Cognitive functioning and pain reactions in hospitalized elders

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BACKGROUND: Objectively coded facial activity provides a useful index of pain among elders who have difficulty in reporting pain because of cognitive impairments. However, limitations of previous research include no direct assessment of participants' level of cognitive impairment; no comparison of the reactions of elders with cognitive impairments with those of nonimpaired elders; observers' expectations about pain levels could have influenced judgements about the severity of pain experienced when global rather than objectively coded measures were used because the painful medical procedure was visible on film. OBJECTIVE: To extend previous findings by incorporating improvements in design and methodology in response to the aforementioned limitations. PARTICIPANTS: Fifty-nine in-patients with a mean age of 73 years. METHODS: Facial reactions were filmed during routine blood tests and coded objectively using the Facial Action Coding System (FACS). Observer ratings of pain were also obtained. RESULTS: FACS indexes revealed substantial changes from baseline to venepuncture indiscriminate of whether elders were cognitively impaired. Furthermore, these changes were apparent to both nurse and student observers although the nurses rated the pain displayed by the patients as being lower. CONCLUSION: After addressing limitations of previous work in this area, the validity of nonverbal indexes of pain in the assessment of elders with cognitive impairments was demonstrated. Such indexes are uniquely suited as outcome measures within the context of clinical trial methodology.




Hadjistavropoulos, T. (1998). Cognitive functioning and pain reactions in hospitalized elders. Pain Research and Management, 3(3), 145–151.

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