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Careful use can guide decision making and improve care.
ABSTRACT
Pain assessment in older adults with dementia recently has received considerable attention from both researchers and clinicians as evidenced by a surge of published behavioral observation tools for pain assessment in this vulnerable population. These behavioral observation methods offer a promising strategy to improve pain assessment in older adults who are not able to communicate their pain verbally. However, some concerns exist related to the interpretation and clinical utility of these methods for decision making related to pain management interventions. This article provides an overview of the general state of knowledge on the use of behavioral observation methods in older adults and discusses the use of such methods to guide decision making in clinical settings.
Pain assessment is a critical concern in older adults with dementia because research has consistently shown pain is underestimated and undertreated in this vulnerable population (Feldt, Ryden, & Miles, 1998; Horgas & Tsai, 1998; Kaasalainen et al., 1998; Sengstaken & King, 1993). Recently, efforts have been directed at developing innovative ways to assess pain using methods that do not rely on older adults' verbal ability to communicate their pain. Among these efforts are behavioral observation methods, which offer a promising future for the pursuit of improved pain management practices in older adults with dementia in both acute and long-term care settings.
The purpose of this article is to provide a general overview of the current state of knowledge on using behavioral observation methods to assess pain in an older adult population and to offer some points for discussion related to the challenges of using behavioral observation methods in clinical practice. In particular, practical concerns related to the interpretation of the scoring and clinical utility of behavioral observation methods will be addressed.
DEFINING PAIN
Pain assessment is an arduous task because of pain's elusive nature. Definitions of pain evolve as current knowledge of pain mechanisms develops. The definition of pain that has guided the majority of research to date was developed by the International Association for the Study of Pain (1979) and describes pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage" (p. 250). However, this...