Journal of the American Medical Directors Association
Original StudiesDevelopment and Psychometric Evaluation of the Pain Assessment in Advanced Dementia (PAINAD) Scale
Section snippets
Design
The Pain Assessment in Advanced Dementia (PAINAD) scale was developed after extensive review of the literature and available pain assessment tools. PAINAD is based on categories and behaviors from the Face, Legs, Activity, Cry, Consolability Scale (FLACC), 22 the DS-DAT, 17 and descriptions of pain taken from the literature and cited by experienced dementia care clinicians.
Study Population
The projects were carried out on a Dementia Special Care Unit (DSCU) where 96 in-patients receive care for dementia. The
Results
Research participants had a mean age of 78.1 ± 5 (SD, range 66–85) years, suffered from dementia for 8.7 ± 4.7 years (range, 1–20 years) and were institutionalized for 16.5 ± 13.5 months (range, 1–50 months). They had severe dementia with the MMSE score of 2.8 ± 4.5 (0–16), BANS- S score of 16.4 ± 4.4 (9–23), and were clearly unable to verbally report symptoms of pain.
PAINAD mean scores (± SD) of the 19 participants who were observed during three different conditions went from 1.3 ± 1.3 during
Discussion
The PAINAD successfully measured pain in individuals with advanced dementia, who were unable to use any of the available pain assessment tools that have been used with cognitively impaired individuals. Fifteen of 19 research participants had MMSE scores under five, and the four that were still able to verbally interact did so on a social level only and were unreliable in their reporting. Although other scales measuring pain are appropriate for research studies, some such as the DS-DAT require
Acknowledgments
For their dedicated support in data collection and tireless efforts to improve dementia care, the authors would like to express their gratitude to the expert clinical staff on the Geriatric Research, Education, and Clinical Center DSCU at the Veterans Affairs Medical Center in Bedford, Massachusetts, Patricia Lane, BSN, RNC, Sally MacDonald, RN, JoAnn Panke, BSN, RNC, RD, and Patricia Smith, RN, who took part in this study. The authors would also like to thank Mary Duffy, RN, DNSc, Boston
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