Abstract
Pain is common among elderly. Very sick elderly persons living in nursing homes often have communication problems because of dementia or stroke, which causes problem to judge pain and evaluate effects of pain treatment. The aim of this study was to describe the prevalence, localisation and expressions of pain and to evaluate the usefulness of some pain assessment methods for nursing home residents. The study included 66 elderly living in a nursing home of which 49% had dementia as main medical diagnosis. A specially trained registered nurse (RN) performed pain assessment by • presenting a set of pain assessment tools • interpreting the nursing home residents' reactions during activity and • interviewing the resident about perceived pain. Two physiotherapists (PTs) performed physical examination including assessment of joint motion and palpation of joints and muscles. Contractures and ambulating status were noted. Cognitive Performance Scale (CPS) assessed cognitive capacity. When assisted by the RN 61% of the residents used independent or by assistance a verbal rating scale. The RN made an estimation of pain in all the nursing home residents and the PTs examined 92% of the residents. Pain was identified in 88% of the residents, 42% of the residents were treated with analgesics and pain was documented in the nurses' daily notes in 27% of the patient records. All residents with contractures had pain in the engaged joint. This study indicates that it is possible to assess pain by combining interview and interpretation of the residents' reactions during activity. Detection of pain by physical examination is a valuable complement especially for persons with decreased ability to communicate.