Pain intensity assessment: a comparison of selected pain intensity scales for use in cognitively intact and cognitively impaired African American older adults

The purpose of this study was to determine the reliability and validity of selected pain intensity scales including the Faces Pain Scale (FPS), the Verbal Description Scale, the Numeric Rating Scale, and the Iowa Pain Thermometer to assess pain in cognitively impaired minority older adults. A descriptive correlational design was used, and a convenience sample of 57 volunteers age 58 and older residing in the South was recruited for this study. The sample consisted of 8 males and 49 females with a mean age of 76. Fifty-nine percent of the sample completed an 11th grade education or less, and 59% completed high school or college. Seventy-seven percent (n = 44) of the sample scored 24 or less on the mental status exam, indicating some degree of cognitive impairment. The remaining 23% (n = 13) were cognitively intact. All of the participants were able to use each of the scales to rate their pain. Concurrent validity of the scales was supported with Spearman rank correlation coefficients ranging from.74 to.83 in the cognitively impaired group and.81 to.96 in the cognitively intact group. Test-retest reliability at a 2-week interval was acceptable in the cognitively intact group (Spearman rank correlations ranged from.73 to.83) and to a lesser degree in the cognitively impaired group (correlations ranged from.52 to.79). When asked about scale preference, both the cognitively impaired and the intact group indicated a preference for the FPS. Findings from this study suggest that cognitive impairment did not inhibit older minority participants' ability to use a variety of pain intensity scales. Additionally, options should be provided that address individual needs of older adults considering specific cognitive level and disability, education, gender, ethnicity, and cultural influences concerning perceptions of the various pain intensity scales. © 2003 by the American Society of Pain Management Nurses