Richard Armour, Barry Murphy-Jones
Journal of Paramedic Practice, Vol. 8, Iss. 11, 04 Nov 2016, pp 533 - 541

There is substantial evidence to suggest adults with cognitive impairment,
caused by degenerative conditions such as dementia, are at a significantly
higher risk of suboptimal pain assessment and management in the acute care
setting when compared to adults without cognitive impairment. This paper aims
to assess the pain assessment tools most appropriate for use in adults with
cognitive impairment as a result of dementia within the out-of-hospital setting.
A search of the literature was conducted in May 2016. The databases searched
were Pubmed (Medline) and Embase. The primary types of literature retrieved
were meta-reviews, systematic reviews or reviews. All subcategories of dementia
were included in this review. From the search strategies, 12 relevant articles and
35 pain assessment tools for use in patients with dementia were identified.
In this review, the Abbey Pain Scale and PAINAD have been identified as tools
substantiated in the literature for use in detecting pain in adults with dementia,
which likely have applications in the out-of-hospital environment. A trial of
either the Abbey Pain Scale or PAINAD in an emergency ambulance service is
appropriate and likely warranted to assess their impact on pain assessment in
this vulnerable patient group.

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