Skip to main content
main-content

Tipp

Weitere Artikel dieser Ausgabe durch Wischen aufrufen

Erschienen in: Zeitschrift für Gerontologie und Geriatrie 3/2013

01.04.2013 | Beiträge zum Themenschwerpunkt

Self- and proxy report for the assessment of pain in patients with and without cognitive impairment

Experiences gained in a geriatric hospital

verfasst von: Dr. A. Lukas, T. Niederecker, I. Günther, B. Mayer, T. Nikolaus

Erschienen in: Zeitschrift für Gerontologie und Geriatrie | Ausgabe 3/2013

Einloggen, um Zugang zu erhalten

Abstract

Background

Pain assessment is a complex procedure in patients with different degrees of cognitive impairment. The challenge is to determine whether self-reporting tools are adequate and to identify the cases in which proxy ratings are necessary.

Patients and methods

As part of an open, prospective observational study, 178 patients underwent a comprehensive pain assessment consisting of the Numeric Rating Scale (NRS), the Verbal Rating Scale with four and five items (VRS4 and VRS5) and the Pain Assessment in Advanced Dementia Scale (PAINAD).

Results

Even without prior knowledge of a patient’s cognitive impairment, this toolkit can be used to reliably identify cases where self-rating is appropriate and where proxy rating becomes necessary. Inter-rater reliability: “good” agreement [Cohen’s κ = 74.2% (p < 0.001) (95%CI, 54.6–93.8%)], test–retest reliability: “moderate” agreement [κ = 55.3% (p < 0.001) (95%CI, 28.5–82.1%)]. Furthermore, movement resulted in a higher correlation between the selected assessments. Self-report assessments are appropriate up to a mini-mental state examination (MMSE) value greater than ten. In comparison to NRS, VRS4 and VRS5 remain more stable as the degree of cognitive impairment increases.

