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Abbey Pain Scale for Dementia Patients

Abbeys pain scale is designed for the assessment of pain in severe dementia patients who are unable to clearly articulate their needs.
Whimpering, crying
Absent 0
Mild 1
Moderate 2
Severe 3
Facial expression
Frowning, tense, frightened, grimacing
Absent 0
Mild 1
Moderate 2
Severe 3
Body language
Rocking, fidgeting, withdrawn, guarding
Absent 0
Mild 1
Moderate 2
Severe 3
Physiological changes
Temperature, diaphoresis, pulse or BP elevations, flushing/pallor
Absent 0
Mild 1
Moderate 2
Severe 3
Physical changes
Skin tears, pressure sores, previous injuries, arthritis, contractures
Absent 0
Mild 1
Moderate 2
Severe 3


Measured Factor
Pain Score
Measured Factor Disease
  • Pain
Measured Factor Detail
Abbey pain scale assessment tool provides the description of the severity of pain in dementia patients with calculated scores being classified based on the type of pain such as acute, chronic and acute on chronic. The calculation of score takes into account patient features such as vocalization, facial expression, body language, physical changes and physiological changes.
Pain Management Specialist
Body System
Multiple body systems
Measured Factor Low Impact
  • Pain score 0-2 is indicative of no pain.
Measured Factor High Impact
  • Pain score 3-7 illustrates mild pain
  • 8-13 indicates illustrates moderate pain
  • score more than 14 illustrates severe pain

Result Interpretation

Ranges Ranges
  • Critical High: 3
  • Normal: 0-2
  • Normal Adult Male: 0-2
  • Normal Adult Female: 0-2
  • Normal Geriatric Male: 0-2
  • Normal Geriatric Female: 0-2
Result High Conditions
  • Pain
Test Limitations
This test does not distinguish between distress and pain and it is reliant upon the nursing staff's interpretation of what the patient is experiencing. It has been suggested that The Abbey Pain Scale should be used in conjunction with the Assessment of Discomfort in Dementia (ADD) protocol that focuses on physical assessment,  review of the patient's history,  assessment of affective needs and the administration of analgesics.


Study Validation 1
The study  was conducted on population that consisted of 50 old patients (70+ years), consecutively admitted to the geriatric wards of Aarhus University Hospital, Denmark fulfilling one of the following inclusion criteria: Mini Mental State Examination (MMSE) < 5, delirium, non-communicative aphasia, or unconsciousness. Abbeys pain scale (APS) has six subscales and ranges from 0 (no pain) to 18 (worst pain). Criterion validity was assessed by using Verbal Rating Scale (VRS) as the gold standard. Cohen's kappa (k) was the measure of agreement. The results of the study demonstrated that Abbeys pain assessment scale should be considered as qualified and usable in severely demented and non-communicative older patients admitted to a geriatric ward.
References: 2
Study Validation 2
The Objective of this study was to develop and validate the Japanese version of the Abbey Pain Scale (APS-J), to assess pain of older adults who live in nursing homes in Japan. The data were collected from residents in two nursing homes in Japan to include: demographics, the Barthel Index, Folstein Mini-Mental Examination (MMSE), APS-J and Verbal Descriptor Scale (VDS) for pain. Two researchers independently assessed the residents' pain using the APS-J while the residents walked or were transferred from bed to wheelchair. Intraclass correlation coefficients (ICC) for inter-rater and test-retest reliability, Chronbach's alpha-value of the APS-J, and correlation between the APS-J and other variables were examined. The study evidenced reliability and validity of APS-J.
References: 3
Study Validation 3
The objective of this study was to determine whether these tools can also be used to evaluate intensity of pain. Cognitively intact [Mini Mental State Examination (MMSE) ≥ 24, n = 60] and impaired people (MMSE < 20, n = 65) in nursing home facilities were included in the study. Participants were observed at rest and during a movement protocol. Directly afterwards, the observer, blinded to cognitive status, completed three behavioural pain assessment instruments (Abbey Pain Scale, Pain Assessment in Advanced Dementia Scale (PAINAD), Non-communicative Patients Pain Assessment Instrument (NOPPAIN) ], before interviewing the resident about pain self-report. The outcomes of the study indicated that the use of the Abbey Pain Scale, PAINAD or NOPPAIN improves both the recognition of pain presence/absence as well as rating pain severity in older people with impaired cognition.
References: 4
Study Additional 1
In the present study a 66-year-old man of Mongolian race presented with coronary arteriosclerosis, spinal canal stenosis, transverse colon cancer, and alcoholic encephalopathy. On admission, a tortured expression and abdominal distention were observed, along with emaciation. However, the patient's tortured expression was not completely relieved; therefore, an assessment of cancer pain was considered. The Abbey Pain Scale was applied. On the basis of the patient's score, analgesics and an opioid, among other medications, were administered. These led to relief of the patient's tortured expression and reduced his Abbey Pain Scale score. Following this, the patient's vital signs continued to be stable, and he was transferred to the referral institution. The results of the study indicate that the application of the Abbey Pain Scale assists in the relief of cancer pain.
References: 5
Study Additional 2
Stroke patients can experience a variety of pain. Many stroke patients have comorbidities such as osteoporosis, arthritis or diabetes causing diabetic neuropathy. As well as pain from other long term conditions, stroke patients can experience central post-stroke pain, headaches, and musculoskeletal issues such as hypertonia, contractures, spasticity, and subluxations. These stroke patients can also have communication difficulties in the form of expressive dysphasia and/or global aphasia. By implementing an observational measurement of pain such as the Abbey pain scale, patients with communication difficulties can have their pain assessed and recorded. Initially 30% of patients on the acute stroke ward did not have their pain assessed and adequately recorded and 15% of patients had inadequate pain relief. After introducing the Abbey pain scale and creating a nurse advocate, an improvement was shown such that only 5% of patients did not have their pain recorded and all had adequate pain relief.
References: 6
Study Additional 3
The objective of this study was to  evaluate the relative psychometric merits of the Abbey Pain Scale, the DOLOPLUS-2 Scale, and the Checklist of Nonverbal Pain Indicators Scale, three well-known pain rating scales that have previously been used to assess pain in nonverbal people with dementia. An observational study design was used. Nurses (n = 26) independently rated a cross-section of people with moderate to severe dementia (n = 126) on two occasions. The Abbey Pain Scale and the DOLOPLUS-2 Scale showed good psychometric qualities in terms of reliability and validity, including resistance to the influence of rater characteristics. The demonstrates that Abbey Pain Scale may be better suited than the other two scales for use by nurse raters who only occasionally use pain rating scales or who have lower level nursing qualifications.
References: 7


