Assessing pain in people with dementia. 1: the challenges

This article is the first of a two-part unit on dementia and pain assessment. It examines literature that describes the problem of pain for people with dementia and the challenges nurses face in undertaking pain assessments.     

Developing a social capital scale for family caregivers of people with dementia

Although several scales have been designed to measure social capital, none have been specialized for caregivers of people with dementia, even though social capital is important in terms of continuing care provision. Therefore, we developed and validated a 17-item measure to assess social capital among caregivers of people with dementia. We assessed psychometric properties using responses from a questionnaire survey that included a draft of a social capital scale. Factor analysis identified three factors involving 17 items with a Cronbach's alpha of .85. The intra-class coefficient for test–retest reliability was .71. The correlation with positive aspects of caregiving was .62 (p < .01). The results suggest that our scale could be a useful tool to assess social capital among caregivers of people with dementia.     

Assessing pain in people with dementia 2: the nurse's role

This is the second in a two-part unit on dementia and pain assessment. The first part examined research on pain in people with dementia and the challenges nurses face with pain assessments. This part explores evidence on the methods and tools available to nurses and other care providers to use in pain assessment. It also outlines some practical implications.     

A possible indicator of functional pain: poor pain scale correlation.

We studied correlations of pain measures in patients with either inflammatory bowel disease (IBD), a disease with a clear organic cause, or irritable bowel syndrome (IBS), a functional pain syndrome in which there is little demonstrable pathology. Correlations were determined between measures on the visual analogue scale (VAS) and on the McGill Pain Questionnaire (MPQ). The VAS score and present pain intensity scale (PPI) of the MPQ correlated well in the organic IBD but correlated poorly in the functional IBS. Differences in correlation between the VAS and PPI scores in functional versus organic disease did not appear to be due to altered sensory and affective pain components. This finding is similar to what we observed in our previous study of organic and functional pain syndromes in the musculoskeletal system. Correlations between the other measures are also discussed.     

The prevalence of pain in nursing home residents with dementia measured using an observational pain scale

Background: Studies on pain and pain prevalence in older people with dementia are limited compared to those on cognitively intact older people. Pain prevalence rates in older people with dementia are estimated to be between 28% and 83%. Aims: This study aimed to explore pain prevalence in nursing home residents with dementia using observational scale PACSLAC‐D, and to identify the association between pain prevalence and (dementia) demographic parameters such as cognitive status, gender, analgesic use and co‐morbidity. Methods: Using an observational study design, 117 residents were observed and assessed for pain during personal morning care. Prevalence data were calculated and regression analyses applied. Results: This study showed that almost half of the participants (47%) experienced pain to some extent. However, overall pain intensity scores were relatively mild. Among the independent variables, co‐morbidities, analgesic use and the adjusted interaction term ‘co‐morbidities+analgesic use’ had the strongest associations with pain and were thus shown to be valid significant predictors. Conclusion: With its relatively new approach of measuring pain using an observational scale, this study confirms the expectation gleaned from other studies on less impaired older populations: namely, that pain prevalence in older residents with dementia in Dutch nursing homes is high.     

The assessment and management of pain in people with dementia in care homes

Pain is an unpleasant, subjective sensation and a universal human experience. However, under-recognition of pain in people with dementia is common; with verbal and behavioural expressions of pain misunderstood or not recognised and therefore untreated, to the detriment of the person with dementia. Care staff's success or otherwise in recognising, assessing and managing pain can have far-reaching consequences for the wellbeing of people with dementia. This article examines research on pain and pain in people with dementia and offers practical guidance on recognising, assessing and managing pain and on advocating for people with dementia who are no longer able to articulate their pain.     

Mobility rating scale for elderly people with dementia: preparation of a Japanese-language version of the Southampton Mobility Assessment

Objectives

Improving the mobility of elderly people with dementia appears to be of significant value in maintaining and enhancing their activities of daily living and quality of life. However, a literature search revealed no scales for rating the mobility of elderly people with dementia currently available in Japan. A Japanese-language version of a rating scale for the mobility of elderly people with dementia, the Southampton Mobility Assessment (SMA), was prepared and its reliability and validity were evaluated.

Participants

Eighty-five elderly people with dementia.

Methods

Reliability was assessed using limits of agreement based on the analysis by Bland and Altman. Validity was evaluated using Spearman's rank correlation coefficients to assess associations between the scores on the Japanese-language version of the SMA and the scores on the subscales of the Barthel Index.

Results

The limits of agreement between two raters were −1.2 and 1.2, and the evaluation of repeatability revealed that 98% of the differences were within two standard deviations (−0.3 and 0.3). A high correlation was found between the scores on the Japanese-language version of the SMA and the Barthel Index.

Conclusions

These results demonstrate that the Japanese-language version of the SMA possesses high reliability and validity, suggesting its suitability in the assessment of mobility when developing physiotherapy approaches intended to enhance the mobility and quality of life of elderly people with dementia.     

