Pain assessment in persons with dementia: relationship between self-report and behavioral observation

To investigate the relationship between self-report and behavioral indicators of pain in cognitively impaired and intact older adults.

Quasi-experimental, correlational study of older adults.

Data were collected from residents of nursing homes, assisted living, and retirement apartments in north-central Florida.

One hundred twenty-six adults, mean age 83; 64 cognitively intact, 62 cognitively impaired.

Pain interviews (pain presence, intensity, locations, duration), pain behavior measure, Mini-Mental State Examination, analgesic medications, and demographic characteristics. Participants completed an activity-based protocol to induce pain.

Eighty-six percent self-reported regular pain. Controlling for analgesics, cognitively impaired participants reported less pain than cognitively intact participants after movement but not at rest. Behavioral pain indicators did not differ between cognitively intact and impaired participants. Total number of pain behaviors was significantly related to self-reported pain intensity (beta=0.40, P=.000) in cognitively intact elderly people.

Cognitively impaired elderly people self-report less pain than cognitively intact elderly people, independent of analgesics, but only when assessed after movement. Behavioral pain indicators do not differ between the groups. The relationship between self-report and pain behaviors supports the validity of behavioral assessments in this population. These findings support the use of multidimensional pain assessment in persons with dementia.