Background/Aims: Pain is common in aged care residents with dementia; yet it often goes undetected. A novel tool, the electronic Pain Assessment Tool (ePAT), was developed to address this challenging problem. We investigated the psychometric properties of the ePAT. Methods: In a 10-week prospective observational study, the ePAT was evaluated by comparison against the Abbey Pain Scale (APS). Pain assessments were blindly co-performed by the ePAT rater against the nursing staff of two residential aged care facilities. The residents were assessed twice by each rater: at rest and following movement. Results: The study involved 34 residents aged 85.5 ± 6.3 years, predominantly with severe dementia (Psychogeriatric Assessment Scale – Cognitive Impairment score = 19.7 ± 2.5). Four hundred paired assessments (n = 204 during rest; n = 196 following movement) were performed. Concurrent validity (r = 0.911) and all reliability measures (κw = 0.857; intraclass correlation coefficient = 0.904; α = 0.950) were excellent, while discriminant validity and predictive validity were good. Conclusion: The ePAT is a suitable tool for the assessment of pain in this vulnerable population.

Keywords:
Psychometric properties, Validity, Reliability, Electronic Pain Assessment Tool, Pain, Dementia, Automated facial recognition, Facial action units, Automated facial analysis, Observational pain scales
1.
Horgas AL, Elliott AF, Marsiske M: Pain assessment in persons with dementia: relationship between self-report and behavioral observation. J Am Geriatr Soc 2009; 57: 126–132.
2.
Malara A, De Biase GA, Bettarini F, Ceravolo F, Di Cello S, Garo M, Praino F, Settembrini V, Sgrò G, Spadea F, Rispoli V: Pain assessment in elderly with behavioral and psychological symptoms of dementia. J Alzheimers Dis 2016; 50: 1217–1225.
3.
Neville C, Ostini R: A psychometric evaluation of three pain rating scales for people with moderate to severe dementia. Pain Manag Nurs 2014; 15: 798–806.
4.
Lukas A, Barber JB, Johnson P, Gibson SJ: Observer-rated pain assessment instruments improve both the detection of pain and the evaluation of pain intensity in people with dementia. Eur J Pain 2013; 17: 1558–1568.
5.
Tse MM, Pun SP, Benzie IF: Pain relief strategies used by older people with chronic pain: an exploratory survey for planning patient-centred intervention. J Clin Nurs 2005; 14: 315–320.
6.
van Kooten J, Binnekade TT, van der Wouden JC, Stek ML, Scherder EJ, Husebø BS, Smalbrugge M, Hertogh CM: A review of pain prevalence in Alzheimer’s, vascular, frontotemporal and Lewy body dementias. Dement Geriatr Cogn Disord 2016; 41: 220–232.
7.
Australian Institute of Health and Welfare: Residential aged care in Australia 2010–2011: a statistical overview. Cat No AGE 68. Canberra, Australian Institute of Health and Welfare, 2012.
8.
Hoffmann F, Kaduszkiewicz H, Glaeske G, van den Bussche H, Koller D: Prevalence of dementia in nursing home and community-dwelling older adults in Germany. Aging Clin Exp Res 2014; 26: 555–559.
9.
Prince M, Knapp M, Guerchet M, McCrone P, Prina M, Comas-Herrera A, Wittenberg R, Adelaja B, Hu B, King D, Rehill A, Salimkumar D: Dementia UK: Second Edition – Overview. London, Alzheimer’s Society, 2014.
10.
Matthews FE, Arthur A, Barnes LE, Bond J, Jagger C, Robinson L, Brayne C; Medical Research Council Cognitive Function and Ageing Collaboration: A two-decade comparison of prevalence of dementia in individuals aged 65 years and older from three geographical areas of England: results of the Cognitive Function and Ageing Study I and II. Lancet 2013; 382: 1405–1412.
11.
Centers for Medicare & Medicaid Services: Nursing Home Data Compendium 2015 Edition. Woodlawn, Centers for Medicare & Medicaid Services, 2015, p 185.
12.
Monroe TB, Parish A, Mion LC: Decision factors nurses use to assess pain in nursing home residents with dementia. Arch Psychiatr Nurs 2015; 29: 316–320.
13.
Lautenbacher S, Niewelt BG, Kunz M: Decoding pain from the facial display of patients with dementia: a comparison of professional and nonprofessional observers. Pain Med 2013; 14: 469–477.
14.
