Background: Dementia, ranked as the 7th leading global cause of death, poses challenges for pain assessment due to cognitive and communication impairments. Recent research addresses this gap by examining pain assessment tools for moderate to severe dementia. This review analyses the psychometric properties and clinical utility of these tools, including a comparison with the novel ePAT tool and its potential impact on health. Method: The study used the PRISMA checklist to analyse literature from 2003 to 2023. Online searches with specific keywords and free-text terms were conducted. Titles, abstracts, and full texts of potential studies were evaluated for inclusion, along with relevant bibliographic lists. Selected studies underwent appraisal and analysis. Results: 34 pain assessment tools used for elderly individuals with moderate to severe dementia were found, with PAINAD, CNPI, DOLOPLUS-2, APS, PACSLAC, NOPPAIN, PADE, MOBID, DS-DAT, CPAT, and ePAT being the most frequent. While most tools showed moderate to good validity, reliability, and internal consistency, ePAT showed strong results and a positive health service impact. Conclusions: Based on the evidence reviewed, no definite gold standard tool was detected. Although ePAT shows positive outcomes, its testing has mainly been done in Residential Aged Care Facilities. Further validation and testing across various healthcare settings are needed.
References
[1]
Dementia Australia (n.d.) Causes and Types of Dementia. https://www.dementia.org.au/about-dementia/causes-and-types-dementia
[2]
Adeniji, T. and Oyeyemi, A.Y. (2019) A Review of Non-Verbal Pain Assessment Tools and Management in Patients with Dementia. Nigerian Medical Practitioner, 75, 27-36. https://www.researchgate.net/publication/335107325_A_Review_of_Non-Verbal_Pain_Assessment_Tools_and_Management_in_Patients_with_Dementia#fullTextFileContent
[3]
Cole, L.J., Farrell, M.J., Duff, E.P., Barber, J.B., Egan, G.F. and Gibson, S.J. (2006) Pain Sensitivity and fMRI Pain-Related Brain Activity in Alzheimer’s Disease. Brain, 129, 2957-2965. https://doi.org/10.1093/brain/awl228
[4]
Achterberg, W., Lautenbacher, S., Husebo, B., Erdal, A. and Herr, K. (2020) Pain in dementia. PAIN Reports, 5, e803. https://doi.org/10.1097/pr9.0000000000000803
[5]
Hadjistavropoulos, T., Herr, K., Prkachin, K.M., Craig, K.D., Gibson, S.J., Lukas, A., et al. (2014) Pain Assessment in Elderly Adults with Dementia. The Lancet Neurology, 13, 1216-1227. https://doi.org/10.1016/s1474-4422(14)70103-6
[6]
IASP (2020) IASP Announces Revised Definition of Pain. International Association for the Study of Pain (IASP). https://www.iasp-pain.org/publications/iasp-news/iasp-announces-revised-definition-of-pain/
[7]
Carezzato, N.L., Valera, G.G., Vale, F.A.C. and Hortense, P. (2014) Instruments for Assessing Pain in Persons with Severe Dementia. Dementia & Neuropsychologia, 8, 99-106. https://doi.org/10.1590/s1980-57642014dn82000003
[8]
Achterberg, W., Pieper, M.J.C., van Dalen-Kok, A.H., de Waal, M.W.M., Husebo, B.S., Lautenbacher, S., et al. (2013) Pain management in patients with dementia. Clinical Interventions in Aging, 8, 1471-1482. https://doi.org/10.2147/cia.s36739
[9]
Jones, J., Sim, T. and Hughes, J. (2017) Pain Assessment of Elderly Patients with Cognitive Impairment in the Emergency Department: Implications for Pain Management—A Narrative Review of Current Practices. Pharmacy, 5, Article 30. https://doi.org/10.3390/pharmacy5020030
[10]
