Patient-reported outcome measures to assess pain in older adults with mild-to-moderate cognitive impairment: a scoping review.

OBJECTIVE

Mild-to-moderate cognitive impairments are common and prevalent in 15-20% of adults over the age of 50. People with mild-to-moderate cognitive impairments are often able to complete self-report outcome measures, though may struggle with complex questions. This can be an issue when reporting pain, which is typically assessed through patient-reported outcome measures. The aim of this scoping review was to determine which patient-reported outcomes measures have been used to assess pain in older adults with mild-to-moderate cognitive impairments. A secondary aim included examining definitions of mild-to-moderate cognitive impairments in included studies.

METHODS

A scoping review study design was used to answer the research question. Electronic databases were searched (Medline, CINAHL, Embase, Emcare, APAPsychInfo) to identify relevant articles.

RESULTS

The database search identified 8489 distinct articles. Of the 126 full-text articles examined for eligibility, 33 met the inclusion criteria. The included studies used 35 different patient-reported outcomes measures to assess pain. The most commonly used patient-reported outcome measure was the 11-point numerical rating scale, and other variations of a numerical rating scale, verbal descriptor scale, and faces pain scale were commonly used. Most patient-reported outcome measures assessed pain intensity, with few assessing other pain constructs. Definitions of mild-to-moderate cognitive impairment throughout studies were varied and inconsistent.

DISCUSSION: The heterogeneity in patient-reported outcomes measures used and lack of multidimensionality within assessments suggests gaps in pain assessment for people with mild-to-moderate cognitive impairments. Future studies should determine which measures are most appropriate for this population and forming better definitions of mild-to-moderate cognitive impairment.