Influence of visual ability on the clinical utility of pain intensity rating scales in the older adult

Pain assessment through use of pain intensity rating scales (PIRSs) is a key to pain management in the older adult. The purpose of this study was to examine the clinical utility (i.e., validity, reliability, ease of use and preference) of six PIRSs with older adults who were hospitalized or in extended care facilities. These four concepts of clinical utility were measured in a convenience sample of 75 individuals age 65 or older. A descriptive, correlational design guided the data collection and analysis. Results were analyzed using nonparametric inferential statistics that included the Median and Friedman tests.

Significant differences were found for reliability, ease of use, and preference between the PIRSs based on Visual Ability Groups classified as low, limited, and normal. Identified sample characteristics (e.g., age ethnicity, gender, and education) were also examined and some significant differences found in relation to clinical utility of the PIRSs. This research indicates that visual ability, as well as individual characteristics such as ethnicity and education, should be considered when choosing a PIRS for the older adult. Findings demonstrated that the Visual Number Scale and the Verbal Descriptor Scale are the most appropriate assessment scales for this age group. The Faces Pain Scale and the FACES scale would be recommended for use when this is a preferred scale and the older adult indicates ability to both visualize and use this form of scale. The Verbal Number Scale was only recommended for use when vision was so poor that the visual-type scales could not be seen. The Visual Analogue Scale, due to poor preference ranks and more complicated implementation, is not recommended for this population. Preference was determined to be the most discriminating aspect of clinical utility when choosing a PIRS. A revision of the theoretical model for clinical utility of PIRSs is needed to guide further examination of the numerous factors, including vision, influencing the use and choice of pain assessment rating scales in the older adult population.