Conclusions

In the majority of the cases, our approach enables reliable appropriate pain assessment without the strict prerequisite of an upstream cognitive assessment.
Literatur
1.
Zurück zum Zitat Ags (2002) The management of persistent pain in older persons. J Am Geriatr Soc 50:205–224 CrossRef Ags (2002) The management of persistent pain in older persons. J Am Geriatr Soc 50:205–224 CrossRef
2.
Zurück zum Zitat Almeida OP, Almeida SA (1999) Short versions of the geriatric depression scale: a study of their validity for the diagnosis of a major depressive episode according to ICD-10 and DSM-IV. Int J Geriatr Psychiatry 14:858–865 PubMedCrossRef Almeida OP, Almeida SA (1999) Short versions of the geriatric depression scale: a study of their validity for the diagnosis of a major depressive episode according to ICD-10 and DSM-IV. Int J Geriatr Psychiatry 14:858–865 PubMedCrossRef
3.
Zurück zum Zitat Altman D (1991) Practical statistics for medical research. Chapman and Hall, London Altman D (1991) Practical statistics for medical research. Chapman and Hall, London
4.
Zurück zum Zitat Anonymous (2010) Auswirkungen auf Krankenhausbehandlungen und Pflegebedürftige im Bund und in den Ländern. Wiesbaden Anonymous (2010) Auswirkungen auf Krankenhausbehandlungen und Pflegebedürftige im Bund und in den Ländern. Wiesbaden
5.
Zurück zum Zitat Basler HD, Bloem R, Casser HR et al (2001) Ein struturiertes Schmerzinterview für geriatrische Patienten. Schmerz 15:164–171 PubMedCrossRef Basler HD, Bloem R, Casser HR et al (2001) Ein struturiertes Schmerzinterview für geriatrische Patienten. Schmerz 15:164–171 PubMedCrossRef
6.
Zurück zum Zitat Basler HD, Hueger D, Kunz R et al (2006) Assessment of pain in advanced dementia. Construct validity of the German PAINAD. Schmerz 20:519–526 PubMedCrossRef Basler HD, Hueger D, Kunz R et al (2006) Assessment of pain in advanced dementia. Construct validity of the German PAINAD. Schmerz 20:519–526 PubMedCrossRef
7.
Zurück zum Zitat Closs S, Barr B, Briggs M et al (2004) A comparison of five pain assessment scales for nursing home residents with varying degrees of cognitive impairment. J Pain Symptom Manage 27:196–205 PubMedCrossRef Closs S, Barr B, Briggs M et al (2004) A comparison of five pain assessment scales for nursing home residents with varying degrees of cognitive impairment. J Pain Symptom Manage 27:196–205 PubMedCrossRef
8.
Zurück zum Zitat Feldt KS (2000) The checklist of nonverbal pain indicators (CNPI). Pain Manag Nurs 1:13–21 PubMedCrossRef Feldt KS (2000) The checklist of nonverbal pain indicators (CNPI). Pain Manag Nurs 1:13–21 PubMedCrossRef
9.
Zurück zum Zitat Folstein MF, Folstein SE, Mchugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198 PubMedCrossRef Folstein MF, Folstein SE, Mchugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198 PubMedCrossRef
10.
Zurück zum Zitat Gibson S (2006) Older People’s Pain. In: Pain clinical updates, IASP Press, Seattle, p 1–4 Gibson S (2006) Older People’s Pain. In: Pain clinical updates, IASP Press, Seattle, p 1–4
11.
Zurück zum Zitat Grace J, Amick MM (2005) Cognitive screening of older adults. Med Health R I 88:8–11 PubMed Grace J, Amick MM (2005) Cognitive screening of older adults. Med Health R I 88:8–11 PubMed
12.
Zurück zum Zitat Groll DL, To T, Bombardier C et al (2005) The development of a comorbidity index with physical function as the outcome. J Clin Epidemiol 58:595–602 PubMedCrossRef Groll DL, To T, Bombardier C et al (2005) The development of a comorbidity index with physical function as the outcome. J Clin Epidemiol 58:595–602 PubMedCrossRef
13.
Zurück zum Zitat Hadjistavropoulos TP, Herr KP, Turk DCP et al (2007) An interdisciplinary expert consensus statement on assessment of pain in older persons. Clin J Pain 23(Suppl):1–43 CrossRef Hadjistavropoulos TP, Herr KP, Turk DCP et al (2007) An interdisciplinary expert consensus statement on assessment of pain in older persons. Clin J Pain 23(Suppl):1–43 CrossRef
14.
