A Comparison of Facial Expressions due to Pain and Depressive Symptoms in Patients with Alzheimer’s Disease

• Main Authors: Wan-Ting Chiu, 邱琬婷
• Other Authors: Li-Chan Lin
• Format: Others
• Language: zh-TW
• Published: 2010
• Online Access: http://ndltd.ncl.edu.tw/handle/79257435998573584223

碩士 === 國立陽明大學 === 臨床暨社區護理研究所 === 98 === Aim：The purpose of this study is to gain an appreciation of the facial expressions of dementia patients experiencing pain or depressive symptoms, and compare between them. Background：The need for palliative care in dementia patients has often been underestimated, primarily because the pain scale evaluation of their facial expressions rely on very course indicators, such as: sad look, frowning, etc., which are also very frequently present in the facial expressions of geriatric depression patients, so the inability to appropriately distinguish and classify the relative intensity of facial expressions of pain or to confuse pain expressions with those of other emotional face expressions may be the reason behind the underestimation of actual patient pain levels. Method: This studies employs a quantitative approach with data collection through survey interviews and behavioral observation, for samples from the Veterans Homes in Taipei, Taitung, and Taoyuan, selecting data on 105 residents with dementia and 94 residents from the care centers for aging, beginning with their demographic data, MMSE, and ADL, followed by a five- day observational period to collect data regarding their facial expressions and depressive symptoms, as well as clinical interviews and administration of a self-scoring pain scale and depression symptom scale. All of the collected data were then analyzed with descriptive statistics methods and Kappa consistency statistics, to elucidate the relations among pain and depressive symptoms in various facial expressions. Results：In the cognitively unimpaired control group and dementia residents, the prevalence of existing pain was 41.9% and 51.6% respectively. Comparing the cognitively unimpaired group and dementia residents’ pain facial expressions and self-scores, there are significant relations in the following Action Unit (AU), AU4 Brow lowerer and AU6+7 Orbit tightening, as well as for AU43 Eyes Closure and AU45 Blink in the cognitively unimpaired group, and AU25+26+27 Open mouth show a significant relationship in the dementia residents. In regard to depressive symptoms, the cognitively unimpaired exhibited significant relationships between their facial expressions and CSDD for the following: AU1+4 omega sign, AU15 Lip corner depressor,and AU24 Lip Pressor. For the Geriatric Depression Scale (GDS) components, significant relations involved: AU1+4 omega sign,AU7 Lid tightener, AU15 Lip corner depressor, and AU24 Lip Pressor. Among the dementia patients, significant relationships were only observed among depressive facial expressions and CSDD for AU15 Lip corner depressor, with no significant Action Units (AU) pairings with GDS. Conclusion：This study deploys the FACS (Facial Action Coding System) assessment methods, to help establish better clarity in facial movement descriptive classifications of facial activity indicating pain or depressive symptoms, and the findings should contribute to further efforts in developing and evaluating pain scales, advancing the accuracy and consistency of pain assessment, as well as its clinical utility.