Apinis C, Tousignant M, Arcand M, Tousignant-Laflamme Y: Can adding a standardized observational tool to interdisciplinary evaluation enhance the detection of pain in older adults with cognitive impairments? Pain Med 2014; 15: 32–41.
15.
Fisher SE, Burgio LD, Thorn BE, Allen-Burge R, Gerstle J, Roth DL, Allen SJ: Pain assessment and management in cognitively impaired nursing home residents: association of certified nursing assistant pain report, Minimum Data Set pain report, and analgesic medication use. J Am Geriatr Soc 2002; 50: 152–156.
16.
Pautex S, Michon A, Guedira M, Emond H, Le Lous P, Samaras D, Michel JP, Herrmann F, Giannakopoulos P, Gold G: Pain in severe dementia: self-assessment or observational scales? J Am Geriatr Soc 2006; 54: 1040–1045.
17.
Nygaard HA, Jarland M: Are nursing home patients with dementia diagnosis at increased risk for inadequate pain treatment? Int J Geriatr Psychiatry 2005; 20: 730–737.
18.
Gallini A, Andrieu S, Donohue JM, Oumouhou N, Lapeyre-Mestre M, Gardette V: Trends in use of antipsychotics in elderly patients with dementia: impact of national safety warnings. Eur Neuropsychopharmacol 2014; 24: 95–104.
19.
Nakanishi M, Nakashima T, Shindo Y, Niimura J, Nishida A: Japanese care location and medical procedures for people with dementia in the last month of life. J Alzheimers Dis 2016; 51: 747–755.
20.
Jensen-Dahm C, Palm H, Gasse C, Dahl JB, Waldemar G: Postoperative treatment of pain after hip fracture in elderly patients with dementia. Dement Geriatr Cogn Disord 2016; 41: 181–191.
21.
van Kooten J, van der Wouden JC, Sikkes SAM, Smalbrugge M, Hertogh C, Stek ML: Pain, neuropsychiatric symptoms, and quality of life of nursing home residents with advanced dementia in the Netherlands: a cross-sectional study. Alzheimer Dis Assoc Disord 2017; 31: 315–321.
22.
Jakobsson ULF, Hallberg IR: Pain and quality of life among older people with rheumatoid arthritis and/or osteoarthritis: a literature review. J Clin Nurs 2002; 11: 430–443.
23.
Ibrahim JE, Murphy BJ, Bugeja L, Ranson D: Nature and extent of external-cause deaths of nursing home residents in Victoria, Australia. J Am Geriatr Soc 2015; 63: 954–962.
24.
Rostad HM, Puts MTE, Cvancarova Småstuen M, Grov EK, Utne I, Halvorsrud L: Associations between pain and quality of life in severe dementia: a Norwegian cross-sectional study. Dement Geriatr Cogn Dis Extra 2017; 7: 109–121.
25.
Klapwijk MS, Caljouw MA, Pieper MJ, van der Steen JT, Achterberg WP: Characteristics associated with quality of life in long-term care residents with dementia: a cross-sectional study. Dement Geriatr Cogn Disord 2016; 42: 186–197.
26.
Corbett A, Husebø BS, Malcangio M, Staniland A, Cohen-Mansfield J, Aarsland D, Ballard C: Assessment and treatment of pain in people with dementia. Nat Rev Neurol 2012; 8: 264–274.
27.
Lichtner V, Dowding D, Esterhuizen P, Closs SJ, Long AF, Corbett A, Briggs M: Pain assessment for people with dementia: a systematic review of systematic reviews of pain assessment tools. BMC Geriatr 2014; 14: 138.
28.
Corbett A, Husebø BS, Achterberg WP, Aarsland D, Erdal A, Flo E: The importance of pain management in older people with dementia. Br Med Bull 2014; 111: 139–148.
29.
Hadjistavropoulos T, Herr K, Prkachin KM, Craig KD, Gibson SJ, Lukas A, Smith JH: Pain assessment in elderly adults with dementia. Lancet Neurol 2014; 13: 1216–1227.
30.
Prkachin KM: Assessing pain by facial expression: facial expression as nexus. Pain Res Manag 2009; 14: 53–58.
31.
Ekman P, Friesen WV, Hager JC (eds): Facial Action Coding System. Salt Lake City, Research Nexus, Network Research Information, 2002.
32.
Lints-Martindale AC, Hadjistavropoulos T, Barber B, Gibson SJ: A psychophysical investigation of the facial action coding system as an index of pain variability among older adults with and without Alzheimer’s disease. Pain Med 2007; 8: 678–689.
