The purposes of this study were to develop and evaluate the psychometric properties of an instrument with nonverbal cues to assess pain in confused older adults, and to describe the differences among selected demographic variables and scores on the pain and confusion measures. The Pain Assessment Tool in Confused Older Adults (PATCOA) was evaluated with 116 cognitively intact older adults undergoing orthopedic surgery. The interrater reliability for each nonverbal cue ranged from 56.5% to 100%, and the Spearman correlations were .16 to 1.00. Nine nonverbal pain cues were subjected to exploratory factor analysis. Four components explained 69.83% variance. Older adults reported significantly higher levels of pain on the visual analog scale, yet age was not related to the nonverbal pain cues. Women reported significantly more pain than did men. No significant gender differences were found regarding the display of nonverbal pain cues and the level of acute confusion, or with race and self-report of pain, display of nonverbal pain cues, or level of confusion. The development and testing of the PATCOA are initial steps that contribute to our knowledge about acute pain assessment in confused older adults.
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