The Credibility of Self-reported Pain Among Institutional Older People with Different Degrees of Cognitive Function in Taiwan

Despite many studies conducted to validate the self-reported pain of vulnerable patients, it is unclear at what level of cognitive impairment individuals still can provide reliable information. The aims of this study were to examine the reliability and validity of self-reported pain by degree of patients' cognitive function and to determine important predictors of self-reported pain in cognitively impaired residents in long-term care facilities. The 414 participants were divided into four groups according to their scores on the Mini-Mental State Examination (nonimpaired, mild, moderate, and severe cognitive impairment). Multifaceted measures were performed to validate residents' pain reports. Self-reported pain and pain behaviors were measured using the Verbal Descriptor Scale and the Doloplus-2 scale. Known correlates of pain including functional disability, depression, and agitation were compared, using the Barthel Index, the Cornell scale, and the Cohen-Mansfield Agitation Inventory. Intra-rater and interrater reliability were generally acceptable in groups with no impairment to moderate cognitive impairment. The relationships between residents' self-reported pain and the known correlates of pain were almost all significant across groups with no impairment to moderate cognitive impairment, but fewer were significant in the severely impaired group. Regression analyses revealed that multiple pain indicators together were significantly better predictors of self-reported pain in moderately and severely impaired residents. The findings from this study support residents with cognitive impairment up to a moderate level can report pain reliably. However, for those in later stages of dementia, a multifaceted approach is suggested to help in pain recognition.