Since the WOMAC pain scale is inadequate for elders with
low cognitive functioning, alternative pain measures are
needed. A possible alternative is assessment of activity level.
We noted that Mr. T was usually very active and had
good mobility, but when he suffered from pain in the lower
extremities, he avoided activities (e.g., standing up,
walking) or refused to do exercises. On day 2 of the intervention,
we saw him sit in a chair, which was unusual; he
then refused to stand up and pointed to his knee, saying,
"It hurts." We stopped the intervention for that day and
did it another day. Although Mr. T was able to communicate
his pain on this occasion, often he could not do so.
However, an unusual activity level in itself may be an indicator
of pain in demented elders with OA of the lower
extremities.