Although many reliable and valid pain assessment tools for cognitively intact and impaired geriatric patients are currently available, clinical evidence emphasized by Keela Herr, PhD, RN, FAAN, AGSF, co-director of the John A. Hartford Center for Geriatric Nursing Excellence at the University of Iowa College of Nursing, suggests those scales are not consistently administered throughout practice settings.
At a plenary session of the American Pain Society’s 32nd Annual Scientific Meeting, held May 8-13, 2013, in New Orleans, LA, Herr said one study found 95 percent of geriatric hospital patients experiencing pain received no objective pain assessment based on a valid tool during initial assessment from a doctor. In the hospice setting, initial assessment was sound, but reassessment — which Herr said is crucial to monitoring a treatment’s effectiveness — was extremely low.
Additionally, a study by Elizabeth Manias of the University of Melbourne School of Health Sciences found that a group of nurses were applying the same strategies they used throughout their careers to all geriatric pain patients, rather than individualizing care with available tailored pain scales, while another study by Andrea Gilmore, RN, of the University of Wisconsin-Madison School of Nursing, conducted qualitative interviews of 13 nurses across four nursing homes and discovered that they lacked clear procedures for assessing pain.
But Herr said issues surrounding pain assessment in older adults also stem from the sheer number of tools available and the variability among them, as she noted “there are now over 35 non-verbal pain tools available across the world — ranging from five behavioral categories to 60 individual behaviors and from presence of pain to pain intensity — and there’s no single best tool for practices to use.”