Scherder Erik, van Manen Femke
Clinical Neuropsychology, Vrije Universiteit, Amsterdam, The Netherlands.
J Adv Nurs. 2005 Oct;52(2):151-8. doi: 10.1111/j.1365-2648.2005.03577.x.
This paper reports on a study examining the level of agreement between the pain perceptions of nursing assistants, older people without dementia and patients with Alzheimer's dementia. It was hypothesized that nursing assistants would overestimate the pain experience of patients with Alzheimer's dementia.
There is now increasing evidence that, in contrast to other subtypes of dementia, patients with Alzheimer's disease might experience a decrease in pain. It is unfortunate that these latest insights into the complex relationship between subtypes of dementia and pain are not always included in education programmes for nursing assistants.
Twenty patients with Alzheimer's disease and 17 older people with arthrosis and/or osteoporosis but no dementia and their personal nursing assistants participated in the study. Pain experience was assessed using the Coloured Analogue Scale for the assessment of Pain Intensity and Pain Affect, the Faces Pain Scale, and the Checklist of Non-verbal Pain Indicators. The data were collected in 2002-2003.
Before and after walking, the absolute difference in pain evaluation between nursing assistants and older people without dementia was statistically significantly less than the difference in pain evaluation between nursing assistants and patients with Alzheimer's disease on the Coloured Analogue Scale for Pain Intensity (P = 0.007 and P = 0.04, respectively) and on the Coloured Analogue Scale for Pain Affect (P = 0.009 and P = 0.01, respectively).
Nursing assistants may overestimate the extent of suffering from pain of patients with Alzheimer's disease. They might be very well able to estimate this pain, provided they were educated about new insights into the influence of the various subtypes of dementia on pain.
本文报告一项研究，该研究考察了护理助理、无痴呆症老年人以及阿尔茨海默病痴呆患者在疼痛感知方面的一致性水平。研究假设护理助理会高估阿尔茨海默病痴呆患者的疼痛体验。
现在越来越多的证据表明，与其他痴呆亚型不同，阿尔茨海默病患者可能会出现疼痛减轻的情况。遗憾的是，这些关于痴呆亚型与疼痛之间复杂关系的最新见解并不总是被纳入护理助理的教育课程中。
20名阿尔茨海默病患者、17名患有关节炎和/或骨质疏松症但无痴呆症的老年人及其个人护理助理参与了该研究。使用疼痛强度和疼痛情感彩色模拟量表、面部疼痛量表以及非言语疼痛指标清单来评估疼痛体验。数据于2002年至2003年收集。
在行走前后，护理助理与无痴呆症老年人在疼痛评估上的绝对差异在疼痛强度彩色模拟量表（分别为P = 0.007和P = 0.04）和疼痛情感彩色模拟量表（分别为P = 0.009和P = 0.01）上，在统计学上显著小于护理助理与阿尔茨海默病患者在疼痛评估上的差异。
护理助理可能高估了阿尔茨海默病患者的疼痛程度。如果对他们进行关于痴呆各亚型对疼痛影响的新见解的教育，他们很可能能够准确估计这种疼痛。