Jennifer Abbey
PhD, 1996
Honorary clinical professor, Joanna Briggs Institute, Faculty of health sciences, University of Adelaide
Research Interests: She was formerly the director of the Dementia Collaborative Research and Training Centre for Consumers, Carers and Social Research as well as the Deputy Director of the Eastern Australia Dementia Training and Study Centre
Her expert areas include ageing, dementia and palliative care
Piller, Neil Brenton
Ph.D, 1977
Professor, Flinders University of South Australia, Department of Surgery, Adelaide, Australia
Research Interests: His expert areas include medicine, pharmacology and toxicology, Immunology and microbiology
He has been bestowed with lifetime researcher award for lymphoedema darwin ALA/ILF at Asia Pacific Lymphology Conference in June 2016


  1. Abbey J, Piller N, De Bellis A, Esterman A, Parker D, Giles L, Lowcay B. The Abbey pain scale: a 1-minute numerical indicator for people with end-stage dementia.Int J Palliat Nurs. 2004 Jan;10(1):6-13
  2. Gregersen M, Melin AS, Nygaard IS, Nielsen CH, Beedholm-Ebsen M.Reliability of the Danish Abbey Pain Scale in severely demented and non-communicative older patients. Int J Palliat Nurs. 2016 Oct 2;22(10):482-488
  3. Takai Y, Yamamoto-Mitani N, Chiba, Kato A. Feasibility and clinical utility of the Japanese version of the Abbey pain scale in Japanese aged care. Pain Manag Nurs. 2014 Jun;15(2):439-48.
  4. Lukas A, Barber JB, Johnson P, Gibson SJ. Observer-rated pain assessment instruments improve both the detection of pain and the evaluation of pain intensity in people with dementia. Eur J Pain. 2013 Nov;17(10):1558-68.
  5. Okimasa S, Saito Y, Okuda H, Fukuda T, Yano M, Okamoto Y, Ono E, Ohdan H. Assessment of cancer pain in a patient with communication difficulties: a case report.J Med Case Rep. 2016 Jun 2;10(1):148
  6. Nesbitt J, Moxham S, Ramadurai G, Williams L. Improving pain assessment and management in stroke patients.BMJ Qual Improv Rep. 2015 Mar 11;4(1)
  7. Neville C, Ostini R.A psychometric evaluation of three pain rating scales for people with moderate to severe dementia.Pain Manag Nurs. 2014 Dec;15(4):798-806.

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