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.


1Vocalization

E.g. whimpering, groaning, crying

2Facial expression

E.g. looking tense, frowning grimacing, looking frightened

3Body language

E.g. fidgeting, rocking, guarding part of body, withdrawn

4Behavioral change

E.g. increased confusion, refusing to eat, alteration in usual patterns

5Physiological changes

E.g. temperature, pulse or blood pressure outside normal limits, perspiring, flushing or pallor

6Physical changes

E.g. skin tears, pressure areas, arthritis, contractures, previous injuries
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1. Fill in the calculator/tool with your values and/or your answer choices and press Calculate.

2. Then you can click on the Print button to open a PDF in a separate window with the inputs and results. You can further save the PDF or print it.

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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

Last Checked: April 20, 2020

Next Review: April 20, 2025