Table 1 Characteristics of included studies

Akbarzadeh, 2007, Sweden [33]

To psychometrically test the Swedish version of the Doloplus-2 instrument for its use among older people

Three acute and one psycho-geriatric ward in a hospital

N = 48

NR, sample > 65

NR

NR^†

Yes

Ando, 2010, Japan [23]*

To develop a Japanese version of the Doloplus-2 and to apply it to elderly patients with Alzheimer’s disease (AD)

General hospital, surgical and psychiatric ward

N = 6

Mean 78.4 (4.7)

50%

Moderate to severe AD

Mean MMSE 7.6 (5.5) and HDS-R 6.4 (5.6)

Yes

Ando, 2016, Japan [54]

To assess whether the Japanese Doloplus-2 scale could effectively identify pain in elderly individuals with moderate-to-severe dementia

Geriatric hospital

N = 39 (n = 19)

Mean 84.5 (6.6) experimental group

Mean 87.5 (7.1) control group

79% (experimental group)

90% (control group)

Moderate to severe dementia

Mean MMSE in experimental group 10.9 (SD 6.5), not reported for control group

The participants had to have the ability to say that they were currently in pain

Bauer, 2007, France [44]

To investigate the tolerability of equimolar mix in very elderly patients undergoing painful procedures

Hospital, geriatric short-stay unit

N = 62

(n = 43 procedures)

Mean 87 (5)

62.9%

54.8% of the participants were reported to have mild to moderate cognitive disorders

NR

Chen, 2010a, Taiwan [22]** ^a

To translate the French version of the Doloplus-2 scale into Chinese and to evaluate the psychometric properties and the clinical feasibility of the translated instrument

LTC, five dementia special care units

N = 241

Mean 79.3 (9.4)

49%

Moderate to severe dementia

Mean MMSE 5.26 (SD 5.46)

Yes

Chen, 2010b, Taiwan [38]^a

To validate RNs’ and NAs’ report in assessing present pain and to investigate the potential influencing factors of institutionalized older people with dementia

LTC, six dementia special care units

N = 304

Mean 79.9 (8.8)

42%

Dementia

66% had a MMSE ≤10

The participant were asked about pain presences, intensity and location

Chen, 2014, Taiwan [45]

To test a causal model of the predictors of agitation

LTC, 11 dementia special care units

N = 405

Mean 80.6 (7.9)

33%

Varying stages of dementia

59.5% had a MMSE ≤10. Mean MMSE 8.9 (SD 6.8; range 0–26)

NR

Couilliot, 2013, France [55]

To investigate the acceptability and feasibility of an acupuncture intervention on persistent musculoskeletal pain in a geriatric population

Geriatric hospital

N = 60 (varying for the different time points n = 43 to n = 57)

Mean 83 (range 67–105)

80%

55.0% was diagnosed with dementia

62% were able to answer MMSE; mean 18.8 (SD 5.4)

63% of the participant diagnosed with dementia were able to self-rate their pain at the time of inclusion

Hadjistavropolous, 2008, Canada [46]

To examine the extent to which each of Doloplus-2’s items were predictive of delirium, depression, and dementia severity

Three LTC homes and a LTC unit within a large regional hospital

N = 160

Mean 86.3 (6.9)

70.6%

Varying stages of dementia

Mean HDS 91.0 (SD 49.2)

NR

Hølen, 2005, Norway [21]

To translate the Doloplus-2 into Norwegian, to test the Doloplus-2 with regard to criterion validity and to obtain the administrators’ evaluation of the clinical performance of the Doloplus-2

NHs, three special units for dementia

N = 59

Median 82 (range 39)

80%

Dementia

88% had a MMSE <24; median 9 (Q1 = 3, Q3 = 18)

Yes

Hølen, 2007, Norway [47]

To test the criterion validity and inter-rater reliability of the Doloplus-2, and to explore a design for validations of behavioral pain assessment tools

Two NHs and a geriatric hospital unit

N = 41

Mean 84

74%

Cognitively impaired

Median MMSE 10.

50% scored 0–10; 36% scored 11–20; 14% scored 21–30 on the MMSE.

Yes

Monacelli, 2013, Italy [53]

To re-assess pain after 1 year in a group of elderly NH residents with dementia

One NH

N = 23

Mean 88.1 (2.4)

78%

Moderate to severe dementia

Mean MMSE 10.3 (SD 2.2)

Yes

Neville, 2014, Australia [48]

To evaluate the relative psychometric merits of the APS, the Doloplus-2 Scale, and the CNPI

Three residential aged care facilities

N = 126

Mean 85.2 (6.6; range 69–96)

83%

Moderate to severe dementia

Mean GDS 5.7 (SD 1.5; range 0–7)

NR

Pautex, 2007, Switzerland [49]

To report the psychometric properties of the observational Doloplus-2 scale using the VAS pain score as a gold standard and evaluate its performance

A geriatric hospital and a department of psychiatry

N = 180

Mean 83.7 (6.5)

73%

74% had dementia (the remaining 26% had no cognitive decline).

