IntroductionDiscomfort Scale for Dementia of the Alzheimer Type (DS-DAT) was developed based on interviews with experienced dementia care nurses . Discomfort was defined as a negative emotional and/or physical state in response to internal or environmental conditions.
DS-DAT has nine items that are made operational by 40 defining characteristics. Items are scored 0, 1, 2, or 3 depending on the number of defining characteristics present, their intensity and duration during a 5-minute observation period. When items cannot be observed; for example, a patient with shut eyes could not be rated for a sad facial expression, the item is scored as NA (not applicable) and recoded to “0.” The two positively worded items are reverse coded. Then item’s scores are summed to provide a total score. High scores mean high levels of discomfort observed . |
Adapted from Hurley AC, Volicer BJ, Hanrahan PA, et al. Assessment of discomfort in advanced Alzheimer patients. Res Nurs Health 1992; 15:369-377.
Discomfort ScaleArea | Questions | Score | Noisy Breathing | Negative sounding noise on inspiration or expiration: breathing looks strenuous, labored, or wearing: respirations sound loud, harsh, or gasping: difficulty breathing or trying hard at attempting to achieve a good gas exchange; episodic bursts of rapid breaths or hyperventilation. | [___] | Negative Vocalization | Noise or speech with a negative or disapproving quality: hushed low sounds such as constant muttering with a guttural tone: monotone, subdued, or varying pitched noise with a definite unpleasant sound: faster rate than a conversation or drawn out as in a moan or groan: repeating the same words with a mournful tone: expressing hurt or pain. | [___] | Content Facial Expression | Pleasant, calm looking face, tranquil, at ease, or serene: relaxed facial expression with a slack unclenched jaw: overall look is one of peace. | [___] | Sad Facial Expression | Troubled-looking face, looking hurt, worried, lost, or lonesome: distressed appearance: sunken “hang dog” look with lackluster eyes: tears: crying. | [___] | Frightened Facial Expression | Scared, concerned-looking face: looking bothered, fearful, or troubled: alarmed appearance with open eyes and pleading face. | [___] | Frown | Face looks strained: or scowling looks: displeased expression with a wrinkled brow and creases in the forehead: corners of mouth turned down. | [___] | Relaxed Body Language | Easy openhanded position: look of being in a restful position: may be cuddled up or stretched out: muscles look of normal firmness and joints are without stress: look of being idle/lazy or “laid back”: appearance of “ just killing the day” casual. | [___] | Tense Body Language | Extremities show tension: wringing of hands: clenched fists, or knees pulled up tightly: look of being in a strained and inflexible position. | [___] | Fidgeting | Restless inpatient motion, acting squirmy or jittery appearance of trying to get away from hurt area, forceful touching, tugging or rubbing of body parts. | [___] | | | Total | [___] |
Scores: 0=None 1=Slight 2= Moderate 3=Intense |
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