Physiological Psychology, Otto-Friedrich University, Bamberg, Germany.
Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.
Pain Med. 2017 Nov 1;18(11):2105-2115. doi: 10.1093/pm/pnw281.
Pain assessment in people with advanced dementia relies strongly on observable pain behaviors, such as facial expressions, body movement, and vocalizations. However, the process of inferring pain in others based on such observations is not well understood. We aimed to investigate which features of facial expressions caregivers rely on when inferring the presence and intensity of pain in people with dementia.
A questionnaire, including items on 13 facial descriptors, which were extracted from established observational scales for pain in dementia, was sent to 366 nursing homes in Germany. We asked the nurses to observe patients with dementia and then rate their observations using the facial descriptors, as well as to provide an overall pain estimate of the residents' pain. We used regression analyses to identify which facial descriptors nurses use most commonly to infer whether a person with dementia is in pain and to grade the pain's intensity.
Seventy-nine nursing homes participated (22% response rate), and a total of 284 completed observer ratings were returned. The observed individuals suffered from moderate to severe dementia and were observed in everyday care situations. The average pain estimated by the caregivers was slight to moderate. Mainly anatomically based descriptors ("frowning," "narrowed eyes") and indicators of emotional arousal ("looking tense," looking frightened") significantly predicted the overall pain ratings by nurses, explaining approximately 45% of the variance.
Although all presented facial descriptors were used by the nurses, some descriptors were used clearly more frequently than others to infer whether a resident with dementia was in pain. Development of observational pain tools and training in their use should consider the preexisting assumptions that nurses use to infer pain as well as their potential bias.
在患有晚期痴呆症的人群中，疼痛评估主要依赖于可观察到的疼痛行为，如面部表情、身体运动和发声。然而，基于这些观察来推断他人疼痛的过程尚未得到很好的理解。我们旨在研究护理人员在推断痴呆症患者疼痛的存在和程度时，依赖于面部表情的哪些特征。
一项包括从用于痴呆症疼痛的既定观察量表中提取的 13 个面部描述符的问卷，被发送到德国的 366 家养老院。我们要求护士观察患有痴呆症的患者，然后使用面部描述符对他们的观察进行评分，并对居民的疼痛进行总体疼痛评估。我们使用回归分析来确定护士最常用来推断痴呆症患者是否疼痛以及评估疼痛强度的面部描述符。
79 家养老院参与了调查（22%的回复率），共有 284 份完整的观察者评分返回。被观察的个体患有中度至重度痴呆症，并在日常护理环境中进行观察。护理人员估计的平均疼痛为轻度至中度。主要基于解剖结构的描述符（“皱眉”“眯眼”）和情绪唤起的指标（“看起来紧张”“看起来害怕”）显著预测了护士的总体疼痛评分，解释了约 45%的方差。
尽管护士使用了所有呈现的面部描述符，但有些描述符明显比其他描述符更频繁地用于推断痴呆症居民是否疼痛。在开发观察性疼痛工具和培训其使用时，应考虑护士用于推断疼痛的先存假设以及他们潜在的偏见。
