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The study used expert clinician input and behavioral observation to create a five-item observational scale (0–10). PAINAD was compared with the Discomfort Scale and two visual analog scales during development, and then applied to assess analgesic efficacy in a quality improvement activity. Results supported interrater reliability, internal consistency, and construct validity, with PAINAD detecting pre/post medication score differences.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":40,"@type":76,"position":81},"https://docshare.wps.com/document/research-report/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/development-and-psychometric-evaluation-of-the-pain-assessment-in-advanced-dementia-painad-scale/291278/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/development-and-psychometric-evaluation-of-the-pain-assessment-in-advanced-dementia-painad-scale/291278.png","ImageObject",300,407,{"name":92,"@type":93},"supergirl","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-28","2026-09-17",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",17,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What is the main objective of the PAINAD instrument development study?","Question",{"text":113,"@type":114},"To develop a clinically relevant, easy-to-use pain assessment tool for people with advanced dementia that has adequate psychometric properties.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How is the PAINAD scale structured and scored?",{"text":118,"@type":114},"PAINAD is a five-item observational tool with a total range of 0 to 10.",{"name":120,"@type":111,"acceptedAnswer":121},"What evidence supports PAINAD’s validity and reliability?",{"text":122,"@type":114},"The study reports adequate interrater reliability, satisfactory internal consistency with a one-factor solution, significant correlations with the Discomfort Scale–DSDAT for construct validity, and statistically significant score differences before versus after analgesic medication.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},291278,1789644226,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":39,"category_name":40,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":34,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":130,"read_time":144,"preview_page_count":4},962088121634,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Development and Psychometric Evaluation of the Pain Assessment in Advanced Dementia (PAINAD) Scale  \nVictoria Warden, RN, Ann C. Hurley, RN, DNSc, FAAN, and Ladislav Volicer, MD, PhD, FAAN  \n\n| Objectives: To develop a clinically relevant and easy to use pain assessment tool for individuals with advanced dementia that has adequate psychometric properties.\u003Cbr>Design: Instrument development study using expert clinicians and behavioral observation methods. Measurement of sensitivity of the instrument to detect the effects of analgesic medications in a quality improvement activity.\u003Cbr>Setting: Inpatient dementia special care units in a Veterans Administration Medical Center.\u003Cbr>Participants: Nineteen residents with advanced dementia who were aphasic or lacked the ability to report their degree of pain and six professional staff members. Additionally, data from medical records of 25 residents who were receiving pain medications as required (PRN) were collected.\u003Cbr>Measurements: Based on the literature review, related assessment tools and consultation with expert clinicians, a five-item observational tool with a range of 0 to 10 was developed. The tool, Pain Assessment in Advanced Dementia (PAINAD), was compared with the Discomfort Scale and two visual analog scales (discom- | fort and pain) by trained raters/expert clinicians in the development study, and used for detection of analgesic efficacy in a quality improvement activity.\u003Cbr>Results: Adequate levels of interrater reliability were achieved between dyads of the principal investigator with each clinical research rater and between two raters. PAINAD had satisfactory reliability by internal consistency with a one factor solution. PAINAD and the Discomfort Scale–Dementia of Alzheimer Type (DSDAT) were significantly correlated, providing evidence of construct validity. PAINAD detected statistically significant difference between scores obtained before and after receiving a pain medication.\u003Cbr>Conclusions: The PAINAD is a simple, valid, and reliable instrument for measurement of pain in noncommunicative patients. Since the patient population used for its development and testing was limited to a relatively small number of males, further research is needed before it can be universally recommended.\u003Cbr>(J Am Med Dir Assoc 2003; 4: 9–15)\u003Cbr>Keywords: Alzheimer’s disease; pain; assessment; dementia. |\n| --- | --- |\n\nPain in elderly nursing home residents is a prevalent problem, estimated to occur in 26 to 83% of residents.1–5 Many residents have several diagnoses that may be directly related to pain, such as degenerative arthritis and diabetic neuropathy.6,7 The cognitively intact elderly often underreport pain, believing that pain goes along with aging. Reported pain is often dismissed with statements such as “What do you expect at your age?”8 Because pain is underreported, it is frequently  \nGeriatric Research Education Clinical Center, Edith Nourse Rogers Memorial Veterans Medical Center, Bedford, Massachusetts (V.W., A.C.H., L.V.), The School of Nursing, Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts (A.C.H.), and Departments of Pharmacology and Psychiatry, Boston University School of Medicine (L.V.), Boston, Massachusetts.  \nAddress correspondence to Victoria Warden, GRECC (182B), E. N. Rogers Memorial Veterans Hospital, 200 Springs Road, Bedford, MA 01730 . E-mail: [Victoria.Warden@med.va.gov](Victoria.Warden@med.va.gov).  \nCopyright ©2003 American Medical Directors Association DOI: 10.1097/01.JAM.0000043422.31640.F7  \nundertreated in the elderly.9 This attitude and acceptance of pain as a consequence of aging may lead to less pain assessment in general8 and even less treatment of pain in those cognitively impaired elders who cannot self-report pain.10  \nThe importance of pain detection and treatment was recognized in several reports and practice guidelines. 11,12 Untreated pain can cause secondary symptoms of sleep disturbance, weight loss, and depres","cbCaijOeyXFyVk2z","https://ap.wps.com/l/cbCaijOeyXFyVk2z","pdf",119056,"English","# Objectives\n## Design\n## Setting and Participants\n## Measurements\n# Results\n# Conclusions","[{\"question\":\"What is the main objective of the PAINAD instrument development study?\",\"answer\":\"To develop a clinically relevant, easy-to-use pain assessment tool for people with advanced dementia that has adequate psychometric properties.\"},{\"question\":\"How is the PAINAD scale structured and scored?\",\"answer\":\"PAINAD is a five-item observational tool with a total range of 0 to 10.\"},{\"question\":\"What evidence supports PAINAD’s validity and reliability?\",\"answer\":\"The study reports adequate interrater reliability, satisfactory internal consistency with a one-factor solution, significant correlations with the Discomfort Scale–DSDAT for construct validity, and statistically significant score differences before versus after analgesic medication.\"}]","Development and Psychometric Evaluation of the Pain Assessment in Advanced Dementia (PAINAD) Scale | PDF",18]