The State-of-“Cultural Validity” of Self-Report Pain Assessment Tools in Diverse Older Adults: Table 1

This article describes the steps of a pilot dissemination study toward adopting a pain assessment tool for older homebound adults with dementia. The chosen practice site had not previously used adequate pain assessment tools for older adults with dementia. After the selection process by a pain assessment tool committee, providers (N = 20) were asked to choose between three tools: pain assessment in advanced dementia (PAINAD), the Abbey Pain Scale, and DOLOPLUS-2/ DOLOSHORT. Providers voted to use the PAINAD (54%) for the following 2 weeks. A preintervention audit showed that without the use of a pain assessment tool, 97.7% of the charts did not have any documentation of a pain diagnosis nor an intervention. Postintervention using PAINAD, 91.3% of the charts had both (χ2[1] = 18.645, p < .001). The feedback obtained from providers (n = 10) after 2 weeks of testing the tool was unanimously positive. Many providers reported increased confidence in identifying pain and some changed their practice by placing pain assessment in the forefront of their encounter with their older clients with dementia. PAINAD was adopted as the pain assessment tool for this practice.

Download Full-text

Evaluation of the Usability and Acceptability of the InnoWell Platform as Rated by Older Adults: Survey Study

JMIR Aging ◽

10.2196/25928 ◽

2021 ◽

Vol 4 (2) ◽

pp. e25928

Author(s):

Haley M LaMonica ◽

Anna E Roberts ◽

Tracey A Davenport ◽

Ian B Hickie

Keyword(s):

Older Adults ◽

Social Engagement ◽

Later Life ◽

Well Being ◽

Assessment Tools ◽

Self Report ◽

Digital Tool ◽

System Usability Scale ◽

Mental Well Being ◽

Health And Well Being

Background As the global population ages, there is increased interest in developing strategies to promote health and well-being in later life, thus enabling continued productivity, social engagement, and independence. As older adults use technologies with greater frequency, proficiency, and confidence, health information technologies (HITs) now hold considerable potential as a means to enable broader access to tools and services for the purposes of screening, treatment, monitoring, and ongoing maintenance of health for this group. The InnoWell Platform is a digital tool co-designed with lived experience to facilitate better outcomes by enabling access to a comprehensive multidimensional assessment, the results of which are provided in real time to enable consumers to make informed decisions about clinical and nonclinical care options independently or in collaboration with a health professional. Objective This study aims to evaluate the usability and acceptability of a prototype of the InnoWell Platform, co-designed and configured with and for older adults, using self-report surveys. Methods Participants were adults 50 years and older who were invited to engage with the InnoWell Platform naturalistically (ie, at their own discretion) for a period of 90 days. In addition, they completed short web-based surveys at baseline regarding their background, health, and mental well-being. After 90 days, participants were asked to complete the System Usability Scale to evaluate the usability and acceptability of the prototyped InnoWell Platform, with the aim of informing the iterative redesign and development of this digital tool before implementation within a health service setting. Results A total of 19 participants consented to participate in the study; however, only the data from the 16 participants (mean age 62.8 years, SD 7.5; range 50-72) who completed at least part of the survey at 90 days were included in the analyses. Participants generally reported low levels of psychological distress and good mental well-being. In relation to the InnoWell Platform, the usability scores were suboptimal. Although the InnoWell Platform was noted to be easy to use, participants had difficulty identifying the relevance of the tool for their personal circumstances. Ease of use, the comprehensive nature of the assessment tools, and the ability to track progress over time were favored features of the InnoWell Platform, whereas the need for greater personalization and improved mobile functionality were cited as areas for improvement. Conclusions HITs such as the InnoWell Platform have tremendous potential to improve access to cost-effective and low-intensity interventions at scale to improve and maintain mental health and well-being in later life. However, to promote adoption of and continued engagement with such tools, it is essential that these HITs are personalized and relevant for older adult end users, accounting for differences in background, clinical profiles, and levels of need.

Download Full-text

Using the Model for Improvement to implement the Critical-Care Pain Observation Tool in an adult intensive care unit

BMJ Open Quality ◽

10.1136/bmjoq-2017-000304 ◽

2018 ◽

Vol 7 (4) ◽

pp. e000304 ◽

Cited By ~ 1

Author(s):

Mairi Mascarenhas ◽

Michelle Beattie ◽

Michelle Roxburgh ◽

John MacKintosh ◽

Noreen Clarke ◽

...

