The use of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC) by caregivers in dementia care.

AIM

Pain is often under-detected and under-treated in nonverbal patients with severe dementia. PACSLAC is a behavioural assessment tool designed to improve the detection of pain in severe dementia. Previous studies on PACSLAC were primarily with qualified nurses in Canada and The Netherlands. This pilot study is aimed to evaluate the inter-rater reliability of the PACSLAC when it is administrated by caregiver staff.

METHOD

50 patients from four dementia care facilities were included. For each patient, a PACSLAC rating was completed independently by a medical undergraduate researcher and a caregiver following the caregiver attended the patient's usual personal care with the researcher observing in close proximity.

RESULTS

36 (72%) were female and 14 (28%) were male. The mean age was 82.9 years (SD=7.2) and the mean MMSE score was 7.5 (SD=7.9). A total of 12 caregivers participated in the study. The total PACSLAC scores ranged from 1 to 22 with a mean of 5.7 (SD=4.0). The average percentage of agreement was 0.89 and the Pearson correlation coefficient was 0.83 (p<0.01) for the total PASCLAC scores rated by the researcher and the caregivers.

CONCLUSION

This pilot study demonstrated PACSLAC has good inter-rater reliability when it is used by caregivers. We believe a baseline PACSLAC could be performed for each patient at the time of admission to a dementia care facility and re-administered on regular intervals to detect pain-related behaviour and to prompt earlier pain management. Future studies with larger samples and collaboration between different centres will be useful in providing normative PACSLAC values in New Zealand.