Australas Emerg Care 2018 Nov 27;21(4):131-136. Epub 2018 Sep 27.
Faculty of Health University of Technology Sydney, Ultimo, NSW 2007, Australia; Research and Practice Development Unit, Level 7, Kolling Building, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia.
Background: Pain assessment is challenging in older people with cognitive impairment who present to the emergency department and may result in suboptimal management. Therefore, the usefulness of the Pain Assessment in Advanced Dementia (PAINAD) tool for older people with cognitive impairment presenting with a painful injury was evaluated.
Methods: In this multi-centre observational sub-study, older people (≥65 years) suspected of a long bone fracture were screened for cognitive impairment using the Six Item Screening (SIS) tool. Patients with SIS≤4 were assessed using the PAINAD. Descriptive and correlation statistical analyses were performed. Cronbach's alpha was used to estimate the reliability of the PAINAD.
Results: This predominantly female (63%) sample had a mean age of 85.5±7.5 years and a moderately urgent Australian Triage code (mode: 3). Median pain intensity was low (numerical reporting scale: 5.5 [3.0-8.0]). Median PAINAD score was 'mild' (1.0 [0.0-3.2]) with wide variability (range: 0-9). The PAINAD demonstrated good reliability (Cronbach's α=0.80). Most PAINAD items appeared worthy of retention.
Conclusions: The PAINAD has potential as an effective pain assessment tool for older people with cognitive impairment in emergency departments. Strategies such as partnering with carers and family to collaboratively assess pain require further investigation in this setting.