Pain Assessment Checklist for Seniors with Limited Ability to Communicate – English

Abstract

The Pain Assessment Checklist for Seniors with Limited Ability to Communicate – Dutch (PACSLAC-D) is a specialized observation list designed for the estimation and assessment of pain in individuals who possess severely limited or no verbal communication capabilities. This target population primarily includes older adults suffering from dementia or an intellectual disability.

Originating from the Canadian PACSLAC, the Dutch translation was rigorously refined through further research, resulting in a significantly shortened version containing 24 items, down from the original 60. These items represent specific behavioral manifestations and expressions that are indicative of pain. The PACSLAC-D is intended for use in crucial clinical moments, including baseline measurements upon transfer of a new client, during observed changes in behavior, when pain is suspected, or following therapeutic interventions such as pain medication administration.

Keywords

PACSLAC-D, Pain Assessment Checklist, Pain assessment, Geriatrics, Non-verbal communication, Dementia, Intellectual disability, Observational scale, Zwakhalen, Sensory functions.

Authors

Fuchs-Lacelle S, Hadjistavropoulos T (2004) (Original PACSLAC); Chan S, et al. (2014) (Shortened version PACSLAC-II); Zwakhalen SMG (2007) (Dutch version).

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Purpose

The primary purpose of the PACSLAC-D is to facilitate accurate and objective pain detection in vulnerable populations who cannot reliably self-report their pain experience due to significant cognitive impairment or communication limitations. By standardizing the observation of pain-related behaviors, the instrument aims to reduce the risk of under-treatment of pain in older adults, particularly those with advanced dementia or complex intellectual disabilities.

The scale provides a structured framework for clinicians and caregivers to monitor behavioral changes across various circumstances. Specific situations necessitating the use of PACSLAC-D include initial assessment upon transfer to a new living environment (serving as a critical baseline), monitoring behavioral shifts that may signal underlying distress, confirming suspicions of pain, and evaluating the efficacy of pain management interventions, such as the introduction or adjustment of analgesic medication.

Construct

The PACSLAC-D measures the psychological and physiological construct of observable pain behavior. This construct encompasses the non-verbal and physical manifestations that substitute for verbal self-report in individuals with limited communication skills. The instrument focuses on interpreting behavioral cues as direct indicators of pain presence and intensity.

The 24 items contained within the PACSLAC-D are clustered into categories representing various domains of pain expression. These domains typically include facial expressions (e.g., grimacing, furrowed brow), body movements and posture (e.g., guarding, rigid limbs), changes in activity level (e.g., refusing to eat, increased restlessness), and vocalizations (e.g., moaning, crying, though these are often minimal or non-specific in the target group). The instrument provides an operationalized definition of pain based purely on these observable external signals.

Validity

While specific validity data for the Dutch version (Zwakhalen, 2007) relies on underlying studies of the original PACSLAC and PACSLAC-II, observational pain scales generally prioritize strong criterion validity. This involves demonstrating that the PACSLAC-D scores correlate highly with pain judgments made by expert clinicians who specialize in geriatric pain management. Furthermore, research supporting the PACSLAC-II (Chan et al., 2014) has focused on ensuring content validity, confirming that the 24 retained items comprehensively cover the necessary spectrum of pain behaviors relevant to the cognitively impaired population.

Reliability

For any observational scale, inter-rater reliability is a paramount concern, ensuring that different observers (e.g., nurses, aides, family members) score the same behavior consistently. Studies supporting the PACSLAC and its derivatives typically report acceptable to high levels of inter-rater reliability, suggesting that the behavioral definitions provided in the manual (see PDF links below) are clear and unambiguous. Internal consistency (e.g., Cronbach’s alpha) is also assessed to verify that the 24 items measure a unified underlying construct of pain.

Factor Analysis

The significant reduction of the original PACSLAC from 60 items to 24 items in the PACSLAC-II, upon which the PACSLAC-D is based, was achieved through rigorous factor analysis. This statistical methodology was used to identify distinct, empirically derived factors or domains of pain behavior, eliminating redundant or non-discriminating items. Typically, factor analysis segments the items into categories such as:

• Facial Expressions
• Activity/Body Language
• Physiological/Vegetative Changes
• Vocalizations (Non-speech)

This process ensures that the final 24-item scale is efficient, minimizing observer burden while maximizing the clinical utility and explanatory power of the instrument across the identified behavioral domains.

Instrument

Test Type: Observation Checklist

Format: 24 Items (Shortened version based on PACSLAC-II), rated by an external observer (e.g., caregiver or clinician) based on behavioral manifestations.

Language Available: Dutch (Nederlandse versie).

Population Group: Older adults (Seniors) and individuals with cognitive impairment.

Age Group: Geriatric population.

Population Details: Individuals suffering from mental deterioration (e.g., dementia) or psychological disorders, often requiring assessment related to sensory functions and pain, particularly concerning the head/neck and general body regions.

Test Methodology: Structured behavioral observation over a specific time interval, followed by scoring the presence or absence of the 24 defined pain indicators. The total score indicates the likelihood and severity of pain.

Keywords

Behavioral observation, Cognitive impairment, Geriatric pain, Non-verbal pain, PACSLAC-D, Zwakhalen SMG, Observatie, Mentale achteruitgang.

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Authors

Author ORCID Identifier: Not specified in source material.

Affiliation Email addresses: Not specified in source material.

Correspondence Address: Not specified in source material.

Permissions & Fee and Test Year

The original PACSLAC was published in 2004 (Fuchs-Lacelle & Hadjistavropoulos). The Dutch translation and adaptation (PACSLAC-D) was introduced in 2007 by Zwakhalen SMG. The shortened version (PACSLAC-II) that informed the current 24-item structure was published in 2014 (Chan et al.). Information regarding specific permissions for commercial use or associated testing fees must be obtained directly from the respective authors or copyright holders.

Reference’s

The core references for the development and validation of the PACSLAC family of instruments include:

• Fuchs-Lacelle S, Hadjistavropoulos T (2004). Development and preliminary validation of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC).
• Zwakhalen SMG (2007). Development and validation of the Dutch version (PACSLAC-D).
• Chan S, et al. (2014). Development and evaluation of the PACSLAC-II, a shortened version of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate.

The original documentation related to the Dutch version (PACSLAC-D) is available via the following PDF links:

• The original Explanation Form (Toelichtingsformulier) can be downloaded here: Toelichtingsformulier PDF
• The original Measurement Instrument (Meetinstrument) can be downloaded here: Meetinstrument PDF
• The original Manual (Handleiding) can be downloaded here: Handleiding PDF

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Items of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate – Dutch

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The specific 24 items of the PACSLAC-D are contained within the official Measurement Instrument document, which is accessible via the PDF link provided in the Reference’s section above. The source content does not list the individual items directly.