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. 2009 Jan;57(1):126-32.
doi: 10.1111/j.1532-5415.2008.02071.x. Epub 2008 Nov 18.

Pain assessment in persons with dementia: relationship between self-report and behavioral observation

Ann L Horgas  1 , Amanda F Elliott, Michael Marsiske
Affiliations

Pain assessment in persons with dementia: relationship between self-report and behavioral observation

Ann L Horgas et al. J Am Geriatr Soc. 2009 Jan.

Abstract

Objectives: To investigate the relationship between self-report and behavioral indicators of pain in cognitively impaired and intact older adults.

Design: Quasi-experimental, correlational study of older adults.

Setting: Data were collected from residents of nursing homes, assisted living, and retirement apartments in north-central Florida.

Participants: One hundred twenty-six adults, mean age 83; 64 cognitively intact, 62 cognitively impaired.

Measurements: Pain interviews (pain presence, intensity, locations, duration), pain behavior measure, Mini-Mental State Examination, analgesic medications, and demographic characteristics. Participants completed an activity-based protocol to induce pain.

Results: Eighty-six percent self-reported regular pain. Controlling for analgesics, cognitively impaired participants reported less pain than cognitively intact participants after movement but not at rest. Behavioral pain indicators did not differ between cognitively intact and impaired participants. Total number of pain behaviors was significantly related to self-reported pain intensity (beta=0.40, P=.000) in cognitively intact elderly people.

Conclusion: Cognitively impaired elderly people self-report less pain than cognitively intact elderly people, independent of analgesics, but only when assessed after movement. Behavioral pain indicators do not differ between the groups. The relationship between self-report and pain behaviors supports the validity of behavioral assessments in this population. These findings support the use of multidimensional pain assessment in persons with dementia.

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Conflict of interest statement

Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper.

Figures

Figure 1
Figure 1
Relationship between, Self-report and Observed Pain Behaviors between Cognitively Intact and Impaired Elders (N=126)
See this image and copyright information in PMC

References

    1. American Geriatrics Society. Clinical practice guidelines: the management of persistent pain in older persons. J Am Geriatr Soc. 2002;50:S205–S224. - PubMed
    1. Shega JW, Hougham GW, Stocking CB, et al. Pain in community-dwelling persons with dementia: frequency, intensity, and congruence between patient and caregiver report. J Pain Symptom Manag. 2004;28:585–592. - PubMed
    1. Helme RD, Gibson SJ. The epidemiology of pain in elderly people. Clin Geriatr Med. 2001;17:417–431. - PubMed
    1. Benedetti F, Vighetti S, Ricco C, et al. Pain threshold and tolerance in Alzheimer’s disease. Pain. 1999;80:377–382. - PubMed
    1. Huffman JC, Kunick ME. Assessment and understanding of pain in patients with dementia. Gerontologist. 2000;40:574–581. - PubMed

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