***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The purpose of this study was to examine the psychometric properties ( test-retest and interrater reliability , criterion concurrent validity ) of 3 verbal pain- assessment tools ( Faces Pain Scale , Numerical Rating Scale , Present Pain Intensity Scale )  and a behavioural pain- assessment scale for use with an elderly population . The study used a repeated- measures design to examine the reliability and validity of the tools across 4 groups of participants with varying levels of cognitive impairment using a non-r and om stratified sample of 130 elderly long-term-care residents . The findings support the test-retest and interrater reliability of the  behavioural pain- assessment tool  across all levels of cognitive impairment , whereas the same measures of reliability for the verbal-report tools decreased with increasing cognitive impairment ; however , the majority of elderly with mild to moderate cognitive impairment were able to complete at least 1 of these tools . The findings are discussed in relation to their clinical and research implication BACKGROUND Nursing homes ( NHs ) are less well studied than hospices or hospitals as a setting for terminal care . For more targeted palliative care , more information is needed about the patient characteristics , symptoms , direct causes and underlying diseases , and incidence of terminally ill NH patients . These aspects are examined in this study . METHODS Prospect i ve observational cohort study in 16 NHs representative of the Netherl and s. All long-term care patients assessed by an NH physician to have a life expectancy of 6 weeks or less were enrolled in our study . RESULTS The terminal disease phase was marked with symptoms of low fluid and food intake , general weakness , and respiratory problems or dyspnea . Direct causes of these conditions were diseases of the respiratory system ( mainly pneumonia ) and general disorders ( eg , cachexia ) . The 2 main underlying diseases of the terminal phase were mental and behavioral disorders and diseases of the circulatory system . Cancer was the underlying disease in only 12 % of the patients . Patients with cancer showed a different pattern of symptoms than those without cancer . Per 100 beds per year , 34 NH patients entered the terminal phase . Most patients ( 82.9 % ) died within 7 days of inclusion . CONCLUSIONS For patients without cancer in Dutch NHs , the terminal disease phase is difficult to predict , and once diagnosed , patient survival time is short . A better identification of the symptom burden might improve the prognostication of life expectancy in elderly patients The aim of this study was to assess the  Palliative care Outcome Scale ( POS ) for terminally ill nursing home ( NH ) patients in the Netherl and s. Methods : A prospect i ve observational study of patients with a life-expectancy of six weeks or less in 16 Dutch NHs . NH staff rated the patient characteristics and measured palliative care with the POS , including items on physical , psychosocial , informational , spiritual and practical aspects . Results : POS nonscores ( not applicable ; unknown ) were mainly found in the psychosocial and spiritual domains , particularly in patients with dementia . Mean scores for non-demented patients and patients with dementia were favourable for the majority of the POS items . Conclusion : According to the NH staff , fairly good quality care was provided , but the psychosocial and spiritual aspects of care need to be addressed more in the last days of the dying NH patient 's life . The results indicate that the POS is an appropriate instrument to assess not only cancer patients , but also non-cancer and ( moderately ) severely demented patients Pain is a common problem for many older adults , with up to 50 % of community-dwelling and 70 % to 80 % of nursing home residents experiencing pain regularly . Effective  pain  management requires thorough assessment , appropriate intervention , and systematic re assessment . Pain assessment , however , is complicated by dementia , which impairs memory , reasoning , recognition , and communication , and affects elders ' ability to verbally report pain . As such , observational measures are needed to assess pain in this vulnerable population . The Non-communicative Patient 's Pain Assessment Instrument ( NOPPAIN ) was developed for this purpose , but more validation of this measure is needed . Thus , the purpose of this study was to ( 1 ) evaluate reliability of the NOPPAIN tool when used by nurses and to ( 2 ) compare NOPPAIN ratings with self-report and other well-established behavioral rating procedures . Forty participants ( 20 cognitively intact and 20 impaired ) were r and omly selected for this study from a larger sample . In the parent study , participants were asked to perform everyday activities ( i.e. , sit , st and , walk in place , transfer in and out of bed ) while being videotaped . The tapes , all previously scored using microanalytic observational coding , were rated again by naïve raters using the NOPPAIN measure . Results indicated ( 1 ) high inter- and intrarater reliability of the NOPPAIN and ( 2 ) significant correlations of the NOPPAIN with self-reported pain and detailed behavioral coding . Findings support the reliability and validity of the NOPPAIN measurement tool and suggest this easy-to-use tool may be adequate for measuring pain indicators in older adults The Neuropsychiatric Inventory ( NPI ) is a vali date d clinical instrument for evaluating psychopathology in dementia . The authors developed a brief question naire form of the NPI ( NPI-Q ) , intended for use in routine clinical practice , and cross-vali date d it with the NPI in 60 Alzheimer 's patients .  