Abstract
This study examined the applicability of three different pain rating scales, the Visual Analogue Scale (VAS), the Graphic Rating Scale (GRS) and the Numeric Rating Scale (NRS), in geriatric patients. Data collection was performed in a geriatric clinic at a university hospital. A structured interview was conducted with 167 patients (mean age=80.5 years). Patients rated their current experience of pain twice with a 5-minute pause in-between on the VAS, GRS and NRS, and were then asked if they experienced pain, ache or hurt (PAH) or other symptoms. The correlations were high and significant both between the ratings of the VAS, GRS and NRS (r=0.78−0.92; p<0.001) (alternative-forms reliability), and between the test and retesting (r=0.75 − r=0.83; p<0.001) (test-retest reliability). A logistic regression analysis showed that the probability to accomplish a rating on the pain scales decreased with advancing age of the patient, and this was especially marked for the VAS. The probability of agreement between the patients’ ratings of pain and the verbal report of PAH tended to decrease with advancing age; this was especially so for the VAS. Patients who verbally denied PAH but reported pain on the scales rated it significant lower (p<0.001) than those who verbally reported PAH and rated the pain as well. Eighteen percent of patients who denied pain but rated a pain experience verbally expressed suffering or distress. The study suggests that pain rating scales such as the VAS, GRS and NRS can be used to evaluate pain experience in geriatric patients. However, agreement between verbally expressed experience of PAH, and the rated experience of pain tended to decrease with advancing age. This indicates that the pain-evaluating process will be substantially improved by an additional penetration supported by a wide variety of expression of hurt, ache, pain, discomfort and distress.
Similar content being viewed by others
References
Ferrell B.A., Ferrell B.R., Osterweil D.: Pain in the nursing home. J. Am. Geriatr. Soc. 38: 409–414, 1990.
Ross M.M., Crook J.: Elderly recipients of home nursing services: pain, disability and functional competence. J. Adv. Nurs. 27: 1117–1126, 1998.
Closs S.J.: Pain in elderly patients: a neglected phenomenon? J. Adv. Nurs. 19: 1072–1081, 1994.
Ferrell B.A.: Pain management in elderly people. J. Am. Geriatr. Soc. 39: 64–73, 1991.
Jensen M.P.: Validity of self-report and observation measures. In: Jensen T.S., Turner J. A., Wiesenfeld-Hallin Z. (Eds.), Proceedings of the 8th World Congress on Pain, Progress in Pain Research and Management. IASP Press, Seattle, 1997, pp. 637–661.
Jacox A.K.: Assessing pain. Am. J. Nurs. 79: 895–900, 1979.
AHCPR: Management of cancer pain. U.S. Department of Health and Human Services, Public Health Service, 1992.
Turk D.C., Melzack R.: The measurement of pain and the assessment of people experiencing pain. In: Turk D.C., Melzack R. (Eds.), Handbook of pain assessment. Guilford Press, New York, 1992, pp. 3–12.
Closs S.J.: Pain and elderly patients: a survey of nurses knowledge and experiences. J. Adv. Nurs. 23: 237–242, 1996.
McCaffery M.: Nursing management of the patient with pain, ed. 2. Lippincott, Philadelphia, 1979.
Gaston-Johansson F.: Pain Assessment: With particular reference to pain terms, instrument development and pain description. Dissertation, University of Göteborg, 1985.
Ferrell B.R., Ferrell B.A.: Pain in elderly persons. In: McGuire D.B., Yarbro C.H., Ferrell B.R. (Eds.), Cancer pain management. Jones and Bartlett Publishers, Boston, 1995, pp. 159–205.
Herr K.A., Mobily P.R.: Comparison of selected pain assessment tools for use with the elderly. Appl. Nurs. Res. 6: 39–46, 1993.
Parmelee P.A.: Assessment of pain in the elderly. In: Lawton M.P., Teresi J. (Eds.), Annual Review of Gerontology and Geriatrics. Springer, New York, 1994, pp. 281–301.
Yates P., Dewar A., Fentiman B.: Pain: The views of elderly people living in long-term residential care settings. J. Adv. Nurs. 4: 667–674, 1995.
Grossman S.A., Sheidler V.R., McGuire D.B., Geer C., San-tor D., Piantadosi S.: A comparison of the Hopkins Pain Rating Instrument with standard visual analogue and verbal descriptor scales in patients with cancer pain. J. Pain Symptom Manage. 7: 196–203, 1992.
Price C.I., Curless R.H., Rodgers H.: Can stroke patients use visual analogue scales? Stroke 30: 1357–1361, 1999.
Carlsson A.M.: Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain 16: 87–101, 1983.
