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Context: There is need for tools to help detect pain or lack of comfort in persons unable to communicate. However, pain and (dis)comfort tools have not been compared, and it is unclear to what extent they discriminate between pain and other possible sources of discomfort, or even if items differ., Objectives: To map and compare items in tools that assess pain and the broader notion of discomfort or comfort in people with severe dementia or at the end of life., Methods: Using qualitative content analysis with six classifications, we categorized each item of four thoroughly tested observational pain tools (Pain Assessment in Advanced Dementia [PAINAD], Pain Assessment Checklist for Seniors with Limited Ability to Communicate [PACSLAC], Doloplus-2, and draft Pain Assessment in Impaired Cognition [PAIC]), and four discomfort tools (including distress, comfort, and quality of life in severe dementia or at the end of life; Discomfort Scale-Dementia Alzheimer Type [DS-DAT], Disability Distress Assessment Tool [DisDAT], End-of-Life in Dementia-Comfort Assessment in Dying with Dementia [EOLD-CAD], and Quality of Life in Late-Stage Dementia [QUALID] scale). We calculated median proportions to compare distributions of categories of pain and discomfort tools., Results: We found that, despite variable content across tools, items from pain and discomfort tools overlapped considerably. For example, positive elements such as smiling and spiritual items were more often included in discomfort tools but were not unique to these. Pain tools comprised more "mostly descriptive" (median 0.63 vs. 0.44) and fewer "highly subjective" items (0.06 vs. 0.18); some used time inconsistently, mixing present and past observations., Conclusion: This analysis may inform a more rigorous theoretical underpinning and (re)development of pain and discomfort tools and calls for empirical testing of a broad item pool for sensitivity and specificity in detecting and discriminating pain from other sources of discomfort., (Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the effect of a dance-based therapy on depressive symptoms among institutionalized older adults., Design: Randomized controlled trial., Setting: Nursing homes., Participants: Older adults (60 years or older) permanently living in a nursing home., Intervention: Exercise Dance for Seniors (EXDASE) Program designed for the use in long-term care settings performed once a week for 60 minutes for 3 months., Measurements: Baseline measures included sociodemographic characteristics, ability to perform basic as well as instrumental activities of daily living, basic mobility, self-rated health, and cognitive status. Outcome measures were collected before and after the intervention and included assessment of depressive symptoms using the geriatric depression scale (GDS)., Results: Comparison of participants with MMSE of 15 or higher showed that GDS scores in the intervention group significantly improved (P = .005), whereas the control group had a trend of further worsening of depressive symptoms (P = .081). GLM analysis documented highly statistically significant effect of dance therapy (P = .001) that was not influenced by controlling for intake of antidepressants and nursing home location. Dance therapy may have decreased depressive symptoms even in participants with MMSE lower than 15 and resulted in more discontinuations and fewer prescriptions of antidepressants in the intervention group than in the control group., Conclusion: This study provides evidence that dance-based exercise can reduce the amount of depressive symptoms in nursing home residents. In general, this form of exercise seems to be very suitable and beneficial for this population., (Copyright © 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)