Zurück zum Zitat Herr K (2011) Pain assessment strategies in older patients. J Pain 12:3–13 CrossRef Herr K (2011) Pain assessment strategies in older patients. J Pain 12:3–13 CrossRef
15.
Zurück zum Zitat Herr KA, Spratt K, Mobily PR et al (2004) Pain intensity assessment in older adults: use of experimental pain to compare psychometric properties and usability of selected pain scales with younger adults. Clin J Pain 20:207–219 PubMedCrossRef Herr KA, Spratt K, Mobily PR et al (2004) Pain intensity assessment in older adults: use of experimental pain to compare psychometric properties and usability of selected pain scales with younger adults. Clin J Pain 20:207–219 PubMedCrossRef
16.
Zurück zum Zitat Hjermstad MJ, Fayers PM, Haugen DF et al (2011) Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage 41:1073–1093 PubMedCrossRef Hjermstad MJ, Fayers PM, Haugen DF et al (2011) Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage 41:1073–1093 PubMedCrossRef
17.
Zurück zum Zitat Horgas AL, Elliott AF, Marsiske M (2009) Pain assessment in persons with dementia: relationship between self-report and behavioral observation. J Am Geriatr Soc 57:126–132 PubMedCrossRef Horgas AL, Elliott AF, Marsiske M (2009) Pain assessment in persons with dementia: relationship between self-report and behavioral observation. J Am Geriatr Soc 57:126–132 PubMedCrossRef
18.
Zurück zum Zitat Husebo BS, Strand LI, Moe-Nilssen R et al (2009) Pain behaviour and pain intensity in older persons with severe dementia: reliability of the MOBID Pain Scale by video uptake. Scand J Caring Sci 23:180–189 PubMedCrossRef Husebo BS, Strand LI, Moe-Nilssen R et al (2009) Pain behaviour and pain intensity in older persons with severe dementia: reliability of the MOBID Pain Scale by video uptake. Scand J Caring Sci 23:180–189 PubMedCrossRef
19.
Zurück zum Zitat Ivemeyer D, Zerfaß R (2005) Demenztests in der Praxis – Ein Wegweiser. Elsevier GmbH, München Ivemeyer D, Zerfaß R (2005) Demenztests in der Praxis – Ein Wegweiser. Elsevier GmbH, München
20.
Zurück zum Zitat Jensen MP, Karoly P, Braver S (1986) The measurement of clinical pain intensity: a comparison of six methods. Pain 27:117–126 PubMedCrossRef Jensen MP, Karoly P, Braver S (1986) The measurement of clinical pain intensity: a comparison of six methods. Pain 27:117–126 PubMedCrossRef
21.
Zurück zum Zitat Jones KR, Fink R, Hutt E et al (2005) Measuring pain intensity in nursing home residents. J Pain Symptom Manage 30:519–527 PubMedCrossRef Jones KR, Fink R, Hutt E et al (2005) Measuring pain intensity in nursing home residents. J Pain Symptom Manage 30:519–527 PubMedCrossRef
22.
Zurück zum Zitat Jones KR, Vojir CP, Hutt E et al (2007) Determining mild, moderate, and severe pain equivalency across pain-intensity tools in nursing home residents. J Rehabil Res Dev 44:305–314 PubMedCrossRef Jones KR, Vojir CP, Hutt E et al (2007) Determining mild, moderate, and severe pain equivalency across pain-intensity tools in nursing home residents. J Rehabil Res Dev 44:305–314 PubMedCrossRef
23.
Zurück zum Zitat Keefe FJ, Block AR (1982) Development of an observation method for assessing pain behavior in chronic low back pain patients. Behav Ther 13:363–375 CrossRef Keefe FJ, Block AR (1982) Development of an observation method for assessing pain behavior in chronic low back pain patients. Behav Ther 13:363–375 CrossRef
24.
Zurück zum Zitat Leong IY, Chong MS, Gibson SJ (2006) The use of a self-reported pain measure, a nurse-reported pain measure and the PAINAD in nursing home residents with moderate and severe dementia: a validation study. Age Ageing 35:252–256 PubMedCrossRef Leong IY, Chong MS, Gibson SJ (2006) The use of a self-reported pain measure, a nurse-reported pain measure and the PAINAD in nursing home residents with moderate and severe dementia: a validation study. Age Ageing 35:252–256 PubMedCrossRef
25.
Zurück zum Zitat Lukas A, Schuler M, Fischer TW et al (2012) Pain and dementia: a diagnostic challenge. Z Gerontol Geriatr 45:45–49 PubMedCrossRef Lukas A, Schuler M, Fischer TW et al (2012) Pain and dementia: a diagnostic challenge. Z Gerontol Geriatr 45:45–49 PubMedCrossRef