33.
Atee M, Hoti K, Parsons R, Hughes JD: Pain assessment in dementia: evaluation of a point-of-care technological solution. J Alzheimers Dis 2017; 60: 137–150.
34.
Australian Pain Society: Pain in residential aged care facilities: management strategies. North Sydney, Australian Pain Society, 2005.
35.
Takai Y, Yamamoto-Mitani N, Chiba Y, Nishikawa Y, Hayashi K, Sugai Y: Abbey Pain Scale: development and validation of the Japanese version. Geriatr Gerontol Int 2010; 10: 145–153.
36.
Gregersen M, Melin AS, Nygaard IS, Nielsen CH, Beedholm-Ebsen M: Reliability of the Danish Abbey Pain Scale in severely demented and non-communicative older patients. Int J Palliat Nurs 2016; 22: 482–488.
37.
Abbey J, Piller N, De Bellis A, Esterman A, Parker D, Giles L, Lowcay B: The Abbey Pain Scale: a 1-minute numerical indicator for people with end-stage dementia. Int J Palliat Nurs 2004; 10: 6–13.
38.
Jorm AF, Mackinnon AJ, Henderson AS, Scott R, Christensen H, Korten AE, Cullen JS, Mulligan R: The Psychogeriatric Assessment Scales: a multi-dimensional alternative to categorical diagnoses of dementia and depression in the elderly. Psychol Med 1995; 25: 447–460.
39.
Mackinnon A, Mulligan R: The Psychogeriatric Assessment Scales (PAS): psychometric properties in French and German speaking populations. Int J Geriatr Psychiatry 2001; 16: 892–899.
40.
Jorm AF, Mackinnon AJ, Christensen H, Henderson AS, Jacomb PA, Korten AE: The Psychogeriatric Assessment Scales (PAS): further data on psychometric properties and validity from a longitudinal study of the elderly. Int J Geriatr Psychiatry 1997; 12: 93–100.
41.
Australian Government, Department of Health: Aged Care Funding Instrument (ACFI) Assessment Pack. Canberra, Department of Health, Commonwealth of Australia, 2016.
42.
Portney L, Mary P: Foundations of clinical research: applications to practice. Upper Saddle River, Pearson/Prentice Hall, 2009.
43.
Bland JM, Altman DG: Cronbach’s alpha. BMJ 1997; 314: 572.
44.
Viera AJ, Garrett JM: Understanding interobserver agreement: the kappa statistic. Fam Med 2005; 37: 360–363.
45.
Herr K, Bjoro K, Decker S: Tools for assessment of pain in nonverbal older adults with dementia: a state-of-the-science review. J Pain Symptom Manage 2006; 31: 170–192.
46.
Qi S, Diane J, Kay D: The psychometric properties, feasibility and utility of behavioural-observation methods in pain assessment of cognitively impaired elderly people in acute and long-term care: a systematic review. JBI Libr Syst Rev 2012; 10: 977–1085.
47.
Zwakhalen SM, Hamers JP, Abu-Saad HH, Berger MP: Pain in elderly people with severe dementia: a systematic review of behavioural pain assessment tools. BMC Geriatr 2006; 6: 3.
48.
Hadjistavropoulos T, LaChapelle DL, MacLeod FK, Snider B, Craig KD: Measuring movement-exacerbated pain in cognitively impaired frail elders. Clin J Pain 2000; 16: 54–63.
49.
Feldt KS: The Checklist of Nonverbal Pain Indicators (CNPI). Pain Manag Nurs 2000; 1: 13–21.
50.
Husebø BS, Strand LI, Moe-Nilssen R, Husebø SB, Ljunggren AE: Pain behaviour and pain intensity in older persons with severe dementia: reliability of the MOBID Pain Scale by video uptake. Scand J Caring Sci 2009; 23: 180–189.
51.
Erdal A, Flo E, Selbaek G, Aarsland D, Bergh S, Slettebø DD, Husebø BS: Associations between pain and depression in nursing home patients at different stages of dementia. J Affect Disord 2017; 218: 8–14.
52.
van Dalen-Kok AH, Pieper MJC, de Waal MWM, Lukas A, Husebø BS, Achterberg WP: Association between pain, neuropsychiatric symptoms, and physical function in dementia: a systematic review and meta-analysis. BMC Geriatr 2015; 15: 49.
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