Hadjistavropoulos, T., Fitzgerald, T.D. and Marchildon, G.P. (2010) Practice Guidelines for Assessing Pain in Older Persons with Dementia Residing in Long-Term Care Facilities. Physiotherapy Canada, 62, 104-113. https://doi.org/10.3138/physio.62.2.104
[11]
Herr, K., Bjoro, K. and Decker, S. (2006) Tools for Assessment of Pain in Nonverbal Older Adults with Dementia: A State-Of-The-Science Review. Journal of Pain and Symptom Management, 31, 170-192. https://doi.org/10.1016/j.jpainsymman.2005.07.001
[12]
AGS Panel on Persistent Pain in Older Persons (2002) The Management of Persistent Pain in Older Persons. Journal of the American Geriatrics Society, 50, 205-224. https://doi.org/10.1046/j.1532-5415.50.6s.1.x
[13]
Herr, K., Zwakhalen, S. and Swafford, K. (2017) Observation of Pain in Dementia. Current Alzheimer Research, 14, 486-500. https://doi.org/10.2174/1567205013666160602234526
[14]
Lichtner, V., Dowding, D., Esterhuizen, P., Closs, S.J., Long, A.F., Corbett, A., et al. (2014) Pain Assessment for People with Dementia: A Systematic Review of Systematic Reviews of Pain Assessment Tools. BMC Geriatrics, 14, Article No. 138. https://doi.org/10.1186/1471-2318-14-138
[15]
Atee, M., Hoti, K. and Hughes, J.D. (2017) Psychometric Evaluation of the Electronic Pain Assessment Tool: An Innovative Instrument for Individuals with Moderate-To-Severe Dementia. Dementia and Geriatric Cognitive Disorders, 44, 256-267. https://doi.org/10.1159/000485377
[16]
Abbey, J., Piller, N., Bellis, A.D., Esterman, A., Parker, D., Giles, L., et al. (2004) The Abbey Pain Scale: A 1-Minute Numerical Indicator for People with End-Stage Dementia. International Journal of Palliative Nursing, 10, 6-13. https://doi.org/10.12968/ijpn.2004.10.1.12013
[17]
Ersek, M., Herr, K., Neradilek, M.B., Buck, H.G. and Black, B. (2010) Comparing the Psychometric Properties of the Checklist of Nonverbal Pain Behaviors (CNPI) and the Pain Assessment in Advanced Dementia (PAIN-AD) Instruments. Pain Medicine, 11, 395-404. https://doi.org/10.1111/j.1526-4637.2009.00787.x
[18]
Lints-Martindale, A.C., Hadjistavropoulos, T., Lix, L.M. and Thorpe, L. (2012) A Comparative Investigation of Observational Pain Assessment Tools for Older Adults with Dementia. The Clinical Journal of Pain, 28, 226-237. https://doi.org/10.1097/ajp.0b013e3182290d90
[19]
Cervo, F.A., Bruckenthal, P., Chen, J.J., Bright-Long, L.E., Fields, S., Zhang, G., et al. (2009) Pain Assessment in Nursing Home Residents with Dementia: Psychometric Properties and Clinical Utility of the CNA Pain Assessment Tool (CPAT). Journal of the American Medical Directors Association, 10, 505-510. https://doi.org/10.1016/j.jamda.2009.05.011
[20]
Zwakhalen, S.M., Hamers, J.P., Abu-Saad, H.H. and Berger, M.P. (2006) Pain in Elderly People with Severe Dementia: A Systematic Review of Behavioural Pain Assessment Tools. BMC Geriatrics, 6, Article No. 3. https://doi.org/10.1186/1471-2318-6-3
[21]
H？len, J.C., Saltvedt, I., Fayers, P.M., Hjermstad, M.J., Loge, J.H. and Kaasa, S. (2007) Doloplus-2, a Valid Tool for Behavioural Pain Assessment? BMC Geriatrics, 7, Article No. 29. https://doi.org/10.1186/1471-2318-7-29
[22]
Husebo, B.S., Strand, L.I., Moe‐Nilssen, R., Husebo, S.B. and Ljunggren, A.E. (2010) Pain in Older Persons with Severe Dementia. Psychometric Properties of the Mobilization-Observation-Behaviour-Intensity-Dementia (MOBID‐2) Pain Scale in a Clinical Setting. Scandinavian Journal of Caring Sciences, 24, 380-391. https://doi.org/10.1111/j.1471-6712.2009.00710.x
[23]
Husebo, B., Malcangio, M., Staniland, A., Cohen-Mansfield, J., Aarsland, D. and Ballard, C. (2012) Assessment and Treatment of Pain in People with Dementia. Nature Reviews Neurology, 8, 264-274.
