Journal
CLINICAL JOURNAL OF PAIN
Volume 30, Issue 9, Pages 816-824Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/ajp.0000000000000039
Keywords
dementia; long-term care; nursing home; older adults; elderly; Alzheimer disease
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Funding
- Saskatchewan Health Research Foundation, Saskatoon, Saskatchewan
- Alzheimer Society of Canada, Toronto, Ontario
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Objectives: Our goal was to develop and validate, based on theoretical and empirical knowledge, the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC-II), a shorter tool that would improve on the PACSLAC, while addressing limitations of the original version. Methods: The PACSLAC was revised based on the relevant clinical and theoretical literature. Psychometric properties and clinical utility of the resulting 31-item PACSLAC-II were examined. Specifically, the PACSLAC-II was used to assess pain based on video footage of long-term care (LTC) residents with dementia undergoing painful procedures as part of routine care. Its ability to discriminate pain from non-pain-related states was compared with that of preexisting pain assessment tools using archival data. A second phase involved the use of the PACSLAC and PACSLAC-II by LTC staff to solicit feedback from health care providers. Mixed-methods analysis of this feedback was conducted. Results: The PACSLAC-II demonstrated satisfactory reliability, excellent validity, and ability to differentiate between pain and nonpain states. The PACSLAC-II also accounted for unique variance in differentiating between pain and nonpain states, even after controlling for the preexisting tools combined, including the PACSLAC. The PACSLAC-II was also preferred by many LTC nurses and care aides, because of its length and condensed nature, which was thought to facilitate documentation and greater efficiency in pain management. Discussion: Findings indicate that the empirical and theoretically driven revisions to the PACSLAC led to improved ability to differentiate between pain and nonpain states, while retaining its clinical utility.
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