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A natural history of the Edinburgh Feeding Evaluation in Dementia (EdFED) scale Roger Watson

A natural history of the Edinburgh Feeding Evaluation in Dementia (EdFED) scale Roger Watson University of Sheffield Worldwide University Network Lecture 24 April 2008. What is dementia?

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A natural history of the Edinburgh Feeding Evaluation in Dementia (EdFED) scale Roger Watson

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  1. A natural history of the Edinburgh Feeding Evaluation in Dementia (EdFED) scale Roger Watson University of Sheffield Worldwide University Network Lecture 24 April 2008

  2. What is dementia? Various brain disorders that have, in common, loss of brain function which is progressive and, eventually, severe. How many people have dementia? 750,000 in UK (population 50 million) 60,000 in Scotland (population 5 million) 6 million in USA (population 300 million)

  3. What are the types of dementia? Alzheimer’s disease Vascular dementia Lewy body dementia Fronto-temporal Huntington’s disease AIDS-related Parkinson’s associated Creutzfeld Jakob disease Brain tumour Hydrocephalus Alcohol Treatable - eg malnutrition, hormones

  4. What causes dementia? • Genetics • Co-morbidity • Lifestyle • Infection • Old age?: 40-65 1 in 1000 • 65+ 1 in 50 • 70+ 1 in 20 • 80+ 1 in 5 • 90+ 1 in 2 • At present there is no ‘cure’ for dementia

  5. What happens to someone with dementia? • Progressive cognitive decline: • loss of memory • subtle changes in personality • Behavioural change: • wandering • aggression • incontinence • problems with eating

  6. Food and dementia Almost inevitable disturbances to eating in dementia with decline in eating towards the terminal stages Weight loss is also associated with dementia but this may not just be the result of eating difficulty In fact, it has been demonstrated that weight loss can precede the onset of dementia

  7. The EdFED scale

  8. Constructing a concept: • A clear delineation of antecedent factors • A unidimensional description of the concept • Estimation of reliability (internal consistency; interrater reliabilty; intrarater reliability) • Estimation of validity (factorial; convergent; concurrent)

  9. Construction: phenomenology of feeding and dementia Many problems arise for older people with dementia Literature search in 1993 established the ‘state of the art‘ (Watson 1993) Identified range of problems Confirmed paucity of systematic work in the field

  10. Edinburgh Feeding Evaluation in Dementia (EdFED) questionnaire developed: • Originally 13 item questionnaire asking about: • Level of nursing intervention • Problems of people with dementia • Feeding: referring specifically to the act of moving food from a plate to the mouth

  11. Factor analysis Exploratory: (n=196; Watson & Deary 1994) Confirmatory: (n=345; Watson & Deary 1997)

  12. Supervision Physical Help Spillage Leave food on plate Refuse to eat Turn head away Refuse to open mouth Spit out food Leave mouth open Refuse to swallow food

  13. Supervision Physical Help Spillage Leave food on plate Refuse to eat Turn head away Refuse to open mouth Spit out food Leave mouth open Refuse to swallow food

  14. Supervision Physical Help Spillage Leave food on plate Refuse to eat Turn head away Refuse to open mouth Spit out food Leave mouth open Refuse to swallow food

  15. Supervision Physical Help Spillage Leave food on plate Refuse to eat Turn head away Refuse to open mouth Spit out food Leave mouth open Refuse to swallow food

  16. Mokken scaling n=345 (Watson 1997) Stochastic version of Guttman scaling which searches for hierarchical, unidimensional scales. 6 items related to feeding behavioural problems scaled

  17. Louis Guttman 1916-1987

  18. Robert J Mokken 1929-

  19. EdFED scale (Edinburgh data; Watson 1996) Leave mouth open Refuse to swallow food Spit out food Turn head away Refuse to open mouth Refuse to eat Increasing level of difficulty

  20. EdFED scale (Derbyshire data; Watson et al 2001a) Leave mouth open Refuse to swallow food Spit out food Turn head away Refuse to open mouth Refuse to eat Increasing level of difficulty

  21. Chinese translation and validation of EdFED: The C-EdFED (Lin & Chang 2003) Translated into Chinese: Equality of items 0.97 Back translated into English: Item Kappa range 0.44-1.00 Consistency between raters and across time: ICC range 0.85-0.90

  22. EdFED scale (Taiwanese data; Lin & Watson 2008) Leave mouth open Refuse to swallow food Spit out food Turn head away Refuse to open mouth Refuse to eat Increasing level of difficulty

  23. Reliability (Watson et al 2001b) Internal consistency > 0.90 Intraclass correlations Interrater (1,1 model) 0.51 p = 0.023 Intrarater (2,1 model) 0.94 p < 0.001

  24. Validity (Watson 1997) Concurrent Spearman’s rho with EdFED Questionnaire items related to nursing intervention* all correlate at: rho > 0.5 p < 0.001 * supervision, physical help, nursing care

  25. Validity (Watson et al 2001a) Convergent Pearson’s correlation with: INSRT r = 0.47 p = 0.001 BFDST r = 0.57 p = 0.016 IC/ARST r = -0.36 p = 0.088 RSIF r = -0.31 p = 0.218 SD/SA r = - 0.63 p = 0.069

  26. Responsiveness (Watson 1997) Increase in feeding difficulty over 18 months Time 1 Time 2 Mean difference CI (95%) 7.96 9.21 1.24 0.44-2.04 p < 0.001

  27. Constructing a concept: • A clear delineation of antecedent factors • A unidimensional description of the concept • Estimation of reliability (internal consistency; interrater reliabilty; intrarater reliability) • Estimation of validity (factorial; convergent; concurrent)

  28. Constructing a concept: • A clear delineation of antecedent factors • A unidimensional description of the concept • Estimation of reliability (internal consistency; interrater reliabilty; intrarater reliability) • Estimation of validity (factorial; convergent; concurrent) • Translation and cross-cultural validity

  29. Roger Watson Professor of Nursing University of Sheffield, UK email: roger.watson@sheffield.ac.uk

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