AD: 39%; Mixed: 34%; Vascular: 20%; Other causes: 5%

Median MMSE

18.0 (±7.7).

CDR score of 1 (mild dementia): 37%; score of 2 (moderate): 41%; score of 3 (severe): 33%

The participants had to have the ability to reliably use the VAS

Pickering, 2010, multinational [50]

To evaluate the translation of the Doloplus-2 scale in five languages, as regards test–retest and inter-rater reliability

Multicenter; NHs, LTC settings, rehabilitation, home dwelling, acute care, other

N = 341

Mean 82 ± 2

70%

Different incapacities; dementia, aphasia, behavioral disorders, ‘other’

MMSE range 0–12

Yes

Rodríguez-Mansilla, 2015, Spain [56]

To assess the effectiveness of ear acupressure and massage vs. control in the improvement of pain, anxiety and depression in persons diagnosed with dementia

Residential homes

N = 120

Range 67–91

77.4%

Dementia

MMSE 0–20 was one of the inclusion criteria

NR

Sheu, 2011, Canada [51]

To examine the validity of facial expression components of 6 widely used pain assessment scales developed for elders with dementia

Hospital

N = 30

NR, sample > 65

NR

The majority had cognitive impairment

All patients had capacity to comprehend and communicate in English, so as to cooperate with instructions

Stacpoole, 2014, UK [52]

To evaluate the effects of the Namaste Care program on the behavioral symptoms of residents with advanced dementia in care homes and their pain management

Five dementia care homes

N = 37

Mean 78.5

59.4%

Severe dementia

AD: 46%; Vascular: 19%; Mixed: 5.3%; Fronto-temporal: 2.7%; Unspecified: 27%

BANS-S score ranged 17–28.

NR

Torvik, 2009, Norway [43]^b

To describe the pain and use of pain medication in nursing home patients and examine which variables that were associated with pain

Seven NHs

Data abstracted is on the not self-reporting/proxy-rated group N = 86 (n = 77)

Mean 86 (6)

77%

MMSE was not scored because of cognitive impairment or lack of language

Yes

Torvik, 2010, Norway [42]^b

To examine the use of Doloplus-2 in a nonverbal nursing home population, and to evaluate its reliability and validity by comparing registered nurses’ estimation of pain with Doloplus-2 scores

Seven NHs

N = 77

Mean 86 (6.6)

75%

None of the patients could complete the MMSE due to severe cognitive impairment, even though the majority had not been given any dementia diagnosis

Yes

Voyer, 2008, Canada [41]^c

To determine detection rates of delirium and delirium symptoms by nurses among elderly residents with dementia and to identify factors associated with undetected cases of delirium

Three LTC facilities and one LTC unit of a large hospital

N = 156 (n = 109)

Mean 86.3 (6.9)

73.7%

Dementia

Early: 3.1%; Middle:; 72.1%; Late: 24.8% according to FAST score

AD: 34.2%; Vascular: 18.1%; Mixed: 14.2%; Subcortical: 4.5%; Unspecified: 29.1%

NR

Voyer, 2009, Canada [39]^c

To investigate predisposing factors associated with delirium among demented long-term-care residents and to assess the cumulative effect of these factors on the likelihood of having delirium

Three LTC facilities and one LTC unit of a large regional hospital

N = 155

Mean 86.3 (6.9)

73.6%

Dementia

Mean HDS 91.1 (SD 48.9)

NR

Voyer, 2011, Canada [40]^c

To investigate individual and environmental factors associated with delirium severity among older persons with delirium superimposed on dementia

Three LTC facilities and one LTC unit of a large regional hospital

N = 71

Mean 87.7 (7.4)

71.8%

Dementia

Mean HDS 79.6 (SD 43.5)

NR

Zwakhalen, 2006, the Netherlands [24]

To evaluate the psychometric properties of translated versions of the PAINAD, PACSLAC, and Doloplus-2 scales

NHs, 12 psycho-geriatric wards and a somatic NH ward

N = 128 (assessed at rest T1 n = 89, at specific moment T3 n = 26)

Mean 82.4 (6.8)

78%

Dementia

AD: 32.0%; Vascular: 18.8%; Other (e.g. Parkinson’s disease, frontal lobe): 5.5%; Mixed: 3.9%; Unknown: 8%

Mild: 21.9%; Moderate to moderately severe: 28.1%; Severe to very severe: 47.7%; Unknown/missing: 2.3% according to CPS score

Patients were questioned about their current pain intensity using self-report scales