Paula R. Mobily

Pain intensity assessment in older adults: Use of experimental pain to compare psychometric properties and usability of selected pain scales with younger adults

Objectives:To determine: (1) the psychometric properties and utility of 5 types of commonly used pain rating scales when used with younger and older adults, (2) factors related to failure to successfully use a pain rating scale, (3) pain rating scale preference, and (4) factors impacting scale preference. Methods:A quasi-experimental design was used to gather data from a sample of 86 younger (age 25–55) and 89 older (age 65–94) adult volunteer subjects. Responses of subjects to experimentally induced thermal stimuli were measured with the following pain intensity rating scales: vertical visual analog scale (VAS), 21-point Numeric Rating Scale (NRS), Verbal Descriptor Scale (VDS), 11-point Verbal Numeric Rating Scale (VNS), and Faces Pain Scale (FPS). Results:All 5 pain scales were effective in discriminating different levels of pain sensation; however the VDS was most sensitive and reliable. Failure rates for pain scale completion were minimal, except for the VAS. Although age did not impact failure to properly use this pain intensity rating scale, but rather those conditions more commonly associated with advanced age, including cognitive and psychomotor impairment did. The scale most preferred to represent pain intensity in both cohorts of subjects was the NRS, followed by the VDS. Scale preference was not related to cognitive status, educational level, age, race, or sex. Conclusion:Although all 5 of the pain intensity rating scales were psychometrically sound when used with either age group, failures, internal consistency reliability, construct validity, scale sensitivity, and preference suggest that the VDS is the scale of choice for assessing pain intensity among older adults, including those with mild to moderate cognitive impairment.

Comparison of selected pain assessment tools for use with the elderly

p AIN IN THE ELDERLY is receiving increasing attention by researchers and practitioners. Given the potential impact of pain on the elderlys activities and quality of life, it is important that health care providers evaluate a pain complaint carefully. Accurate assessment of clinical pain is critical for evaluation of treatments in controlled studies and for implementation and evaluation of interventions in the care of the elderly. However, little attention has been devoted to determining if tools used to assess pain in adults are valid and reliable with elderly populations. Studies that determine the ability, utility, and practicality of measures to evaluate pain are necessary to assist with decision making when selecting a tool for use with the elderly.

Evaluation of the faces pain scale for use with the elderly

OBJECTIVE The specific objective for this research was to determine initial psychometric properties of the Faces Pain Scale (FPS) as a measure of pain intensity for use with the elderly. DESIGN The study was descriptive correlational in nature, with nonrandom sampling. A total sample of 168 community subjects (30-121, depending on task completed), aged 65 or older, participated in the research protocol. To determine the validity, reliability, and scaling properties of the FPS, rating and ranking procedures, placement tasks, and test-retest methods were used. RESULTS Response to six Likert-type items indicated that subjects agreed that the FPS represents pain: however, it is clear that the perception of the meaning of the faces can be influenced by the context in which they are presented. Rank ordering tasks for the individual faces demonstrated near-perfect agreement between the actual expected ranking and the ranking produced by the subjects (Kendalls W = .97, p = .00). When subjects placed individual faces along a 1-m-long red wedge indicating the amount of pain represented by each face, statistically significant separation of the faces in the anticipated equal interval position was demonstrated by the lack of overlap of the 95% confidence intervals when all faces were viewed and positioned simultaneously. However, when subjects placed faces independent of others, the expected placement fell outside the 95% confidence limit for three of the five faces placed. In addition, the actual intervals between the five faces placed by subjects demonstrated substantial variances from the 167 mm expected in several instances. Rating a vividly remembered painful experience about the degree of pain perceived using the FPS initially and again 2 weeks later, the FPS demonstrated strong reproducibility over time with a Spearman rho correlation coefficient of .94 (p = .01). CONCLUSION These results provide preliminary support for the construct validity, strong ordinal properties, and strong test-retest reliability of the FPS with a sample of elderly individuals. The equality of intervals in the FPS has not been fully supported in the older adult, but given the complexity of the task used, the results should not be considered to be refuted. Further evaluation of the FPS with experimental and clinical pain conditions and comparison with other standard pain assessment instruments in the elderly population are warranted.

An epidemiologic analysis of pain in the elderly: the Iowa 65+ Rural Health Study

Despite acknowledgment that pain is likely to be a major problem for many older adults, it is difficult to accurately estimate the frequency of pain problems for this population because of the lack of systematic epidemiological investigation. This article reports a study of the prevalence and nature of pain in a population of 3,097 rural persons 65 years and older (the Iowa 65+ Rural Health Study). Of the subjects, 86% reported pain of some type in the year prior to the interview, and 59% reported multiple pain complaints. Joint pain was the most prevalent site of pain reported, followed by night leg pain, back pain, and leg pain while walking. As reported severity of pain increased, there was a corresponding increase in impact on daily activities.

Complexities of pain assessment in the elderly. Clinical considerations.