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Pain Assessment ◽

Best Practice ◽

Assessment Tool ◽

Assessment Tools ◽

Self Report ◽

Process Measures ◽

Adult Intensive Care Unit

Managing pain is challenging in the intensive care unit (ICU) as often patients are unable to self-report due to the effects of sedation required for mechanical ventilation. Minimal sedative use and the utilisation of analgesia-first approaches are advocated as best practice to reduce unwanted effects of oversedation and poorly managed pain. Despite evidence-based recommendations, behavioural pain assessment tools are not readily implemented in many critical care units. A local telephone audit conducted in April 2017 found that only 30% of Scottish ICUs are using these validated pain instruments. The intensive care unit (ICU) at Raigmore Hospital, NHS Highland, initiated a quality improvement (QI) project using the Model for Improvement (MFI) to implement an analgesia-first approach utilising a validated and reliable behavioural pain assessment tool, namely the Critical-Care Pain Observation Tool (CPOT). Over a six-month period, the project deployed QI tools and techniques to test and implement the CPOT. The process measures related to (i) the nursing staff’s reliability to assess and document pain scores at least every four hours and (ii) to treat behavioural signs of pain or CPOT scores ≥ 3 with a rescue bolus of opioid analgesia. The findings from this project confirm that the observed trends in both process measures had reduced over time. Four hourly assessments of pain had increased to 89% and the treatment of CPOT scores ≥3 had increased to 100%.

Download Full-text

Instruments to Assess Mobility Limitation in Community-Dwelling Older Adults: A Systematic Review

Journal of Aging and Physical Activity ◽

10.1123/japa.2013-0181 ◽

2015 ◽

Vol 23 (2) ◽

pp. 298-313 ◽

Cited By ~ 21

Author(s):

Jane Chung ◽

George Demiris ◽

Hilaire J. Thompson

Keyword(s):

Older Adults ◽

Community Dwelling ◽

Mobility Limitation ◽

Assessment Tools ◽

Self Report ◽

Clear Understanding ◽

Lower Extremity Function ◽

Search Terms ◽

Community Dwelling Older Adults ◽

Selection Of

Mobility is critical in maintaining independence in older adults. This study aims to systematically review the scientific literature to identify measures of mobility limitation for community-dwelling older adults. A systematic search of PubMed, CINAHL, and psycINFO, using the search terms “mobility limitation”, “mobility disability”, and “mobility difficulty” yielded 1,847 articles from 1990 to 2012; a final selection of 103 articles was used for the present manuscript. Tools to measure mobility were found to be either self-report or performance-based instruments. Commonly measured constructs of mobility included walking, climbing stairs, and lower extremity function. There was heterogeneity in ways of defining and measuring mobility limitation in older adults living in the community. Given the lack of consistency in assessment tools for mobility, a clear understanding and standardization of instruments are required for comparison across studies and for better understanding indicators and outcomes of mobility limitation in community-dwelling older adults.

Download Full-text

LITERATURE REVIEW: PAIN ASSESSMENT TOOLS IN CRITICALLY ILL ADULT PATIENTS WITH VENTILATOR

Nurscope Jurnal Penelitian dan Pemikiran Ilmiah Keperawatan ◽

10.30659/nurscope.2.2.13-19 ◽

2016 ◽

Vol 2 (2) ◽

pp. 13

Author(s):

INDAH SRI WAHYUNINGSIH

Keyword(s):

