Pain assessment in the elderly: a psychometric evaluation of self-report and behavioral methods.

Abstract

<p>Limited research has been done that examines appropriate and reliable methods to assess for pain in the elderly population. For the cognitively impaired elderly, pain assessment is further complicated by their limited communication abilities. Reliable and clinically feasible methods are desperately needed to assess pain so that it can be managed appropriately. The purpose of this study was to examine the psychometric properties (Le., testretest and interrater reliability, criterion concurrent validity) of three verbal pain assessment tools (i.e., Faces scale, numerical rating scale, present pain intensity scale) and a behavioural pain assessment scale within the elderly population. This measurement study used a repeated measures design to examine the reliability and validity of these pain assessment tools across four groups of elderly participants: 1) cognitively intact, 2) mildly cognitively impaired, 3) moderately cognitively impaired, and 4) extremely cognitively impaired, using a nonrandom stratified sample of 130 elderly residents who live in long term care. The findings support the test-retest and interrater reliability of the behavioural pain assessment tool across all four groups of the elderly whereas the same measures of reliability for the verbal pain assessment tools decrease with increasing cognitive impairment. However, the majority of elderly with mild to moderate cognitive impairment were able to complete at least one of the verbal pain assessment tools. The Present Pain Intensity scale had the strongest criterion concurrent validity for the elderly with moderate cognitive impairment (r=0.64, p=O.OOl). The findings are discussed in relation to its clinical and research implications.</p>