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The purpose of this study was a psychometric evaluation of the PAINAD to assess pain in hospitalized cognitively impaired and intact older adults admitted for surgical repair of a hip fracture.A descriptive correlational design was used. A convenience sample of older patients hospitalized for surgical repair of a hip fracture was used. Twelve of the patients had cognitive impairment and 13 were cognitively intact. All were assessed for pain using both the self-report numeric rating scale and an observational assessment tool, the PAINAD.A positive correlation was found between the PAINAD and a self-report pain scale, providing evidence of concurrent validity. PAINAD scores were higher when patients were likely to experience pain than when unlikely, providing evidence of discriminant validity. The results of this study provide evidence supporting the validity and reliability of the PAINAD in the pain assessment of hospitalized post-orthopaedic surgical older adults who are unable or reluctant to self-report pain.