Downie W.W., Leatham P.A., Rhind V.M., Wright V., Branco J. A., Anderson J. A.: Studies with pain rating scales. Ann. Rheum. Dis. 37: 378–381, 1978.
Kremmer E., Hampton Atkinson J., Ignelzi R.J.: Measurement of pain: Patient preference does not confound pain measurement. Pain 10: 241–248, 1981.
Seymour R.A.: The use of pain scales in assessing the efficacy of analgesics in post-operative dental pain. Eur. J. Clin. Pharmacol. 23: 441–444, 1982.
Ahles T.A., Blanchard E.B., Ruckdeschel J.C.: The multidimensional nature of cancer-related pain. Pain 17: 277–288, 1983.
Carpenter J.S., Brockopp D.: Comparison of patients’ ratings and examination of nurses’ responses to pain intensity rating scales. Cancer Nurs. 18: 292–298, 1995.
Paice J.A., Cohen F.L.: Validity of a verbally administered numeric rating scale to measure cancer pain intensity. Cancer Nurs. 20: 88–93, 1997.
DeLoach L.J., Higgins M.S., Caplan A.B., Stiff J.L.: The visual analog scale in the immediate postoperative period: intrasubject variability and correlation with a numeric scale. Anesth. Analg. 86: 102–106, 1998.
Choiniere M., Melzack R., Girard N., Rondeau J., Paquin M.J.: Comparisons between patients’ and nurses’ assessment of pain and medication efficacy in severe burn injuries. Pain 40: 143–152, 1990.
Tesler M.D., Savedra M.C., Holzemer W.L., Wilkie D.J., Ward J.A., Paul S.M.: The word-graphic rating scale as a measure of children’s and adolescents’ pain intensity. Res. Nurs. Health 14: 361–371, 1991.
Choiniere M., Amsel R.: A visual analogue thermometer for measuring pain intensity. J. Pain Symptom Manage. 11: 299–311, 1996.
Price D.D., McGrath P.A., Rafii A., Buckingham B.: The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 17: 45–56, 1983.
Heft M.W., Parker S.R.: An experimental basis for revising the graphic rating scale for pain. Pain 19: 153–161, 1984.
Chapman C.R., Casey K.L., Dubner R., Foley K.M., Grace-ly R.H., Reading A.E.: Pain measurement: an overview. Pain 1: 1–31, 1985.
Huskisson E.C.: Measurement of pain. Lancet 2: 1127–1131, 1974.
Jensen M.P., Karoly P., Braver S.: The measurement of clinical pain intensity: a comparison of six methods. Pain 27: 117–126, 1986.
McGuire D.B., Yarbro C.H.: The measurement of clinical pain. Nurs. Res. 33: 152–156, 1984.
Scott J., Huskisson E.C.: Graphic representation of pain. Pain 2: 175–184, 1976.
Gaston-Johansson F.: Measurement of pain: the psychometric properties of the Pain-O-Meter, a simple, inexpensive pain assessment tool that could change health care practices. J. Pain Symptom Manage. 12: 172–181, 1996.
Revill S.I., Robinson J.O., Rosen M., Hogg M.I.: The reliability of a linear analogue for evaluating pain. Anaesthesia 31: 1191–1198, 1976.
Ferraz M.B., Quaresma M.R., Aquino L.R., Atra E., Tugwell P., Goldsmith C.H.: Reliability of pain scales in the assessment of literate and illiterate patients with rheumatoid arthritis. J. Rheumatol. 17: 1022–1024, 1990.
Jensen M.P., McFarland C.A.: Increasing the reliability and validity of pain intensity measurement in chronic pain patients. Pain 55: 195–203, 1993.
Weiner D.K., Peterson B.L., Logue P., Keefe F.J.: Predictors of pain self-report in nursing home residents. Aging Clin. Exp. Res. 10: 411–420, 1998.
Herr K.A., Mobily P.R.: Complexities of pain assessment in the elderly. Clinical considerations. J. Gerontol. Nurs. 17: 12–19, 1991.
Gueldner S.H., Hanner M.B.: Methodological issues related to gerontological nursing research. Nurs. Res. 38: 183–185, 1989.
Williams M.A., Oberst M.T., Bjorklund B.C., Kruse H.A., Coggon S.A.: Response formats in questionnaires used with older adults. In: Midwest Nursing Research Conference, Wichita, Kansas, 1988.
Walsh T.D.: Letter to the Editor. Pain 19: 96–98, 1984.
Donovan M., Dillon P., McGuire L.: Incidence and characteristics of pain in a sample of medical-surgical inpatients. Pain 30: 69–78, 1987.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bergh, I., Sjöström, B., Odén, A. et al. An application of pain rating scales in geriatric patients. Aging Clin Exp Res 12, 380–387 (2000). https://doi.org/10.1007/BF03339864
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03339864