• Alice Jordan, Claud Regnard, John T O'Brien, and Julian C Hughes.
• Northumbria Healthcare NHS Foundation Trust, UK. ajordan@hartlepoolhospice.co.uk
• Palliat Med. 2012 Oct 1;26(7):873-8.

ObjectiveThere is a concern that pain is under-recognized in dementia. However, there may be other causes of distress. We wished to evaluate the utility of a distress tool and a pain tool.MethodsNursing home residents with advanced dementia were observed using pain (Pain Assessment in Advanced Dementia scale (PAINAD)) and distress (Disability Distress Assessment Tool (DisDAT)) assessment tools. Those in pain were treated. Reassessment occurred at one and three months.ResultsFrom 79 participants, 13 were assessed as being in pain. Psychosocial factors explained the behaviour of a false positive group. Both tools showed a significant decrease in pain following intervention (p = 0.008). Behaviours were similar in both groups.ConclusionsBoth tools are useful. However, the pain tool also picks up distress, which is not caused by pain. It could potentially lead to false ascriptions of pain. The distress tool picks up a broader array of signs, which may be useful both in practice and in research.

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