EFFICACY OF THE PAINAD SCALE FOR PAIN ASSESSMENT IN ELDERLY PATIENTS WITH ADVANCED DEMENTIA: A NARRATIVE REVIEW

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INTRODUCTION The rise of the elderly population increases the prevalence of dementia syndromes, which are characterized by cognitive, behavioral and fun ctional deterioration. This scenario challenges healthcare services, especially regarding pain management, as approximately 50% to 80% of residents in long-term care facilities experience recurrent pain. Due to the patient’s progressive communication decline, pain often remains underdetected and undertreated. The Pain Assessment in Advanced Dementia (PAINAD) scale is a nonverbal pain assessment tool developed to address this problem. OBJECTIVE This narrative review aims to evaluate the efficacy of the Pain Assessment in Advanced Dementia (PAINAD) scale for pain assessment in elderly patients with advanced dementia unable to self - report, comparing it to standard clinical observation. MATERIALS AND METHODS This narrative literature review was based on a quali tative and descriptive analysis of scientific publications retrieved from PubMed and Google Scholar. A foundational 2006 source was included to assess the historical baseline and the early clinical demand for observational instruments. Furthermore, studies from 2011 to 2016 were required to analyze the development of the PAINAD scale in comparison with recent literature (2018 -2024). This timeline was expanded due to the scarcity of specific clinical data within the last five years. The final selection crite ria included clinical trials, systematic reviews, validation studies, and international guidelines addressing the use of the PAINAD scale in elderly patients with advanced dementia and impaired communication. RESULTS AND DISCUSSION Early studies indicated that PAINAD presented significant limitations, such as small sample sizes and inconsistent findings, in addition to low specificity for pain and high false-positive rates. Nevertheless, this tool has recently demonstrated high clinical applicability due to its didactic and brief nature, as well as its high sensitivity for pain. PAINAD also shows high rates of inter -rater reliability, construct validity and reproducibility, including its adaptation to Brazilian Portuguese. Evidence from clinical trials shows that systematic pain management guided by such tools can lead to a 17% reduction in agitation levels, proving that many behavioral symptoms are manifestations of physical distress. In comparison to non-standardized clinical observation, the systematic use of the scale provided better detection of pain -related behavior, such as restlessness. Consequently, addressing this situation with proper pain management contributes to more accurate intervention and reduction in agitation and negative vocalizations. Whi le international guidelines recommend the use of standardized observational tools in advanced dementia patients unable to self-report, the PAINAD scale is frequently highlighted by studies as a promising instrument. CONCLUSION The analyzed studies emphasize the importance of pain assessment, especially in patients unable to self- report their suffering. Stigmas associated with advanced dementia also interfere with the treatment process, as agitation and restlessness - which may stem from pain - are often mis interpreted as inherent symptoms of their condition. This leads to the inappropriate prioritization of antipsychotics for such manifestations. Therefore, the PAINAD scale is essential for pain management for non -verbal elderly patients. Without the standar dization provided by this tool, healthcare professionals may underestimate pain, confusing it with dementia symptoms and, consequently, adopting inadequate clinical interventions.