Literature Review ◽

Critically Ill ◽

Sensitivity And Specificity ◽

Pain Assessment ◽

Adult Patients ◽

Assessment Tools ◽

Self Report ◽

Validity And Reliability ◽

Keywords Pain ◽

Google Search

Critically ill adult patients with a ventilator in intensive care often receive treatment that causes pain. Pain is a symptom that often occurs in critically ill adult patients with ventilator and it is very individual. Pain assessment in critically ill patients with the ventilator is needed because of the patient unable to self-report of pain. Pain assessments critically ill adult patients have been developed. However, there is no valid and reliable instrument to assess pain. The objectives of the literature review are to identify the instruments of pain assessment in patients with ventilator. The method of literature was performed through seeking publication of articles in MEDLINE, Google Search, PubMed, and Proquest with keywords pain assessment, tool, critical care, adult, critically ill, unconscious and ventilator. Literatures were undertaken from 2000-2015 with a cross-sectional study design, before and after studies and observational study. The results of the study according to the characteristics of the research was found five pain assessment instruments, they were NVPS, P.A.I.N, Comfort scale, BPS and CPOT. The validity and reliability CPOT is highest among others. All instruments had been measured its validity and reliability, but it had never tested its sensitivity and specificity. So, more researches should be conducted related to the sensitivity and specificity of all the instruments of pain in critically ill adult patients with a ventilator.�Keywords : Pain assessment, critically ill, adult, ventilator.

Download Full-text

Pain Assessment and Documentation for Older Adults Presenting with Non-surgical Conditions in Emergency Room

Innovation in Aging ◽

10.1093/geroni/igab046.2279 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 596-597

Author(s):

Raza Haque ◽

Mara Bezerko ◽

Lauren Tibbits ◽

Karen Tate

Keyword(s):

Older Adults ◽

Emergency Department ◽

Emergency Room ◽

Pain Assessment ◽

Assessment Tools ◽

Diagnostic Categories ◽

Icd 10 ◽

Ed Visits ◽

Surgical Conditions ◽

First Pain

Abstract Pain is one of the most common reasons for Emergency Department (ED) visits among older adults. However, timely pain assessment and management in this population in ED is a challenging task due to many factors ranging from; sensory, cognitive impairments, chronic pain, reliability of assessment tools, multimorbidity and system factors such as triage-based dynamic ED workflow. Where the implementation of the EMR was anticipated to improve patientcare, literature has indicated the barriers in effective utilization of the EMR for this purpose. We posit that pain assessment and documentation could be variable among older adults presenting with non-surgical conditions. Objectives:1. To examine the proportion of documented initial pain assessment of nonsurgical older adults visiting emergency department 2. To examine the number of initial pain assessments documented in the chart by the five major categories of ICD-10 diagnoses upon discharge. Methods A retrospective exploratory chart review of 4613 emergency room visits for first pain assessment in the EMR conducted for all adults 65 years or older, presenting with non-surgical conditions, who were discharged same day at an urban teaching hospital. Results In our study 75.72% of encounters reviewed had a documented pain assessment. Completed pain assessments for the corresponding five most common non-surgical diagnostic categories presenting to our ED: Abdominal pain (92.59%), MSK (92.11 %), chest pain (83.92%), dyspnea ( 80%) and falls (79.46%). Conclusion Frequency of pain assessment and the management process of older adults presenting with non-surgical conditions in the institution studied was variable and differed based on presenting conditions.

Download Full-text

Practice recommendations for pain assessment by self-report with African American older adults

Geriatric Nursing ◽

10.1016/j.gerinurse.2014.08.014 ◽

2015 ◽

Vol 36 (1) ◽

pp. 67-74 ◽

Cited By ~ 8

Author(s):

Staja “Star” Booker ◽

Chris Pasero ◽

Keela A. Herr

Keyword(s):

Older Adults ◽

African American ◽

Pain Assessment ◽

Self Report ◽

Practice Recommendations ◽

African American Older Adults

Download Full-text

Association between Self-Reported and Accelerometer-Based Estimates of Physical Activity in Portuguese Older Adults

Sensors ◽

10.3390/s21072258 ◽

2021 ◽

Vol 21 (7) ◽

pp. 2258

Author(s):

Célia Domingos ◽

Nadine Correia Santos ◽

José Miguel Pêgo

Keyword(s):

