely to occur in individuals aged 60 and older as in younger persons [1-3]. The prevalence of pain in elderly nursing home residents is 40–80% [4-9], showing that they are at great risk of experiencing pain. As in most countries, the population of individuals over the age of 65 in the Netherlands is growing fast. Demographic trends make it likely that in 2040, 22.9% of the population will belong to this category [10].More than 50% of US nursing home residents have substantial cognitive impairment or dementia [6]. This si