Friday, 10 February 2017

Assessing eating difficulties in older people with dementia: EdFED Scale

Roger Watson
Professor of Nursing
University of Hull

The Edinburgh Feeding Evaluation in Dementia Scale was developed at the
University of Edinburgh and work to establish its reliability and validity has
continued at the University of Hull.

The scale is designed to assess the level of difficulty that an older person with
dementia is experiencing with eating. It is short and easy to use in the clinical
areas. The procedure for using the EdFED Scale is as follows:

1. A nurse who is familiar with the individual about whom the questions
are being asked, for example, a key worker, primary nurse or team
leader should complete this questionnaire.
2. The questionnaire refers to recent, usual behaviour related to feeding.
3. A response should be given to each question.
4. Responses are as follows: A – “never”
                                              B – “sometimes”
                                              C – “often”
Please circle the appropriate response
5. “Refusal” and “inability” mean the same thing in the context of this

Q1 Does the patient ever refuse to eat?                                         A B C
Q2 Does the patient turn his/her head away while being fed?           A B C
Q3 Does the patient refuse to open his/her mouth?                         A B C
Q4 Does the patient spit out his/her food?                                      A B C
Q5 Does the patient leave his/her mouth open food to drop out?      A B C
Q6 Does the patient refuse to swallow?                                         A B C

Psychometric properties
Factor analysis:
The items of the EdFED Scale can be distinguished from other indicators of difficulty in older people such as the level of nursing help required or the of food and leaving food on the plate by factor analysis.

Mokken scaling:
The EdFED Scale is a Mokken scale: older people with dementia displaying a level of difficulty on the scale will display all the items below that point the scale.

The EdFED Scale is internally consistent and is reliable between raters and ratings.

The EdFED Scale correlates with other measures of eating difficulty and is with the level of nursing care required but it does not correlate with of unrelated constructs such as choking.

Using the EdFED Scale
There is no copyright on the EdFED scale and individuals are welcome to use it. Further details may be obtained from Roger Watson (

Watson R (1994) Measuring feeding difficulty in patients with dementia: a scale Journal of Advanced Nursing 19 257-263

Watson R (1994) Measuring feeding difficulty in patients with dementia: and validation of the EdFED Scale#1 Journal of Advanced Nursing850-855

Watson R (1994) Measurement of feeding difficulty in patients with dementia of Psychiatric and Mental Health Nursing 1 45-46

Watson R & Deary IJ (1994) Measuring feeding difficulty in patients with multivariate analysis of feeding problems, nursing interventions and difficulty Journal of Advanced Nursing 20 283-287

Watson R (1996) Mokken scaling procedure (MSP) applied to feeding in elderly people with dementia International Journal of Nursing 33 385-393

Watson R & Deary IJ (1996) Is there a relationship between feeding difficulty nursing intervention in elderly people with dementia? NT Research 1:1 45

Watson R & Deary IJ (1996) A longitudinal study, using structural equation of feeding difficulty in elderly patients with dementia Journal of Nursing 26 25-32

Watson R (1997) Construct validity of a scale for the measurement of feeding in elderly people with dementia Clinical Effectiveness in Nursing 1 115

Watson R Green S & Legg L (2001) The Edinburgh Feeding Evaluation in Scale #2 (EdFED#2): convergent and discriminant validity Clinical in Nursing 5 44-46

Watson R MacDonald J & McReady T (2002) The Edinburgh Feeding in Dementia Scale #2 (EdFED#2): inter- and intra-rater reliability Effectiveness in Nursing 5 184-186

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