Physical Activity ◽

Older Adults ◽

Health Outcomes ◽

Accurate Method ◽

Assessment Tools ◽

Self Report ◽

Wide Range ◽

Positive Correlations ◽

Objectively Measured ◽

Activity Survey

Accurate assessment of physical activity (PA) is crucial in interventions promoting it and in studies exploring its association with health status. Currently, there is a wide range of assessment tools available, including subjective and objective measures. This study compared accelerometer-based estimates of PA with self-report PA data in older adults. Additionally, the associations between PA and health outcomes and PA profiles were analyzed. Participants (n = 110) wore a Xiaomi Mi Band 2® for fifteen consecutive days. Self-reported PA was assessed using the International Physical Activity Questionnaire (IPAQ) and the Yale Physical Activity Survey (YPAS). The Spearman correlation coefficient was used to compare self-reported and accelerometer-measured PA and associations between PA and health. Bland–Altman plots were performed to assess the agreement between methods. Results highlight a large variation between self-reported and Xiaomi Mi Band 2® estimates, with poor general agreement. The highest difference was found for sedentary time. Low positive correlations were observed for IPAQ estimates (sedentary, vigorous, and total PA) and moderate for YPAS vigorous estimates. Finally, self-reported and objectively measured PA associated differently with health outcomes. Summarily, although accelerometry has the advantage of being an accurate method, self-report questionnaires could provide valuable information about the context of the activity.

Download Full-text

Are the current pain assessment tools used by paramedics in Ireland, suitable for use with cognitively impaired (dementia) patients?

Irish Journal of Paramedicine ◽

10.32378/ijp.v3i2.143 ◽

2018 ◽

Vol 3 (2) ◽

Author(s):

Liam Rooney

Keyword(s):

Pain Assessment ◽

Rating Scale ◽

Assessment Tool ◽

Hospital Setting ◽

Reliability And Validity ◽

Pain Scale ◽

Assessment Tools ◽

Self Report ◽

Good Reliability ◽

Dementia Patients

BackgroundDementia is a disease affecting 55,000 Irish people. (1) It is characterised by progressive cognitive impairment, ranging from mild impairment, which may affect memory, to severe impairment where the ability to communicate may be absent. These people are at risk of having their pain underassessed and undermanaged. (2) A survey exploring Irish Paramedics and Advanced Paramedics views on the current pain assessment tools available to them, and whether these tools are suitable for use with dementia patients is proposed. Existing observational pain assessment tools used with dementia patients are examined and their suitability for pre-hospital use discussed.IntroductionAdults with cognitive impairments, such as dementia, are at a much higher risk of not receiving adequate analgesia for their pain. (3) It is estimated between 40% and 80% of dementia patients regularly experience pain. (4) Current pain assessment tools used pre-hospital in Ireland are: Numerical Rating Scale for patients >8yrs, Wong Baker Scale for pediatric patients and the FLACC Scale for infants. There is no specific pain assessment tool for use with patients who are not capable of self-reporting their level of pain.ObjectiveThis research aimed to identify observational pain assessment tools used in this cohort. The most consistently recommended tools were identified. The suitability of these tools for use in the pre-hospital setting assessed.FindingsLiterature review identified 29 observational pain assessment tools. There is a lack of literature relating to the pre-hospital setting. The American Geriatric Society (AGS) identified six pain behaviors in dementia patients, changes in facial expression, activity patterns, interpersonal relationships and mental status, negative vocalisation, change in body language. These six criteria should be the foundation of any pain assessment tool. (5) The three most consistently recommended tools identified were as follows:Abbey Pain Scale6 items assessed, meets AGS criteria, quick and easy to implement, moderate to good reliability and validity (6)Doloplus 215 items assessed, meets 5 of 6 AGS criteria, requires observation over time, prior knowledge of patient required, moderate to good reliability and validity (6)PAINAD5 items assessed, meets 3 of 6 AGS criteria, less then 5 minutes to implement, may be influenced by psychological distress, good reliability and validity (6) ConclusionThe ability to self report pain is deemed “gold standard”. Patients with mild to moderate disease, and indeed, some with severe disease, may retain the ability to self report. An observational tool is required when dementia has progressed to the point where the patient becomes unable to self report or becomes non-verbal. It is in these patients where undetected, misinterpreted or inaccurate assessment of pain becomes frequent. (7) The aim of any tool is to gain a good assessment of pain, however, the pain scale used should be suitable to the clinical setting. The feasibility of an assessment tool is an important factor along with reliability and validity. No one assessment tool could be recommended over another. Abbey and PAINAD have potential for use pre-hospital, however, further research, clinical evaluation and trial in an ambulance service is required.

Download Full-text