Patient-reported outcome measures to assess pain in older adults with mild-to-moderate cognitive impairment: a scoping review.

OBJECTIVE: Mild-to-moderate cognitive impairments are common and prevalent in 15-20% of adults over the age of 50. People with mild-to-moderate cognitive impairments are often able to complete self-report outcome measures, though may struggle with complex questions. This can be an issue when reporting pain, which is typically assessed through patient-reported outcome measures. The aim of this scoping review was to determine which patient-reported outcomes measures have been used to assess pain in older adults with mild-to-moderate cognitive impairments. A secondary aim included examining definitions of mild-to-moderate cognitive impairments in included studies. METHODS: A scoping review study design was used to answer the research question. Electronic databases were searched (Medline, CINAHL, Embase, Emcare, APAPsychInfo) to identify relevant articles. RESULTS: The database search identified 8489 distinct articles. Of the 126 full-text articles examined for eligibility, 33 met the inclusion criteria. The included studies used 35 different patient-reported outcomes measures to assess pain. The most commonly used patient-reported outcome measure was the 11-point numerical rating scale, and other variations of a numerical rating scale, verbal descriptor scale, and faces pain scale were commonly used. Most patient-reported outcome measures assessed pain intensity, with few assessing other pain constructs. Definitions of mild-to-moderate cognitive impairment throughout studies were varied and inconsistent. DISCUSSION: The heterogeneity in patient-reported outcomes measures used and lack of multidimensionality within assessments suggests gaps in pain assessment for people with mild-to-moderate cognitive impairments. Future studies should determine which measures are most appropriate for this population and forming better definitions of mild-to-moderate cognitive impairment.