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To compensate for poor acute pain detection in elderly inpatients with inability to communicate verbally (ICV), the Doloplus Collective team devised the 5-item Algoplus(R) behavior-assessment scale specifically aimed at quickly detecting acute pain in these individuals. Algoplus(R) was developed in three successive phases, including expert opinions, caregivers interviews, patient video recordings and statistical procedures. Among the 1500 recorded primary pain behaviors, 48 were selected and clustered into a 5-item scale. This version was validated based on 349 old inpatients (204 with acute pain and 145 without) from different care settings and hospitals. Comparators were objective acute pain clinical situations, experts' clinical judgment on acute pain presence, and self-rating scales (Visual Analog Scale, Numeric Rating Scale and Verbal Descriptor Scale) for a communicative subsample (n=134). Algoplus(R) showed good discriminant validity with adequate internal consistency (Kuder-Richardson-20, 0.712), excellent interrater reliability (intraclass coefficient, 0.812) and high sensitivity to change during specific pain situations and after starting pain management. Excellent correlations were observed between Algoplus(R) and experts' clinical judgment, acute pain clinical situations or each comparator self-rating-pain score. For patients with acute pain conditions, a score 2 out of 5 on the Algoplus(R) scale was retained as the threshold for the presence of acute pain in elderly ICV inpatients, with 87% sensitivity and 80% specificity. In addition, the very brief rating time of ~1min is particularly relevant in acute-care settings, where repetitive pain-monitoring is required. [ABSTRACT FROM AUTHOR]

Palliative care is no longer limited to patients with terminal cancer but now includes other diseases at terminal stage such as advanced Alzheimer disease. Accompanying the elderly at the end of life involves medical, psychological and social approaches. The expression of symptoms, and especially that of pain, can be atypical. Medical prescription should take into account both the change in drug metabolism and the more frequent occurrence of side effects in the elderly. Accompanying the patient at the end of life is an increasing part of care in geriatric institutions. Indispensable factors today are adapted personnel, training, specific support and social actualization.