Essay: A comparison of three pain assessment tools for adults with severe dementia

Background
As of today there are more than 36 million people suffering from the consequences of dementia worldwide and this number is only said to be increasing.(Guerchet et al. 2013) This has become a public health issue as the health costs are growing at an equal rate. The treatment of dementia in long-term care presents a big challenge for both the geriatricians and the caretakers. Due to cognitive impairment struggles such as loss of language and ability to communicate can arise. For example the assessment of pain.
Pain is a common, yet underestimated problem amongst older adults. Literature agrees that approximately 50% of the adults with dementia are experiencing pain on a regular basis. (Achterberg et al. 2013)The distress and discomfort caused by this pain, makes the use of proper assessment tools a necessity.
In general self-testing tools are still the golden standard for pain assessment. Self-testing is valid for adults who are in a mild stage of dementia, but it is no longer useable when they have gotten to a more severe stage and their communicating skills have become impaired. (Closs et al. 2004) For adults with severe dementia we use observational tools which has six important domains. These domains are body language, negative vocalisation, facial expression, changes in interpersonal interactions, changes in activity patterns and mental status changes. (AGS Panel on Persistent Pain in Older Persons. 2002) However, it should be kept in mind that interdisciplinary evaluation is also a valid observational tool.(Apinis et al. 2014)
Over the years more than 28 observational assessment tools have been developed. Due to the fact that there are so many of them, it is hard to know which tool observes and detects pain most effectively. Some of the assessment tools however, are not useable because they are only available in certain languages, are invalid or are not feasible in daily practice. Based on the findings of an important systematic review, eight assessment tools stood out. (Lichtner et al. 2014) Three of them will be discussed in this article: Pain assessment checklist for seniors with limited ability to communicate (PACSLAC), Pain assessment in advanced dementia (PAINAD) and the DOLOPLUS-2 scale.
The aim of this study is to create a transparent evaluation of three pain rating scales for adults with severe dementia which can be accomplished by answering specific sub-questions. A literature study is executed to gather information through articles. These articles contain systematic reviews, prospective observational cohort surveys and controlled cross-sectional studies.
Based on these articles, we will try to answer the following sub-questions:
1. Which tool is the most effective tool to assess pain in adults with severe dementia?
2. What are the (comparative) validity and reliability of these tools?