a natural history of the edinburgh feeding evaluation in dementia (edfed) scale roger watson
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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? - PowerPoint PPT PresentationTRANSCRIPT
A natural history of the Edinburgh Feeding Evaluation in Dementia (EdFED) scale
Roger WatsonUniversity of Sheffield
Worldwide University NetworkLecture
24 April 2008
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)
What are the types of dementia?
Alzheimer’s diseaseVascular dementiaLewy body dementiaFronto-temporalHuntington’s diseaseAIDS-relatedParkinson’s associatedCreutzfeld Jakob diseaseBrain tumourHydrocephalusAlcoholTreatable - eg malnutrition, hormones
What causes dementia?
GeneticsCo-morbidityLifestyleInfectionOld age?: 40-65 1 in 1000
65+ 1 in 5070+ 1 in 2080+ 1 in 590+ 1 in 2
At present there is no ‘cure’ for dementia
What happens to someone with dementia?
Progressive cognitive decline:loss of memorysubtle changes in personality
Behavioural change:wanderingaggressionincontinenceproblems with eating
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
The EdFED scale
Constructing a concept:
1. A clear delineation of antecedent factors
2. A unidimensional description of the concept
3. Estimation of reliability (internal consistency; interrater reliabilty; intrarater reliability)
4. Estimation of validity (factorial; convergent; concurrent)
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
Edinburgh Feeding Evaluation in Dementia (EdFED) questionnaire developed:
Originally 13 item questionnaire asking about:
Level of nursing interventionProblems of people with dementia
Feeding: referring specifically to the act of moving food from a plate to the mouth
Factor analysis
Exploratory:(n=196; Watson & Deary 1994)
Confirmatory:(n=345; Watson & Deary 1997)
SupervisionPhysical Help
SpillageLeave food on plate
Refuse to eatTurn head away
Refuse to open mouthSpit out food
Leave mouth openRefuse to swallow food
SupervisionPhysical Help
SpillageLeave food on plate
Refuse to eatTurn head away
Refuse to open mouthSpit out food
Leave mouth openRefuse to swallow food
SupervisionPhysical Help
SpillageLeave food on plate
Refuse to eatTurn head away
Refuse to open mouthSpit out food
Leave mouth openRefuse to swallow food
SupervisionPhysical Help
SpillageLeave food on plate
Refuse to eatTurn head away
Refuse to open mouthSpit out food
Leave mouth openRefuse to swallow food
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
Louis Guttman1916-1987
Robert J Mokken1929-
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 eatIncreasing
level of difficulty
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 eatIncreasing
level of difficulty
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
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 eatIncreasing
level of difficulty
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
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
Validity (Watson et al 2001a)
Convergent
Pearson’s correlation with:
INSRTr = 0.47 p = 0.001BFDST r = 0.57 p = 0.016
IC/ARST r = -0.36 p = 0.088RSIF r = -0.31 p = 0.218SD/SAr = - 0.63 p = 0.069
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
Constructing a concept:
1. A clear delineation of antecedent factors
2. A unidimensional description of the concept
3. Estimation of reliability (internal consistency; interrater reliabilty; intrarater reliability)
4. Estimation of validity (factorial; convergent; concurrent)
Constructing a concept:
1. A clear delineation of antecedent factors
2. A unidimensional description of the concept
3. Estimation of reliability (internal consistency; interrater reliabilty; intrarater reliability)
4. Estimation of validity (factorial; convergent; concurrent)
5. Translation and cross-cultural validity
