Validation of the Spanish version of the Edinburgh Feeding Evaluation in Dementia Scale for older people with dementia

Abstract

AimsTo adapt the Edinburgh Feeding Evaluation in Dementia Scale (EdFED) for use in a Spanish-speaking population and to assess its validity and reliability in patients with dementia.MethodA cross-sectional study was carried out in two stages: 1. Cross-cultural adaptation (translation, back-translation, review by committee of experts, pilot test and weighting of results); 2. Clinimetric validation comprising interobserver reliability assessment, test-retest reliability and internal consistency. To determine construct validity, confirmatory factorial analysis and principal components analysis were performed by oblique rotations. Criteria validity was analysed using the Pearson correlation (p<0.05) with the BMI, MNA and analytical values of albumin, transferrin, cholesterol, absolute lymphocytes and total proteins.Data collection was carried out for six months in 2016 in nursing homes and Alzheimer’s day centers in the province of Málaga (Spain), at nine centers, with 262 patients (aged over 60 years and presenting feeding difficulties), 20 nurses, 20 professional caregivers and 103 family caregivers.ResultsA version of EdFED culturally adapted to Spanish was obtained. The sample presented the following characteristics: 76.3% women, mean age 82.3 years (SD: 7.9); MNA 18.73 (SD: 4.44); BMI 23.99 (SD: 4.72); serum albumin 3.79 mg/dl (SD: 0.36). A Cronbach’s alpha of 0.88 was obtained, with an inter-item global correlation of 0.43 and a homogeneity index ranging from 0.42 to 0.73. The exploratory factor analysis reproduced the three-factor model identified by the original authors, explaining 62.32% of the total variance. The criterion validity showed a good inverse correlation with MNA and a moderate one with albumin, total proteins, transferrin and BMI.DiscussionThe Spanish version of EdFED is reliable and valid for use in elderly people with dementia. The most appropriate for our environment is the three-factor model, which maintains the original factors, with a slight redistribution of the items.

Review of Food Intake Difficulty Assessment Tools for People with Dementia

“…The EdFED was reported to significantly correlated to Initial Nutrition Risk Screening Tool and Mini Nutritional Assessment (Saucedo Figueredo et al, 2018;Watson, Green, et al, 2001;Liu et al, 2013), and could be differentiated from swallowing difficulty assessment tool (Watson, Green, et al, 2001;Watson & Lou, 2013). Theoretically, the score of the EdFED increases, the level of cognitive status declines, the length of mealtime extends, and the food consumption, weight and Body Mass Index decreases (Bagnasco et al, 2015;Côt et al, 2018;Lin et al, 2008;Liu et al, 2013;Saucedo Figueredo et al, 2018). However, the studies showed inconsistent findings.…”

Interventions maintaining eating Independence in nursing home residents: a multicentre qualitative study

“…At the environmental level, NH carers are used to stimulating sight, hearing, and smell memory aimed at preparing residents through rituals by enacting a mechanism that seems to trigger a conditioned reflex [ 32 , 33 ], trying to compensating some pathophysiological changes occurring due to dementia (e.g., visual and smell changes [ 7 ]). The ritualization of these interventions anchored in previous cultural patterns (e.g., ringing of the church bells near mealtimes) seems to be mixed with specialized interventions, such as tables already equipped by the staff as in a restaurant.…”

“…In the first stage of dementia, eating difficulties manifest usually as a refusal to eat as taste and smell change, and major depression can trigger anorexia and weight loss [ 7 , 8 ]. Loss of appetite, behavioural disorders, and apraxia are typical symptoms in the moderate stages of dementia whereas in advanced stages, a decline in all ADLs, including eating, becomes evident.…”

Informal dementia caregivers’ experiences and perceptions about mealtime care: A qualitative evidence synthesis

“…In the early stages of dementia, problematic eating behaviours often manifest in their refusal to eat due to changes in taste and smell, resulting in weight loss. People with more advanced dementia have been shown to be unable to recognize and swallow food (Gomez‐Busto andia, Ruiz de Alegria, & Frances, 2009; Saucedo Fig ueredo et al., 2018). It is estimated that up to 40% of people with dementia are already malnourished by the time they are diagnosed (Sergi, De Rui, Coin, Inelmen, & Manzato, 2013).…”