[24]
Warden, V., Hurley, A.C. and Volicer, L. (2003) Development and Psychometric Evaluation of the Pain Assessment in Advanced Dementia (PAINAD) Scale. Journal of the American Medical Directors Association, 4, 9-15. https://doi.org/10.1097/01.jam.0000043422.31640.f7
[25]
Rababa, M. (2018) Pain Assessment in People with Dementia: Remaining Controversies. Global Journal of Health Science, 10, 62-69. https://doi.org/10.5539/gjhs.v10n5p62
[26]
van Herk, R., van Dijk, M., Baar, F.P.M., Tibboel, D. and de Wit, R. (2007) Observation Scales for Pain Assessment in Older Adults with Cognitive Impairments or Communication Difficulties. Nursing Research, 56, 34-43. https://doi.org/10.1097/00006199-200701000-00005
[27]
Ersek, M., Neradilek, M.B., Herr, K., Hilgeman, M.M., Nash, P., Polissar, N., et al. (2019) Psychometric Evaluation of a Pain Intensity Measure for Persons with Dementia. Pain Medicine, 20, 1093-1104. https://doi.org/10.1093/pm/pny166
[28]
Atee, M., Hoti, K., Parsons, R. and Hughes, J. (2018) A Novel Pain Assessment Tool Incorporating Automated Facial Analysis: Interrater Reliability in Advanced Dementia. Clinical Interventions in Aging, 13, 1245-1258. https://doi.org/10.2147/cia.s168024
[29]
Atee, M., Hoti, K., Parsons, R. and Hughes, J.D. (2017) Pain Assessment in Dementia: Evaluation of a Point-Of-Care Technological Solution. Journal of Alzheimer’s Disease, 60, 137-150. https://doi.org/10.3233/jad-170375
[30]
Atee, M., Hoti, K. and Hughes, J.D. (2018) A Technical Note on the Painchek？ System: A Web Portal and Mobile Medical Device for Assessing Pain in People with Dementia. Frontiers in Aging Neuroscience, 10, Article 117. https://doi.org/10.3389/fnagi.2018.00117
[31]
Villanueva, M., Smith, T., Erickson, J., Lee, A. and Singer, C. (2003) Pain Assessment for the Dementing Elderly (PADE): Reliability and Validity of a New Measure. Journal of the American Medical Directors Association, 4, 1-8. https://doi.org/10.1016/s1525-8610(04)70257-1
[32]
Fry, M. and Elliott, R. (2018) Pragmatic Evaluation of an Observational Pain Assessment Scale in the Emergency Department: The Pain Assessment in Advanced Dementia (PAINAD) Scale. Australasian Emergency Care, 21, 131-136. https://doi.org/10.1016/j.auec.2018.09.001
[33]
Natavio, T., McQuillen, E., Dietrich, M.S., Wells, N., Rhoten, B.A., Vallerand, A.H., et al. (2020) A Comparison of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC) and Pain Assessment in Advanced Dementia Scale (PAINAD). Pain Management Nursing, 21, 502-509. https://doi.org/10.1016/j.pmn.2020.04.001
[34]
Schofield, P. (2018) The Assessment of Pain in Older People: UK National Guidelines. Age and Ageing, 47, i1-i22. https://doi.org/10.1093/ageing/afx192
[35]
Smith, T.O. and Harvey, K. (2022) Psychometric Properties of Pain Measurements for People Living with Dementia: A COSMIN Systematic Review. European Geriatric Medicine, 13, 1029-1045. https://doi.org/10.1007/s41999-022-00655-z
[36]
Han, S., Kim, Y., Park, J. and Moon, Y. (2017) Assessment of Pain in the Elderly: A Literature Review. The National Medical Journal of India, 30, 203-207. https://doi.org/10.4103/0970-258x.218673
[37]
Smith, M. (2005) Pain Assessment in Nonverbal Older Adults with Advanced Dementia. Perspectives In Psychiatric Care, 41, 99-113. https://doi.org/10.1111/j.1744-6163.2005.00021.x
[38]
Neville, C. and Ostini, R. (2014) A Psychometric Evaluation of Three Pain Rating Scales for People with Moderate to Severe Dementia. Pain Management Nursing, 15, 798-806. https://doi.org/10.1016/j.pmn.2013.08.001
[39]
Felton, N., Lewis, J.S., Cockburn, S., Hodgson, M. and Dawson, S. (2021) Pain Assessment for Individuals with Advanced Dementia in Care Homes: A Systematic Review. Geriatrics, 6, Article 101. https://doi.org/10.3390/geriatrics6040101