26.
Zurück zum Zitat Mahoney FI, Barthel D (1965) Functional evaluation: the Barthel Index. Md State Med J 14:56–61 Mahoney FI, Barthel D (1965) Functional evaluation: the Barthel Index. Md State Med J 14:56–61
27.
Zurück zum Zitat Mitchell AJ, Bird V, Rizzo M et al (2010) Which version of the geriatric depression scale is most useful in medical settings and nursing homes? Diagnostic validity meta-analysis. Am J Geriatr Psychiatry 18:1066–1077 PubMedCrossRef Mitchell AJ, Bird V, Rizzo M et al (2010) Which version of the geriatric depression scale is most useful in medical settings and nursing homes? Diagnostic validity meta-analysis. Am J Geriatr Psychiatry 18:1066–1077 PubMedCrossRef
28.
Zurück zum Zitat Morrison RS, Siu AL (2000) A comparison of pain and its treatment in advanced dementia and cognitively intact patients with hip fracture. J Pain Symptom Manage 19:240–248 PubMedCrossRef Morrison RS, Siu AL (2000) A comparison of pain and its treatment in advanced dementia and cognitively intact patients with hip fracture. J Pain Symptom Manage 19:240–248 PubMedCrossRef
29.
Zurück zum Zitat Pautex S, Herrmann F, Le Lous P et al (2005) Feasibility and reliability of four pain self-assessment scales and correlation with an observational rating scale in hospitalized elderly demented patients. J Gerontol A Biol Sci Med Sci 60:524–529 PubMedCrossRef Pautex S, Herrmann F, Le Lous P et al (2005) Feasibility and reliability of four pain self-assessment scales and correlation with an observational rating scale in hospitalized elderly demented patients. J Gerontol A Biol Sci Med Sci 60:524–529 PubMedCrossRef
30.
Zurück zum Zitat Pautex S, Michon A, Guedira M et al (2006) Pain in severe dementia: self-assessment or observational scales? J Am Geriatr Soc 54:1040–1045 PubMedCrossRef Pautex S, Michon A, Guedira M et al (2006) Pain in severe dementia: self-assessment or observational scales? J Am Geriatr Soc 54:1040–1045 PubMedCrossRef
31.
Zurück zum Zitat Pesonen A, Kauppila T, Tarkkila P et al (2009) Evaluation of easily applicable pain measurement tools for the assessment of pain in demented patients. Acta Anaesthesiol Scand 53:657–664 PubMedCrossRef Pesonen A, Kauppila T, Tarkkila P et al (2009) Evaluation of easily applicable pain measurement tools for the assessment of pain in demented patients. Acta Anaesthesiol Scand 53:657–664 PubMedCrossRef
32.
Zurück zum Zitat Pickering G, Jourdan D, Dubray C (2006) Acute versus chronic pain treatment in Alzheimer’s disease. Eur J Pain 10:379–384 PubMedCrossRef Pickering G, Jourdan D, Dubray C (2006) Acute versus chronic pain treatment in Alzheimer’s disease. Eur J Pain 10:379–384 PubMedCrossRef
33.
Zurück zum Zitat Reisberg B (1988) Functional assessment staging (FAST). Psychopharmacol Bull 24:653–659 PubMed Reisberg B (1988) Functional assessment staging (FAST). Psychopharmacol Bull 24:653–659 PubMed
34.
Zurück zum Zitat Robinson CL (2007) Relieving pain in the elderly. Health Prog 88:48–53, 70 PubMed Robinson CL (2007) Relieving pain in the elderly. Health Prog 88:48–53, 70 PubMed
35.
Zurück zum Zitat Rösler M, Frey U, Retz-Junginger P et al (2003) Diagnostik in der Demenz: Standardisierte Untersuchungsinstrumente im Überblick. Fortschr Neurol Psychiatr 71:187–198 PubMedCrossRef Rösler M, Frey U, Retz-Junginger P et al (2003) Diagnostik in der Demenz: Standardisierte Untersuchungsinstrumente im Überblick. Fortschr Neurol Psychiatr 71:187–198 PubMedCrossRef
36.
Zurück zum Zitat Schiavenato M, Craig KD (2010) Pain assessment as a social transaction: beyond the “gold standard”. Clin J Pain 26:667–676 PubMed Schiavenato M, Craig KD (2010) Pain assessment as a social transaction: beyond the “gold standard”. Clin J Pain 26:667–676 PubMed
37.
Zurück zum Zitat Schuler MS, Becker S, Kaspar R et al (2007) Psychometric properties of the German “Pain Assessment in Advanced Dementia Scale” (PAINAD-G) in nursing home residents. J Am Med Dir Assoc 8:388–395 PubMedCrossRef Schuler MS, Becker S, Kaspar R et al (2007) Psychometric properties of the German “Pain Assessment in Advanced Dementia Scale” (PAINAD-G) in nursing home residents. J Am Med Dir Assoc 8:388–395 PubMedCrossRef
