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The detection of pain in persons with advanced dementia is challenging due to their inability to verbally articulate the pain they are experiencing. Pain Assessment in Advanced Dementia (PAINAD) is an observer-rated pain assessment tool developed based on non-verbal expressions of pain for persons with severe dementia. This study aimed to perform construct validation of PAINAD for pain assessment in persons with severe dementia in Malaysia. This was a prospective cross-sectional study conducted from 27 April 2022 to 28 October 2022 in eight public hospitals in Malaysia. The PAINAD scale was the index test, and the Discomfort Scale—Dementia of the Alzheimer Type (DS-DAT) and Nurse-Reported Pain Scale (NRPS) were the reference tests for construct and concurrent validity assessment. Pain assessment for the study subjects was performed by two raters concurrently at rest and during activity. The PAINAD score was determined by the first rater, whereas the DS-DAT and NRPS were assessed by the second rater, and they were blinded to each other's findings to prevent bias. PAINAD showed good positive correlations ranging from 0.325 to 0.715 with DS-DAT and NRPS at rest and during activity, with a p-value of <0.05. It also demonstrated statistically significant differences when comparing pain scores at rest and during activity, pre- and post-intervention. In conclusion, the PAINAD scale is a reliable observer-rated pain assessment tool for persons with severe dementia in Malaysia. It is also sensitive to changes in the pain level during activity and at rest, pre- and post-intervention. [ABSTRACT FROM AUTHOR]

Competing Interests: None

(1) Background: Older people with COVID-19 infection report worse clinical outcomes. There is a paucity of local data and this study aimed to describe the clinical progression of older people admitted to a university hospital in Malaysia with COVID-19 infection. (2) Methods: Older people (≥60 years) admitted with COVID-19 infection confirmed with RT-PCR from 27 February 2020-25 May 2020 were included in this study. Data on patient characteristics, hospital treatment, and inpatient outcomes were collected via hospital-held electronic medical records. Analysis was done to describe the cohort and identify factors associated with inpatient mortality. (3) Results: 26 participants were included (mean age 76.2 years, female 57.7%). All had at least one comorbid condition and half were frail. About 19.2% had non-respiratory (atypical) symptoms; 23.1% had a severe disease that required intensive care unit monitoring; 46.2% were given COVID-19 targeted therapy. Inpatient mortality and overall complication rates were 23.1% and 42.3%, respectively. Delirium on presentation and lower Ct-value were associated with mortality. (4) Conclusions: Older people with COVID-19 infection have severe infection and poor hospital outcomes. Vigilant hospital care is necessary to address their multimorbidity and frailty, along with appropriate treatment for their infection.