There are two excellent scales to help you with this problem--the Faces Pain Scales for use with the elderly and the Alzheimer's Discomfort Scale. Herr published an article on the use of the Faces Pain Scales in the Clinical Journal of Pain in 1998. It showed that this scale is a reliable and valid measure using a seven point Likert scale with the use of painted faces. The patient with dementia can pick out the level of pain they have relative to the face.

The Alzheimer's Discomfort Scale by Hurley is another excellent tool, which was published in Research in Nursing and Health in 1992. This interesting scale requires no verbal response from the older person, it is simply an observation assessment scale. These two references help therapists quantify an important part of the rehabilitation process, and then by documenting this deficit, can show improvement.

Discomfort Scale for Dementia of the Alzheimer’s Type

 (DS-DAT)

Behavioral Indicator:

Freq.

(5 min)            

Duration

<1 min

> 1 min

Intensity

High

Low

Noisy Breathing: negative sounding noise on inspiration

or expiration, breathing looks strenuous, labored, or wearing;

respirations sound loud, harsh or gasping; difficulty breathing

or trying hard at attempting to achieve a good gas exchange;

episodic bursts of rapid breaths or hyperventilation.

 

 

 

 

 

Negative Vocalizations: noise or speech with a negative

or disapproving quality; hushed low sounds such as a constant

muttering with a guttural tone; monotone, subdued, or varying

pitched sound with a definite unpleasant sound; faster rate than

a conversation or drawn out as in a moan or groan; repeating

the same words with a mournful tone; expressing hurt or pain.

 

 

 

Lack of Content Facial Expression: pleasant calm looking face; tranquil, at ease or serene; relaxed facial expression with a slack unclenched jaw; overall look is one of peace.

 

 

 

Sad Facial Expression: troubled look on face, looking hurt,

worried, lost, or lonesome; distressed appearance, sunken, “hound

dog” look with lackluster eyes; tears, crying.

 

 

 

Frightened Facial Expression:  scared, concerned looking

 face; looking bothered, fearful, or troubled; alarmed appearance

 with open  eyes and pleading face.

 

 

 

Frown:  face looks strained; stern or scowling look, displeased

expression with wrinkled brow and creases in the forehead;

corners of the mouth turned down.

 

 

 

Lack of Relaxed Body Language: easy open handed position; looking of being in a restful position and may be cuddled up or stretched out; muscles look of normal firmness and joints are

without stress; look of idle, lazy, or “laid back”; appearance of “just killing the day”; casual.

 

 

 

Tense Body Language: extremities show tension;

wringing hands, clenched fist, or knees pulled up tightly;

look of being in strained or inflexible position.

 

 

 

Fidgeting: restless impatient movement; acts squirmy or

jittery; appearance of trying to get away from hurt area;

forceful touching, tugging, or rubbing of body parts.

 

 

 

Adapted with permission from Hurley A et al, Assessment of Discomfort in Advanced Alzheimer’s Patients. Research in Nursing & Health.  1992, 15, 369-377. John Wiley and Sons Inc.

 

Discomfort Scale for Dementia of the Alzheimer’s Type (DS-DAT)

 

Patient Name:__________________________________ MR#_____________________

 

Date of Birth:___________            Date:_____________        Time:__________________

 

Diagnosis:_______________________________________________________________

 

 

 

Scoring of Discomfort Scale for Dementia of the Alzheimer’s Type:

 

Item Score                   Frequency                    Intensity                        Duration

0                                  0                                  --                                 --

   1                                  1                               Low                             Short

   2                                  1                               High                             Short

   2                                  1                               Low                             Long

   2                                  2                               Low                             Short

   3                                 > 1                             High                             Long

   3                                 > 2                             High                             Short

   3                                 > 2                             Low                             Long

   3                                 > 3                             Low                             Short

 

Frequency: number of episodes during a five minute period

Intensity:  Low = barely to moderately perceptible or

                 High = present in moderate to great magnitude

Duration:  Short = < 1 minute and Long = > 1 minute

Interpretation: higher the score = higher level of discomfort out of 0-27 points

 

Partially adapted with permission from Hurley A et al,  Assessment of Discomfort in Advanced Alzheimer’s Patients.

Innovative Rehabilitation for the Patient with Dementia. S. Staples 2003

 

 

Patient Score:______________________

 

Comments/Assessment:___________________________________________________________________________________________________________________________________________________________________________________________________

 

 

Signed:___________________________________________