Question: In older adults with (moderate/severe) dementia/cognitive impairment what is the most effective non-verbal/observer-rated pain scale?

Answer:

The studies identified by this evidence summary do not report adequate data to support the clinical effectiveness of observational pain assessment tools in older adults with dementia. As noted in the conclusions of the majority of studies, these tools are currently at the development stage and initial data on their psychometric properties and correlation with other methods of pain assessment support the need for further research. There is some evidence, from one small, poorly reported study, that the Pain Assessment in Advanced Dementia (PAINAD) scale may provide a sensitive method for detecting pain as the cause of observed behaviour, however, the high false-positive rate indicates that it frequently detects other sources of distress rather than pain.