Abbey Pain Scale for Dementia Patients
Assesses pain levels in advanced dementia patients or those with communication difficulties.
Refer to the text below the calculator for more information on the Abbey scale and its usage.
The Abbey Scale is used in the pain assessment of patients with severe dementia and potentially in pain, also that who are not verbally able to express and describe the symptoms they experience and their severity.
This assessment is part of an overall pain management plan and should be accompanied by a comprehensive examination to assess for physical injuries, vital signs and sources of potential pain (for example, neuropathic pain).
This is a standardized pain assessment tool that consist of movement based observations in 6 areas, that are each scored with 0 to 3. The scores are then summed to produce the final result.
Abbey Scale Score Interpretation:
Scores ≤2 indicate no pain.
Scores 3-7 indicate mild pain.
Scores 8-13 indicate moderate pain.
Scores ≥14 indicate severe pain.
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About the Abbey Pain Scale
The APS is a standardized pain assessment tool developed by Abbey et al. for use in patients suffering from end-stage severe dementia, who are unable to verbalize their pain level and severity.
This is a standardized pain assessment tool that consist of movement based observations (so assessment should take place whilst patient is moved or during some procedure) in six areas (vocalization, facial expression, body language, behavioral, physiological and physical changes), that are each scored with 0 to 3. The points are then summed to produce the final score.
Abbey Scale Score Interpretation
Scores ≤2 indicate no pain.
Scores 3-7 indicate mild pain.
Scores 8-13 indicate moderate pain.
Scores ≥14 indicate severe pain.
This assessment is part of an overall pain management plan and should be accompanied by a comprehensive examination to assess for physical injuries, vital signs and sources of potential pain (for example, neuropathic pain).
The scale does not differentiate between distress and pain, so measuring the effectiveness of pain-relieving interventions is essential and a second evaluation should be conducted one hour after any intervention taken in response to the initial application of the scale, to evaluate the effectiveness of any pain-relieving intervention.
If, at this assessment, the score on the pain scale is the same, or worse, further intervention should be considered. The scale should be completed hourly until a mild score is obtained, then 4 hourly for 24 hours. Further pain evaluation should take place if patient pain and/or distress persists.
The scale has been subsequently validated in studies such as that of Lu et al. where the Pain Assessment IN Advanced Dementia (PAINAD) and the Abbey Pain Scale (APS) appeared to be more reliable and valid than other scales for assessing osteoarthritic pain while using an exercise program among elderly people.
The APS has been incorporated into Australian pain guidelines and is recommended by researchers a part of formalized pain assessment in dementia sufferers.
The Danish version showed good inter-rater reliability and the Japanese version reported good reliability.
References
Original reference
Abbey J, et al. The Abbey pain scale: a 1-minute numerical indicator for people with end-stage dementia. Int J Palliat Nurs. 2004 Jan;10(1):6-13
Validation
Liu JY, et al. The psychometric qualities of four observational pain tools (OPTs) for the assessment of pain in elderly people with osteoarthritic pain. J Pain Symptom Manage. 2010 Oct;40(4):582-98.
Gregersen M, Melin AS, Nygaard IS, Nielsen CH, Beedholm-Ebsen M. Reliability of the Danish Abbey Pain Scale in severely demented and non-communicative older patients. Int J Palliat Nurs. 2016. 22;10:482-488.
Takai Y, Yamamoto-Mitani N, Chiba Y, Nishikawa Y, Hayashi K, Sugai Y. Abbey Pain Scale: development and validation of the Japanese version. Geriatr Gerontol Int. 2010.10;2:145-53.
Other references
Lichtner V, Dowding D, Esterhuizen P, Closs SJ, Long AF, Corbett A, Briggs M. Pain assessment for people with dementia: a systematic review of systematic reviews of pain assessment tools. BMC Geriatr. 2014; 14: 138.
Specialty: Pain Management
Objective: Assessment
Type: Scale
No. Of Items: 6
Year Of Study: 2004
Abbreviation: APS
Article By: Denise Nedea
Published On: April 20, 2020 · 12:00 AM
Last Checked: April 20, 2020
Next Review: April 20, 2025