Usability Testing of the iPhone App to Improve Pain Assessment for Older Adults with Cognitive Impairment (Prehospital Setting): A Qualitative Study.

Objectives: Pain assessment in older adults with cognitive impairment is often challenging, and paramedics are not given sufficient tools/training to assess pain. The development of a mobile app may improve pain assessment and management in this vulnerable population. We conducted usability testing of a newly developed iPhone pain assessment application with potential users, in this case as a tool for clinical paramedic practice to improve pain assessment of older adults with cognitive impairment. Methods: We conducted usability testing with paramedic students and a Delphi panel of qualified paramedics. Participants studied the app and paper-based algorithm from which the app was developed. The potential use for the app was discussed. Usability testing focus groups were recorded, transcribed verbatim, and analyzed using a thematic approach. Proposed recommendations were disseminated to the Delphi panel that reviewed and confirmed them. Results: Twenty-four paramedic students from two UK ambulance services participated in the focus groups. Usability of the app and its potential were viewed positively. Four major themes were identified: 1) overall opinion of the app for use in paramedic services; 2) incorporating technological applications into the health care setting; 3) improving knowledge and governance; and 4) alternative uses for the app. Subthemes were identified and are presented. Discussion: Our results indicate that the pain assessment app constitutes a potentially useful tool in the prehospital setting. By providing access to a tool specifically developed to help identify/assess pain in a user-friendly format, paramedics are likely to have increased knowledge and confidence in assessing pain in patients with dementia.

Pain interference is associated with psychological concerns related to falls in community-dwelling older adults: multisite observational study.

BACKGROUND: Pain interference and psychological concerns related to falls (PCRF) are pervasive phenomena among community-dwelling older adults, yet their association remains elusive. OBJECTIVE: The purpose of this study was to establish whether pain interference is associated with PCRF in community-dwelling older adults. DESIGN: This was a multisite cross-sectional study. METHOD: Two hundred ninety-five community-dwelling older adults (mean age=77.5 years, SD=8.1; 66.4% female) participated in the study. All participants completed the Brief Pain Inventory (BPI) interference subscale, Short Falls Efficacy Scale-International (FES-I), Activities-specific Balance Confidence Scale (ABC), modified version of the Survey of Activities and Fear of Falling in Elderly Scale (mSAFFE), and Consequences of Falling Scale (CoF). Hierarchical multiple regression analysis were conducted. In the first step of the study, sociodemographic and known risk factors for psychological concerns related to falls were inserted into the model, followed by the BPI interference subscale score in the second step. RESULTS: One hundred sixty-nine participants (57.3%) reported some pain interference. The BPI interference subscale was highly correlated with all PCRF (r>.5, P<.0001). After the adjustment for established risk factors, the BPI interference subscale significantly increased the variance in the Short FES-I (R2 change=13.2%), ABC (R2 change=4.7%), mSAFFE (R2 change=5.0%), and CoF (R2 change=10.0%). Pain interference was a significant and independent predictor in the final model for the Short FES-1 (ß=0.455, P<.001), ABC (ß=-0.265, P<.001), mSAFFE (ß=0.276, P<.001), and CoF (ß=0.390, P<.001). LIMITATIONS: The study was cross-sectional. CONCLUSIONS: Pain interference is an important contributing factor in each of the psychological concerns related to falls. Pain interference had the strongest impact on reducing falls efficacy and increasing older adults' concerns about the consequences of falling.