Hurley et al evaluated discomfort in Alzheimer patients with advanced dementia. They developed a scale that can be used to assess the discomfort and to monitor it over time.
(1) noisy breathing
(2) negative vocalizations (moaning, etc)
(3) sad facial expression
(4) frightened facial expression
(6) tense body language
(8) content facial expression
(9) relaxed body language
(1) The patient is observed for 5 minutes.
(2) Each parameter is assessed for frequency, duration and intensity.
Points for Items 1 to 7
Points for Items 8 and 9
not at all
sometimes AND mild to moderate
almost all of the time OR severe
almost all of the time AND severe
• Body language tense and body language relaxed cannot both be all of the time.
• Other scores would approach the intensity and frequency issue by scoring each separately and then multiplying the values.
total score =
= SUM(points for all 9 parameters)
• minimum score: 0
• maximum score: 27
• The higher the score the greater the perceived discomfort.
• More accurate scoring can be done by someone familiar with the patient. Some of the manifestations may be manifestations of advanced dementia (like moaning).
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