The psychometric quality and clinical usefulness of three pain assessment tools for elderly people with dementia

In view of the need for valid, reliable, and clinically useful scales to assess pain in elderly people with dementia, this study evaluated the psychometric properties of translated versions of the PAINAD, PACSLAC, and DOLOPLUS-2 scales. In an observational study design, two raters simultaneously assessed the nursing home residents (n=128) for pain during influenza vaccination and care situations. The PACSLAC was valued as the most useful scale by nurses. Cronbach's alpha was high (>.80) for the total scale at T2 and T3 and adequate for the 'Facial expression' and 'Social/personality/mood' subscales. IC scores for the 'Activity/body movement' and 'Physiological indicators/eating/sleeping changes/vocal behaviors' subscales were low. It demonstrated good validity and reliability, although the scale should be further refined. This refinement should increase homogeneity. The PAINAD showed good psychometric qualities in terms of reliability, validity, and homogeneity (alpha ranged .69-.74 at T2 and T3) (except for the 'Breathing' item). The PAINAD scale had lower scores for clinical usefulness in this sample. The Dutch version of the DOLOPLUS-2 was considered more difficult to use but showed acceptable psychometric qualities in terms of the issues assessed, except for the 'psychosocial reactions' subscale. IC of the DOLOPLUS were adequate for the total scale (alpha ranged .74-.75) and almost all subscales (alpha ranged .58-.80). Findings of this study provide evidence of validity and reliability of the three pain assessment scales. Now that a pain scale is available, future studies also need to focus on its implementation in nursing practice.     

The DIAL-log study 1: Profiling the experience of people with dementia.

Between July 1996 and December 1997 telephone helpline staff from the Alzheimer's Disease Society (ADS) in London, and six participating ADS regions in England and one in Northern Ireland, documented calls from people with dementia who contacted the service. Each call was recorded as soon as practicable after its completion on a Dementia Information and Advice Line (DIAL) log form (DIAL-log). Sixty-four calls were recorded in this way and 62 completed DIAL-logs were included in the study findings. Analysis of the data was undertaken via SPSS 6.1 for Windows. This article, the first of two, introduces the background to the study and notes that callers reported memory loss and forgetfulness as the most frequently noticed first signs of dementia. The study aims and limitations are also outlined in this first article. The second article will detail the main findings and the challenges that the DIAL-log study may provide for future dementia care practice and research.     

Person-centred care for people with dementia: a quality audit approach

This paper addresses the concept of person-centred care for people with dementia by consideration of an audit process using dementia care mapping as the audit tool. It is argued that this tool is best for identifying the lived experiences of the people in receipt of care. As a result it is able to identify the overall culture of care and its level of 'person-centred' approach. The audit was conducted on 12 units, half of which were day units and the others catering for inpatients. Five patients were mapped on each day for a 4-day period. The results give some idea of the quality of care and identify where improvement is necessary. Scores such as well-being values and the Dementia Care Index give clear signposts to the level of person-centred care and highlight where staff development is necessary. Recommendations are given to aid on-going planning.     

University of Washington self-efficacy scale: a new self-efficacy scale for people with disabilities

Amtmann D, Bamer AM, Cook KF, Askew RL, Noonan VK, Brockway JA. University of Washington Self-Efficacy Scale: a new self-efficacy scale for people with disabilities.ObjectiveTo develop a self-efficacy scale for people living with multiple sclerosis (MS) and spinal cord injury (SCI) that can be used across diagnostic conditions.DesignThe scale was developed using modern psychometric methods including item response theory. Items were administered at 3 time-points of a longitudinal survey of individuals with MS and SCI.SettingSurvey participants with MS were recruited from the National MS Society, and participants with SCI were recruited from the Northwest Regional Spinal Cord Injury Model System and the Shepherd Center at the Virginia Crawford Research Institute in Atlanta, GA.ParticipantsAdults aged 18 years and older reporting a definitive diagnosis of MS (N=473) or SCI (N=253).InterventionsNone.Main Outcome MeasuresEvaluation of the new self-efficacy measure called the University of Washington Self-Efficacy Scale (UW-SES) included comparisons with the Chronic Disease Self-Efficacy Scale and other patient-reported outcome measures.ResultsUW-SES has excellent psychometric properties including well-functioning response categories, no floor effects, and low ceiling effects. A long form (17 items) and a short form (6 items) are available. The correlation between the score on the newly developed scale and the Chronic Disease Self-Efficacy Scale was high (.83), providing support for convergent validity. Higher self-efficacy scores were statistically significantly associated with better mental health, better physical health, less fatigue, less stress, less pain interference, less pain, fewer sleep problems, and lower depressive symptoms.ConclusionsThe UW-SES is a psychometrically sound instrument for measuring self-efficacy, validated in MS and SCI, and can be used across both conditions. Both the long form and the short form are available free of charge.     

老年认知功能障碍病人疼痛行为评估量表研究

疼痛是一种主观感受,认知功能障碍老年人报告疼痛的能力下降或缺如.为探讨认知障碍老年人疼痛评估方法,对国外有关评估量表进行了介绍.