Test-retest reliability of the NPI-Q was acceptable . The prevalence of analogous symptoms reported on the NPI and NPI-Q differed on average by 5 % ; moderate or severe symptom ratings differed by less than 2 % . The NPI-Q provides a brief , reliable , informant-based assessment of neuropsychiatric symptoms and associated caregiver distress that may be suitable for use in general clinical practice & NA ; With the increasing numbers of older adults in our population , nurses are reexamining all aspects of nursing care in order to best meet the needs of these individuals . Normal age changes , the impact of decades of environmental challenges , successful adaptations , acute illnesses , trauma and chronic illnesses combine to create a challenge for accurate and effective assessment of elderly patients . The nurse finds her assessment skills challenged with increasing frequency by the elderly patient who is also acutely confused and experiencing discomfort . The purpose of this study was to explore the clinical utility , validity and reliability of four different approaches to nursing assessment of discomfort with this particularly vulnerable group of elders BACKGROUND depression is common but under-diagnosed in nursing-home residents . There is a need for a st and ardized screening instrument which incorporates daily observations of nursing-home staff . AIM to develop and vali date a screening instrument for depression using items from the Minimum Data Set of the Resident Assessment Instrument . METHODS we conducted semi-structured interviews with 108 residents from two nursing homes to obtain depression ratings using the 17-item Hamilton Depression Rating Scale and the Cornell Scale for Depression in Dementia . Nursing staff completed Minimum Data Set assessment s. In a r and omly assigned derivation sample ( n = 81 ) , we identified Minimum Data Set mood items that were correlated ( P < 0.05 ) with Hamilton and Cornell ratings . These items were factored using an oblique rotation to yield five conceptually distinct factors . Using linear regression , each set of factored items was regressed against Hamilton and Cornell ratings to identify a core set of seven Minimum Data Set mood items which comprise the Minimum Data Set Depression Rating Scale . We then tested the performance of the Minimum Data Set Depression Rating Scale against accepted cut-offs and psychiatric diagnoses . RESULTS a cutpoint score of 3 on the Minimum Data Set Depression Rating Scale maximized sensitivity ( 94 % for Hamilton , 78 % for Cornell ) with minimal loss of specificity ( 72 % for Hamilton , 77 % for Cornell ) when tested against cut-offs for mild to moderate depression in the derivation sample . Results were similar in the validation sample . When tested against diagnoses of major or non-major depression in a subset of 82 subjects , sensitivity was 91 % and specificity was 69 % . Performance compared favourably with the 15-item Geriatric Depression Scale . CONCLUSION items from the Minimum Data Set can be organized to screen for depression in nursing-home residents . Further testing of the instrument is now needed Purpose Quality of care for long-term care ( LTC ) residents with dementia at the end-of-life is often evaluated using st and ardized instruments that were not developed for or thoroughly tested in this population . Given the importance of using appropriate instruments to evaluate the quality of care ( QOC ) and quality of dying ( QOD ) in LTC , we compared the validity and reliability of ten available instruments commonly used for these purpose s. Methods We performed prospect i ve observations and retrospective interviews and surveys of family ( n = 70 ) and professionals ( n = 103 ) of LTC decedents with dementia in the Netherl and s. Results Instruments within the constructs QOC and QOD were highly correlated , and showed moderate to high correlation with overall assessment s of QOC and QOD . Prospect i ve and retrospective ratings using the same instruments differed little . Concordance between family and professional scores was low . Cronbach ’s alpha was mostly adequate . The EOLD – CAD showed good fit with pre-assumed factor structures . The EOLD – SWC and FPCS appear most valid and reliable for measuring QOC , and the EOLD – CAD and MSSE for measuring QOD . The POS performed worst