Establishing a trusting, caring relationship that acknowledges suffering and demonstrates caring is an important first step toward pain management in the elderly. The content of assessing pain in the elderly is similar to that for younger individuals. However, the source of information, manner and timing of assessment, method, and amount of data collected must be adapted to meet the special needs of the elderly individual. Strategies for assessing pain in the elderly must be adapted for those with sensory, cognitive, or psychomotor deficits. Many tools currently available for assessing pain may be effective when adapted to accommodate these changes. Interpreting reports of pain and pain-related behaviors in the elderly is complicated by myths and misunderstandings commonly held by the elderly and many health professionals. Careful consideration must be given to the meaning of pain or lack of pain report, as well as personal biases, which may influence the interpretation of pain behaviors.

Chronic pain and depression.

Because of the increased incidence of chronic disease and other health problems associated with aging, chronic pain is a common companion for the elderly. Pain is of great clinical importance, often associated with disability, loss of independence, and reduced quality of life. A fact that is of interest to psychiatric nurses is that many elderly with complaints of chronic pain also exhibit signs and symptoms of depressive disorders. Treating chronic pain conditions is complex and difficult, and health-care professionals are increasingly recognizing that psychological factors are often involved in the development and continuation of chronic pain problems. Depression is one of these influential variables. Increased understanding of the role of depression in the etiology and maintenance of chronic pain can improve assessment and intervention for the elderly with chronic pain complaints.

Depression and the Experience of Chronic Back Pain - a Study of Related Variables and Age-Differences

Objective:To document the prevalence of depression and examine the relationship between depression and selected pain-related variables associated with chronic back pain among elderly and nonelderly samples. Design:Survey with mailed questionnaire. Setting:Patients seeking treatment at a spine diagnostic and treatment center. Patients:Consecutive sample of elderly subjects (n=69).Nonelderly subjects (n=59) were randomly selected to achieve a sample size comparable to the elderly. Evaluation of depressed mood was determined by Beck Depression Inventory. Main Outcome Measures:Multidimensional Pain Inventory, Pain Disability Index, Pain Duration, Work-Related Disability, Medication Use, and Pain Severity. Results:A high prevalence of dysphoria was found in both age group. No significant differences were found between age and depressed mood. The only significant association between depressed mood and age occurred with pain duration, with the elderly experiencing fewer total hours per day in pain. Combining age groups, multivariate analysis of variance revealed that dysphoric chronic pain patients reported more antidepressant use, greater pain intensity, greater interference due to pain, and less life control than the nondepressed patients. Interference in activities demonstrated the strongest relationship with depressed mood in both age groups. Conclusion:There is a high prevalence of dysphoria in both the elderly and nonelderly with chronic back pain. The relationships between pain-related constructs and depressed mood in chronic back pain patients are similar in the elderly and nonelderly. The impact of the pain experience on the individuals activities, functioning, and feelings of life control should be considered in theoretical and clinical explanations of the association between pain and depression.

Acute confusion assessment instruments: clinical versus research usability.

Acute confusion (AC), also referred to as delirium (AC/delirium), is a common problem seen by health professionals who work in a variety of care settings. This is an evaluative report on the clinical usability of instruments to assess AC/delirium as a part of nursing practice. Specifically, five instruments [the Confusion Assessment Method (CAM), Delirium Rating Scale (DRS), Delirium Symptom Inventory (DSI), Mini-Mental State Examination (MMSE), and Neelon/Champagne (NEECHAM) Confusion Scale] are discussed. The work demonstrates how the cooperation of nurses in practice, education, and research can improve both patient and staff outcomes.

Cognitive-Behavioral Techniques to Reduce Pain - a Validation-Study

The purpose of this study was to identify and validate specific activities considered important in the implementation of three non-pharmacologic pain management interventions--relaxation, distraction and guided imagery. Using a two-round Delphi survey, nurses selected for their expertise in pain management were asked to validate definitions and activities considered important in the implementation of each of these strategies. Data were analyzed using a modification of Fehrings diagnostic content validity method. From this process, a list of activities for each intervention evolved that has implications for nursing research, practice and education.

IATROGENESIS IN THE ELDERLY: Factors of Immobility

Mobility of elderly patients is a consequence of the interaction between factors including biological health, sensory-perceptual capacity, motor skills, cognitive capacity, and ego-strength; and environmental resources including physical and architectural features, medical regimens, institutional policies, resident and staff characteristics, and social support availability. Impaired mobility, whether self- or other-imposed, places the elderly at risk for a multitude of negative physiological and psychological consequences that can affect health, well-being, and quality of life. Understanding the basic mechanisms underlying the physiological and psychological consequences of immobility, the relative time-frame in which they can develop, and the concomitant changes associated with aging provides the basis for interventions aimed at preventing or minimizing them. A multitude of factors that influence the elderlys state of mobility are within nursings realm of practice. Although elderly patients may present a special challenge, the negative consequences of immobility can be avoided, to a significant extent, with astute and vigilant nursing management.