Assessing eating difficulties in older people with dementia: EdFED Scale

Roger Watson
Professor of Nursing
University of Hull

History
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
questionnaire.

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.

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

Validity:
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 (r.watson@hull.ac.uk)

References
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

EdFED (Korean)

Edinburgh Feeding Evaluation in Dementia Questionnaire (EdFED-Q)
1-10번 (0=전혀 아니다, 1=가끔, 2=자주)
1. 환자가 음식을 섭취할 때 밀착된 감독이 필요합니까?			0	1		2
2. 환자가 음식을 섭취할 때 신체적인 도움이 필요합니까?			0	1		2
3. 환자가 음식을 섭취할 때 흘립니까?			0	1		2
4. 환자가 식사 끝에 접시에 음식을 남기는 경향이 있습니까?			0	1		2
5. 환자가 먹기를 거부하기도 합니까?			0	1		2
6. 환자가 음식을 먹이는 동안 고개를 돌립니까?			0	1		2
7. 환자가 입을 벌리기를 거부합니까?			0	1		2
8. 환자가 자기의 음식을 뱉어버립니까?			0	1		2
9. 환자가 입을 벌린 채 음식이 떨어지게 합니까?			0	1		2
10. 환자가 삼키기를 거부합니까?			0	1		2
총점 =
11. 환자에 의해 요구되는 적절한 조력 정도를 표시하기:
지지적-교육적 보조
부분적 보조
전적인 보조

EdFED (traditonal Chinese)

【愛丁堡餵食量表】

下列問題是有關住民在進食時之狀況，答案無所謂「對」或「錯」，請依您的觀察填答：

從不    有時   經常

(1~2次) (>2次)

1. 病人進食時，是否需要密切監督?                                  

2. 病人進食時，是否需要身體上的協助?                         

3. 進食時，是否會溢出（灑出）?                                      

4. 病人是否在進食結束時將食物留於盤中?                      

5. 病人是否拒吃東西?                                                          

6. 病人在被餵食時，是否將頭轉開?                                  

7. 病人是否拒絕張開嘴巴?                                                  

8. 病人是否吐出食物?                                                          

9. 病人是否張開嘴巴任由食物掉出?                                  

10. 病人是否拒絕吞嚥?                                                        

11. 指出病人進食時需要照顧的程度：

□支持－教育性                           □部分代償性                         □完全代償性

12. 病人是否有其他進食相關問題行為？請說明：__________________________

__________________________________________________________________

The Edinburgh Feeding Evaluation in Dementia (EdFED) scale

PATIENT NUMBER:……………………………….

DIAGNOSIS:……………………………………….

AGE:……..

GENDER: MALE/FEMALE (circle)

The EdFED Scale

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 while in hospital.

3. A response should be given to each question.

4. Responses are as follows:

0 – “never”

1 – “sometimes”

2 – “often”

Please circle the appropriate response

5. “Refusal” and “inability” mean the same thing in the context of this

questionnaire.

                                                                                                                                   

Q1 Does the patient ever refuse to eat?                                                  0  1  2

Q2 Does the patient turn his/her head away while being fed?            0  1  2

Q3 Does the patient refuse to open his/her mouth?                              0  1  2

Q4 Does the patient spit out his/her food?                                              0  1  2

Q5 Does the patient leave his/her mouth open

allowing food to drop out?                                                                          0  1  2

Q6 Does the patient refuse to swallow?                                                  0  1  2

                                                                                                                                   

                                                                                    TOTAL                                   

                                                                                    DATE:……………………….

NB – this version of the EdFED is for research purposes and no recommendations are made for action at this stage of use.