Exploring care workers experiences of the assessment of the pain amongst older adults with cognitive impairment

S. Zwakhalen, N. Allcock, R. Docking, I. Gnass, P. Schofield, E. Sirsch, C. Stewart

Research output: Contribution to conferencePosterpeer-review


Assessing pain in older adults with cognitive impairment can be challenging. Over the last decade there has been a variety of observational behavioural scales developed to assess pain in patients with dementia who are unable to use self-report (Zwakhalen et al., 2006; Schofield 2008). However, while there are a range of assessment scales available pain assessment is not performed routinely care homes and acute care settings. The low use of pain assessment scales has previously been described as an important barrier against the accurate treatment of older people with dementia (McAuliffe et al 2009).
In this study we aimed to gain insight in to: 1) care providers’ experiences of assessing pain in cognitively impaired older adults 2) current challenges care workers face in the assessment of pain in cognitively impaired older adults and 3) differences in experiences and challenges of care workers in different European countries.
A convenience sample of care workers was approached through nursing, geriatric care and professional organizations to complete a web-based questionnaire. The questionnaire was available in multiple languages (English, German and Dutch) and data were collected between conducted between September and November 2013. Alongside socio-demographic data the survey contained questions about participants’ knowledge and use of existing pain assessment guidelines,.the usage of exciting pain assessment (observational tools) and the experience health care professional have of implementing the tools. The questionnaire included both open ended and multiple-choice questions. Descriptive and comparative analyses between countries were performed on survey data.
In total 810 respondent completed the questionnaire. The sample consisted of 206 healthcare professionals working in hospital care (HC), 127 working in institutional long term care (ILTC) and 38 in primary care (PC). The 415 respondents mentioning the country of residence were used for further analysis. Findings showed that only a quarter of care workers use guidelines or standards to assess pain. Similar findings on the use of guidelines were found within each responding country. Only 39% of the respondents used an observational pain assessment tool in their current
practice. Observational tools were used less frequently in Austria and the Netherlands (respectively 12.8 and 33.8%) and most frequently in Denmark (55.6 %). Although different pain scales were applied across countries, there was universal agreement about the ease of using the tools to score observational pain. On the other hand respondents emphasized that tools were difficult to interpret. Most care workers were dissatisfied with their current knowledge of pain assessment in cognitively impaired older adults. However, levels of satisfaction varied between countries; respondents in the UK scored on average 2.8, whilst those in Austria had an average score of 3.7 (1 very satisfied; 5 very dissatisfied).
We conclude that there is a lot of room for improvement in the assessment of pain in cognitively impaired older adults. There were many similarities between countries; the problem of interpreting findings of observational pain scales appears to be an international issue. The results of this study will be used to inform the development of a pain assessment toolkit for use amongst cognitively impaired (e.g. dementia) older adults, a European COST collaboration. The aim of this toolkit is to improve the wellbeing of cognitively impaired older adults through improving health professionals assessment and management of pain in this group.
Original languageEnglish
Publication statusPublished - 6 Oct 2014


  • care workers
  • pain assessment
  • older adults
  • cognitive impairment


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