Improving the clinical usefulness of a behavioural pain scale for older people with dementia.

AIM: This paper is a description of the process of item reduction as part of the construction of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate to assess pain in Dutch older nursing home residents with dementia.

BACKGROUND: A valid and reliable clinically useful tool is important for assessing pain in people with dementia. The Pain Assessment Checklist for Seniors with Limited Ability to Communicate has demonstrated good inter- and intra-rater reliability and evidence of construct validity. However, nurses found the scale too long for clinical use.

METHODS: In an observational study in 2005, nursing home patients (n = 128) were observed while receiving an influenza injection, and a selection of patients were also assessed at a patient-specific pain moment. Internal consistency and Principal Component Analysis were used to refine the scale, to examine the psychometric quality and underlying factor structure of the scale.

RESULTS: A brief and manageable version of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate in Dutch was developed, with a three-component solution including 24 items. This version had high levels of internal consistency for the complete scale (Cronbach's alpha range 0.82-0.86) and for all subscales (alpha range 0.72-0.82). Social-emotional items played a significant role in detecting pain.

CONCLUSION: It is important to have a valid, reliable, brief and manageable pain scale available for the nursing home setting. Further research is needed to examine the adequacy and effectiveness of the scale in daily clinical practice.