38.
Zurück zum Zitat Sclan SG, Reisberg B (1992) Functional assessment staging (FAST) in Alzheimer’s disease: reliability, validity, and ordinality. Int Psychogeriatr 4(Suppl 1):55–69 PubMedCrossRef Sclan SG, Reisberg B (1992) Functional assessment staging (FAST) in Alzheimer’s disease: reliability, validity, and ordinality. Int Psychogeriatr 4(Suppl 1):55–69 PubMedCrossRef
39.
Zurück zum Zitat Seymour RA (1982) The use of pain scales in assessing the efficacy of analgesics in post-operative dental pain. Eur J Clin Pharmacol 23:441–444 PubMedCrossRef Seymour RA (1982) The use of pain scales in assessing the efficacy of analgesics in post-operative dental pain. Eur J Clin Pharmacol 23:441–444 PubMedCrossRef
40.
Zurück zum Zitat Shega JW, Hougham GW, Stocking CB et al (2004) Pain in community-dwelling persons with dementia: frequency, intensity, and congruence between patient and caregiver report. J Pain Symptom Manage 28:585–592 PubMedCrossRef Shega JW, Hougham GW, Stocking CB et al (2004) Pain in community-dwelling persons with dementia: frequency, intensity, and congruence between patient and caregiver report. J Pain Symptom Manage 28:585–592 PubMedCrossRef
41.
Zurück zum Zitat Tombaugh TN, Mcintyre NJ (1992) The mini-mental state examination: a comprehensive review. J Am Geriatr Soc 40:922–935 PubMed Tombaugh TN, Mcintyre NJ (1992) The mini-mental state examination: a comprehensive review. J Am Geriatr Soc 40:922–935 PubMed
42.
Zurück zum Zitat Tosato M, Lukas A, Van Der Roest HG et al (2012) Association of pain with behavioral and psychiatric symptoms among nursing home residents with cognitive impairment: results from the SHELTER study. Pain 153:305–310 PubMedCrossRef Tosato M, Lukas A, Van Der Roest HG et al (2012) Association of pain with behavioral and psychiatric symptoms among nursing home residents with cognitive impairment: results from the SHELTER study. Pain 153:305–310 PubMedCrossRef
43.
Zurück zum Zitat Warden V, Hurley AC, Volicer L (2003) Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. J Am Med Dir Assoc 4:9–15 PubMedCrossRef Warden V, Hurley AC, Volicer L (2003) Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. J Am Med Dir Assoc 4:9–15 PubMedCrossRef
44.
Zurück zum Zitat Weyerer S (2005) Gesundheitsberichterstattung des Bundes – Bd 28. Altersdemenz. Robert-Koch-Institut in Zusammenarbeit mit dem Statistisches Bundesamt Weyerer S (2005) Gesundheitsberichterstattung des Bundes – Bd 28. Altersdemenz. Robert-Koch-Institut in Zusammenarbeit mit dem Statistisches Bundesamt
45.
Zurück zum Zitat Zanocchi M, Maero B, Nicola E et al (2008) Chronic pain in a sample of nursing home residents: prevalence, characteristics, influence on quality of life (QoL). Arch Gerontol Geriatr 47:121–128 PubMedCrossRef Zanocchi M, Maero B, Nicola E et al (2008) Chronic pain in a sample of nursing home residents: prevalence, characteristics, influence on quality of life (QoL). Arch Gerontol Geriatr 47:121–128 PubMedCrossRef
46.
Zurück zum Zitat Zwakhalen SM, Hamers JP, Berger MP (2006) The psychometric quality and clinical usefulness of three pain assessment tools for elderly people with dementia. Pain 126:210–220 PubMedCrossRef Zwakhalen SM, Hamers JP, Berger MP (2006) The psychometric quality and clinical usefulness of three pain assessment tools for elderly people with dementia. Pain 126:210–220 PubMedCrossRef
Metadaten
Titel
Self- and proxy report for the assessment of pain in patients with and without cognitive impairment
Experiences gained in a geriatric hospital
verfasst von
Dr. A. Lukas
T. Niederecker
I. Günther
B. Mayer
T. Nikolaus
Publikationsdatum
01.04.2013
Verlag
Springer-Verlag
Erschienen in
Zeitschrift für Gerontologie und Geriatrie / Ausgabe 3/2013
Print ISSN: 0948-6704
Elektronische ISSN: 1435-1269
DOI
https://doi.org/10.1007/s00391-013-0475-y