Pain assessment in nursing home residents poses challenges since many of th
ese individuals are too cognitively impaired to respond to traditional self
-report instruments. Assessment of pain behavior in this population offers
a logical alternative. The purpose of this study was to compare perceptions
of behaviors identified as being pain-related in 42 nursing home residents
with chronic pain, as reported by residents themselves, their nursing home
caregivers and their family caregivers. Our specific research agenda was t
o identify the most salient behaviors that signal pain in nursing home resi
dents; to determine the test-retest agreement of residents' self-perceived
pain behaviors; to learn of the confidence that caregivers feel regarding a
ssessment of residents' pain behavior; and to examine the agreement between
caregivers and residents about pain behaviors in particular residents. We
also wanted to compare residents' and caregivers' ratings of the residents'
pain intensity. Finally, we explored the beliefs of nursing home staff abo
ut the influence of dementia on pain and pain assessment. Twenty-two of 26
pain-related behaviors identified by residents showed fair to perfect test-
retest agreement (kappas 0.40-1). For the vast majority of pain-related beh
avior items, kappas for resident-caregiver agreement were <0.30. Agreement
with regard to pain intensity was similarly poor (r = -0.19-0.34). Confiden
ce in pain rating was high for both nurse (on average, 7.2 on a scale of 0-
10) and family (on average, 6.7) caregivers. Seventy-one percent of nurses
felt that pain assessment is more difficult in demented individuals, but th
at cognitive function does not influence pain prevalence. While nursing hom
e residents with chronic pain and their caregivers have different perceptio
ns regarding which behaviors are pain-related, additional studies are requi
red to determine the underpinnings of these differing perceptions and to de
termine the extent to which formal pain behavior observation protocols will
be useful for evaluating nursing home residents with chronic pain. (C) 199
9 International Association for the Study of Pain. Published by Elsevier Sc
ience B.V.