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Measuring and Quantifying Outcomes
Published in Amy J. Litterini, Christopher M. Wilson, Physical Activity and Rehabilitation in Life-threatening Illness, 2021
Amy J. Litterini, Christopher M. Wilson
For individuals with a diagnosis of mild-to-moderate cognitive impairment and/or dementia, a pain distress intensity scale using a thermometer, which visually represents pain intensity from a low-level (cool color blue) to a high level (bright red), may be appropriate for individuals able to self-report pain through imagery.11 For individuals with advanced dementia, observational pain assessment tools, such as the Pain Assessment in Advanced Dementia scale (PAINAD), are necessary for clinicians to interpret a patient’s nonverbal behaviors (e.g. breathing, negative vocalizations, facial expressions, body language, and consolability).12
Palliative Care and End-of-Life Issues
Published in K. Rao Poduri, Geriatric Rehabilitation, 2017
Rashmi Khadilkar, Hilary Yehling, Quill Timothy E.
Symptom assessment—The assessment of symptoms such as pain, dyspnea, nausea, and anxiety can be difficult in some older adults. Some people are reluctant to reveal discomfort. They may have been trained from a young age to remain stoic. They may wish to minimize their own concerns to not burden their families and caregivers. They may fear that their independence will be curtailed if they admit to any weakness. Those with moderate dementia may not recognize their discomfort or understand what it means. Other patients, such as those with advanced dementia, are unable to clearly express their needs. For example, they may moan or become agitated with any type of discomfort, whether it is physical or emotional. Well-validated tools, such as the Pain Assessment in Advanced Dementia (PAINAD),13 can help with the assessment of pain and can guide the appropriate selection and titration of treatment modalities; palliative care specialists and geriatricians may also be good resources.
Palliative Care Pain Management
Published in Gary W. Jay, Practical Guide to Chronic Pain Syndromes, 2016
As the end of life nears and cognition decreases, it becomes increasingly important to utilize behavioral tools because it becomes difficult to obtain information or utilize the more widely used pain intensity scales. Behavioral tools such as the Pain Assessment in Advanced Dementia (PAINAID) rely on the use of behaviors, vocalization, breathing patterns, facial patterns, and consolability to assess pain (35). Validated tools are also available to assess pain for those in the intensive care unit, although their use is primarily limited to research settings (36, 37).
The dignity in advanced dementia (diadem) study: Developing an integrated geriatric palliative homecare program
Published in Progress in Palliative Care, 2018
Allyn YM Hum, Huei Yaw Wu, Noorhazlina Binte Ali, Ian YO Leong, Jing Jih Chin, Angel OK Lee, Ri Yin Tay, Mervyn YH Koh
In the patient bundle, the Pain Assessment in Advanced Dementia Scale (PAINAD) was chosen over the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC) and Discomfort Scale for Dementia of the Alzheimer’s Type (DS-DAT). The PACSLAC and DS-DAT are comprehensive tools more commonly used in the research setting by trained evaluators.15,16 The PAINAD is an accessible, 5-item observational tool which is simple to administer, monitoring for signs of pain at rest and during movement.17 Caregivers are taught to observe for the identified surrogate measures of discomfort in order to be able to respond with interventions which may provide relief. Outcome of interventions is assessed using change in PAINAD scores.
Evidence of altered pressure pain thresholds in persons with disorders of consciousness as measured by the Nociception Coma Scale–Italian version
Published in Neuropsychological Rehabilitation, 2018
Davide Sattin, Caroline Schnakers, Marco Pagani, Francesca Arenare, Guya Devalle, Fabrizio Giunco, GianBattista Guizzetti, Maurizio Lanfranchi, Ambra M. Giovannetti, Venusia Covelli, Anna Bersano, Anna Nigri, Ludovico Minati, Davide Rossi Sebastiano, Eugenio Parati, MariaGrazia Bruzzone, Silvana Franceschetti, Matilde Leonardi
The Pain Assessment in Advanced Dementia (PAINAD; Warden, Hurley, & Volicer, 2003) is an observational pain scale that shows good psychometric properties. It relies on five types of behaviour as potential indicators of pain: breathing (independent of vocalisation), negative-valenced vocalisation, facial expression, body language, and consolability. Each indicator is rated from 0 to 2, for a maximum total score of 10. It also does not rely on extensive familiarity with the clinical situation of the patient and is much faster to administer. A cutoff score of 2 (or more) for pain was used in the original 10-point scale version of the tool because this scale is not directly developed for acute experimental pain assessment.
Changes in clinical manifestation of fibromyalgia syndromes after Alzheimer’s disease diagnosis
Published in Baylor University Medical Center Proceedings, 2021
For each patient, pain was assessed using the Pain Assessment in Advanced Dementia,8 the widespread pain index validated for FMS,9 and cognition was quantified using the Six-Item Cognitive Impairment Test,10 with nursing home care staff recording mobility assessments on a quarterly basis in line with nursing home policy. Table 2 summarizes changes in these domains over time.