Why was the study done?
Research has shown that we can usually tell if someone with dementia is in pain by observing their facial expressions (such as grimacing). However, we do not know how much caregivers rely on these facial expressions when assessing whether people with dementia are experiencing pain.
The aim of this study was to find out which facial pain reactions are noticed the most by observers and how these facial cues are used when assessing pain in healthy people versus those with dementia, and in younger people versus older people.
We expected that our findings would help us understand whether we can assess pain in older adults with dementia by observing their facial reactions in the same way we can assess facial reactions of younger people with pain.
How was the study done?
This study involved 164 university student volunteers who watched videos of three groups of people experiencing pain. Our groups were:
• younger adults
• older adults without dementia
• older adults with dementia.
We used a special coding system to ensure that people included in all three groups in our videos had similar facial expressions of pain.
Each student observer wore an eye tracker (a device that records which parts of the face they watched). This helped us determine whether the students focused more on the eye or mouth or other areas of the face as they rated each person’s pain.
What were the study results?
Our students did not observe or recognize facial pain cues in dementia patients as consistently as they did for the other two groups.
The pain ratings for the older patients were also less accurate than pain ratings were for the younger patients.
These findings suggest that untrained student observers who evaluate pain in older adults, including dementia patients, are not as accurate as when they are evaluating pain in younger people. Perhaps their ability to evaluate pain can be improved by training caregivers to observe and recognize facial pain cues in these patients.
Better pain assessment can improve our ability to manage pain in people with dementia.