Facial Cues Of Pain In Older Adults: Predicting The Accuracy of Observer Pain Ratings

Date
2019-07
Authors
Stopyn, Rhonda Jennifer Nicole
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Faculty of Graduate Studies and Research, University of Regina
Abstract

Even though people with severe dementia have limitations in their ability to communicate subjective states, nonverbal pain cues, such as facial expressions and other behaviours, have been used successfully as a proxy for verbal pain reports. Although these cues have been shown to be valid in standardized assessments of pain, the extent to which observers, such as caregivers of older adults, rely on specific pain-related facial responses (e.g., movements of the eyes or the mouth) when judging pain remains unclear. Undergraduate student observers viewed three types of videos of individuals expressing pain (younger patients, older patients without dementia, and older patients with dementia) while wearing an eye tracker device that recorded their viewing behaviours. Participants, who were not specifically informed which stimulus patients had dementia and which stimulus patients did not have dementia, provided pain ratings for each patient and indicated whether or not they believed each patient had dementia. Observers assigned higher pain ratings to older adults compared to younger adults and assigned the highest pain ratings to patients with dementia. They also assigned higher pain ratings to older adults whom they subjectively classified as appearing to have dementia than to the remaining older adult patients. Younger adults were assigned more accurate pain ratings (i.e., ratings that corresponded to validated behavioural observation system scores) compared to older adults. Older adults with and without dementia were assigned equally accurate pain scores. Observer pain accuracy scores were also examined in relation to observer impressions about whether or not each patient had dementia. Findings were varied such that observer pain accuracy scores were indicative of both higher and lower accuracy for older adults whom they believed had dementia depending on which validated behavioural observation system was compared. Demographic variables and attention to specific areas of the face (e.g., brows, eyes, mouth) did not predict observer pain accuracy scores for any of the three video conditions. Similar results were found for observer pain accuracy scores based on participants’ impressions about whether or not each patient had dementia. These results add clarity to theoretical predictions concerning the way in which observers decode non-verbal pain expressions in others.

Description
A Thesis Submitted to the Faculty of Graduate Studies and Research In Partial Fulfillment of the Requirements for the Degree of Master of Arts in Clinical Psychology, University of Regina. x, 147 p.
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