in this population . Conclusions Our comparative study of psychometric properties of instruments allows for informed selection of QOC and QOD measures for LTC residents with dementia Objective To determine whether a systematic approach to the treatment of pain can reduce agitation in people with moderate to severe dementia living in nursing homes . Design Cluster r and omised controlled trial . Setting 60 clusters ( single independent nursing home units ) in 18 nursing homes within five municipalities of western Norway . Participants 352 residents with moderate to severe dementia and clinical ly significant behavioural disturbances r and omised to a stepwise protocol for the treatment of pain for eight weeks with additional follow-up four weeks after the end of treatment ( 33 clusters ; n=175 ) or to usual treatment ( control , 27 clusters ; n=177 ) . Intervention Participants in the intervention group received individual daily treatment of pain for eight weeks according to the stepwise protocol , with paracetamol ( acetaminophen ) , morphine , buprenorphine transdermal patch , or pregabaline . The control group received usual treatment and care . Main outcome measures Primary outcome measure was agitation ( scores on Cohen-Mansfield agitation inventory ) . Secondary outcome measures were aggression ( scores on neuropsychiatric inventory-nursing home version ) , pain ( scores on mobilisation-observation-behaviour-intensity-dementia-2 ) , activities of daily living , and cognition ( mini-mental state examination ) . Results Agitation was significantly reduced in the intervention group compared with control group after eight weeks ( repeated measures analysis of covariance adjusting for baseline score , P<0.001 ) : the average reduction in scores for agitation was 17 % ( treatment effect estimate −7.0 , 95 % confidence interval −3.7 to −10.3 ) . Treatment of pain was also significantly beneficial for the overall severity of neuropsychiatric symptoms ( −9.0 , −5.5 to −12.6 ) and pain ( −1.3 , −0.8 to −1.7 ) , but the groups did not differ significantly for activities of daily living or cognition . Conclusion A systematic approach to the management of pain significantly reduced agitation in residents of nursing homes with moderate to severe dementia . Effective management of pain can play an important part in the treatment of agitation and could reduce the number of unnecessary prescriptions for psychotropic drugs in this population . Trial registration Clinical Trials.gov NCT01021696 and Norwegian Medicines Agency EudraCTnr 2008 - 007490 - 20 A method for assessing affect states among older people with Alzheimer 's disease was developed for use in a study design ed to evaluate a special care unit for such residents of a nursing home . The 6-item  Philadelphia Geriatric Center Affect Rating Scale was design ed for the use of research and other staff in assessing positive affect ( pleasure , interest , contentment ) and negative affect ( sadness , worry/anxiety , and anger ) by direct observation of facial expression , body movement , and other cues that do not depend on self-report , among 253 demented and 43 nondemented residents . Each affect scale was highly reliable , expressed in estimated portions of a 10-minute observation period when the affect expression occurred . Validity estimates were affirmative in showing discriminant correlations between the positive states and various independent measures of social and other outwardly engaged behavior and between negative states and other measures of depression , anger , anxiety , and withdrawal . Limited support for the two-factor dimensionality of the affect ratings was obtained , although positive and negative affect were correlated , rather than independent . Some hope is offered that the preference and aversions of Alzheimer patients may be better understood by observations of their emotional behaviors and that such methods may lead to a better ability to judge institutional quality OBJECTIVES To describe the end-of-life symptoms of nursing home ( NH ) and residential care/assisted living ( RC/AL ) residents , compare staff and family symptom ratings , and compare how staff assess pain and dyspnea for cognitively impaired and cognitively intact residents . DESIGN After-death interviews . SETTING Stratified r and om sample of 230 long-term care facilities in four states . PARTICIPANTS Staff ( n=674 ) and family ( n=446 ) caregivers for dying residents . MEASUREMENTS Interview items measured frequency and severity of physical symptoms , effectiveness of treatment , recommendations to improve care , and staff report of assessment 
    Output:
    
The pain assessment s , PAINAD and PACSLAC had the strongest psychometric evidence .
The oral health , discomfort , and three psychological wellbeing measures were vali date d in this setting but require further psychometric evaluation .
Depression measures were poor at detecting depression in this population .
Conclusions Measures for pain are best developed for this population and setting .