BACKGROUND Self-reporting is the gold standard in pain assessment. However, this is not possible among adults who are unable to respond. Thus, the method of choice is to observe behavior in order to assess pain. Nurses rarely conduct pain observations because they do not feel educated enough to use such tools in vulnerable groups. The aim of the study is to analyze the pain situation among older adults (≥65 years) in need of care who are cognitively or physically unable to respond in the outpatient care setting. MATERIALS AND METHODS Our cross-sectional study is based on data from ACHE, a study on pain in outpatient older adults in need of care. Of 355 care-dependent older adults with chronic pain, 81 (22.8%) who were unable to respond received a pain assessment with the Pain Assessment in Advanced Dementia (PAINAD, German: Beurteilung von Schmerz bei Demenz [BESD]) scale. RESULTS The study population (n = 81) was very old (mean age = 84.2 years), female (77.8%), and widowed (50.0%). We observed pain-related behavior among 61.7% of older adults in need of care. The mean BESD score was 2.8 ± 2.5 (range 0-8). We identified a significant difference in the BESD score observed calmly (mean = 1.7 ± 2.5) and under mobilization (mean = 3.4 ± 2.3, p = 0.001). Moreover, only 21 older adults in need of care received a pain assessment 4 weeks prior to our study. CONCLUSION Our findings indicate a deficit in regularly conducted pain assessment among older adults who are unable to respond and are in need of care in the outpatient care setting. An observation tool in that setting is urgently needed and would be a first step in optimizing pain assessment. We recommend conducting observations during regular nursing mobilization.

中文翻译：

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无法提供信息的需要门诊护理的人的痛苦

背景自我报告是疼痛评估的金标准。然而，这对于无法做出反应的成年人来说是不可能的。因此，选择的方法是观察行为以评估疼痛。护士很少进行疼痛观察，因为他们觉得自己没有受过足够的教育，无法在弱势群体中使用这些工具。该研究的目的是分析需要护理的老年人（≥65 岁）在门诊护理环境中在认知或身体方面无法做出反应的疼痛状况。材料和方法 我们的横断面研究基于 ACHE 的数据，这是一项关于需要护理的门诊老年人疼痛的研究。在 355 名患有慢性疼痛的依赖护理的老年人中，81 名 (22.8%) 无法做出反应，接受了晚期痴呆疼痛评估（PAINAD，德语：痴呆疼痛评估 [BESD]) 量表。结果 研究人群 (n = 81) 年龄很大（平均年龄 = 84.2 岁）、女性 (77.8%) 和丧偶 (50.0%)。我们观察到 61.7% 需要护理的老年人的疼痛相关行为。平均 BESD 得分为 2.8 ± 2.5（范围 0-8）。我们发现在平静状态（平均值 = 1.7 ± 2.5）和活动状态下（平均值 = 3.4 ± 2.3，p = 0.001）观察到的 BESD 评分存在显着差异。此外，在我们的研究前 4 周，只有 21 名需要护理的老年人接受了疼痛评估。结论 我们的研究结果表明，在无法做出反应并需要门诊护理的老年人中，定期进行的疼痛评估存在缺陷。在这种情况下迫切需要一种观察工具，这将是优化疼痛评估的第一步。