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.
Highlights
By 2050, the number of people aged over 65 years will have tripled [1,2], and Spain will be one of the oldest countries in the world [3]
A version of Edinburgh Feeding Evaluation in Dementia Scale (EdFED) culturally adapted to Spanish was obtained
A two-stage clinimetric validation study was carried out: in the first stage, EdFED was crossculturally adapted to the Spanish context, and in the second it was empirically validated for use by nurses, professional caregivers and family caregivers
Summary
By 2050, the number of people aged over 65 years will have tripled [1,2], and Spain will be one of the oldest countries in the world [3]. Due to the close association between dementia and aging, it is estimated that the number of people affected by this condition will have risen three-fold [4,5]. A further problem is that up to 40% of people with dementia are already undernourished when the condition is diagnosed [10], and this tends to worsen during their illness, with negative consequences for their progress [1]. Feeding difficulties affect 70% of patients in the advanced stages of dementia [12,13,14,15]. “Difficulty in feeding” is taken to mean any condition that causes a reduction in food intake [16], affecting any of five areas: initiating feeding, maintaining attention, taking or keeping food in the mouth, chewing and swallowing [17]. The first difficulty in feeding is usually “refusing to eat” and one of the last, indicating severity, is “leaving the mouth open” [19]
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