Measuring feeding difficulty in patients with dementia: perspectives and problems

The feeding problems of demented elderly people are well documented and the need for research into the assessment of feeding difficulty and intervention by nurses has been raised The present paper reviews the literature in this area of care and outlines the problems which exist in attempting to investigate the feeding difficulty of demented patients Demented elderly people display a range of behaviours related to feeding including excessive eating in the early stages of dementia and then difficulty with feeding, refusal to eat and, finally, inability to self-feed at all The problems with research in this area revolve around the issue of measurement of feeding difficulty There are problems in deciding what to measure and in how measurements should be made which are clinically meaningful A possible strategy for investigating the feeding difficulty of demented elderly patients is suggested which includes the design of a tool for measurement and the application of single-case studies Any tool which is used for measurement should enable researchers, in the first instance, and then clinicians to categorize the feeding difficulty of individual patients Moreover, such a tool should also be sufficiently sensitive to respond to change in feeding ability The single-case methodology is considered to be the most ethically and statistically appropriate for research with this particular group of patients     

Measuring feeding difficulty in patients with dementia: multivariate analysis of feeding problems, nursing intervention and indicators of feeding difficulty

The feeding difficulty of 196 elderly people with dementia was investigated by means of an 11-item questionnaire administered to nursing staff The questionnaire was analysed by means of multivariate statistics, namely factor analysis The factor analysis demonstrated that the original items could be reduced to three factors These three factors were named (a) patient obstinacy or passivity, (b) nursing intervention, and (c) indicator of feeding difficulty This quantitative analysis confirms a previous qualitative distinction between items in the questionnaire and suggests avenues of research into the relationship between the factors     

Measuring feeding difficulty in patients with dementia: replication and validation of the EdFED Scale #1

A study was conducted in order to replicate a scale which was previously reported for assessing the feeding difficulty of elderly patients with dementia. The clinical significance of the scale was also investigated. It was demonstrated that the scale was replicable in two separate nursing units. Also, it was demonstrated that, according to criteria such as its correlation with levels of nursing intervention, for example physical help, and with an indicator of feeding difficulty, namely leaving food on the plate at the end of a meal, the scale was clinically significant. The consequences and limitations of the present investigation are discussed and recommendations for future lines of enquiry are suggested. Specifically, the possibility of analysing data from such studies by the use of multivariate statistical techniques is raised.     

A longitudinal study of feeding difficulty and nursing intervention in elderly patients with dementia

Structural equation modelling has already been used to study the relationship between feeding difficulty and nursing intervention in elderly people with dementia. Four models were tested and one provided an acceptable fit to the data. However, there were limitations in terms of sample size and the scales used to measure the variables related to feeding difficulty and nursing intervention. In the present study the sample size has been increased and the scaling of variables has been improved and an additional model has been tested. The best fitting model introduces a latent state variable to explain the relationship between feeding difficulty and nursing intervention. In order to study this relationship further several lines of investigation are suggested, including trait validation and state experimentation. These will be explained in the paper.     

痴呆患者进食困难管理的最佳证据总结

目的评价并总结痴呆患者进食困难管理相关证据,旨在为医护人员和有关决策者提供参考。方法系统检索国内外数据库中痴呆患者进食困难管理相关文献,包括临床决策、指南、专家共识、推荐实践、证据总结、系统评价/Meta分析,检索时限为2016年1月—2020年12月,由研究者根据相关文献评价标准进行评价并提取证据。结果共纳入17篇文献,包括1篇临床决策、3篇指南、3篇专家共识、1篇推荐实践、1篇证据总结、8篇系统评价,从组织规范、培训教育、实践3个方面总结出40条证据。结论痴呆患者进食困难管理证据涉及范围较广,内容丰富,科学、有效的管理措施可以减少患者进食困难的发生。证据使用者在证据转化过程中应考虑具体情境,分析证据与临床实践的差距,有针对性地选择证据,以便制订符合个体情况的本土化的痴呆患者进食困难管理方案,改善其营养状况,提升照护质量。     

Feeding difficulty in elderly patients with dementia: Confirmatory factor analysis

The latent structure of feeding difficulty in elderly patients with dementia was investigated using multivariate statistical techniques including exploratory and confirmatory factor analysis. A survey design of 345 elderly patients with the diagnosis of dementia using a questionnaire completed by key workers and primary nurses, was used in local psychogeriatric and continuing care of the elderly facilities.

Feeding difficulty and nursing intervention were estimated followed by fitting of latent variable models of feeding difficulty to the data using structural equation modelling. Three models of feeding difficulty in elderly patients with dementia, with 2, 3 and 4 factor structures respectively were compared. All three models showed a good fit to the data as assessed by several standard criteria. The 3 and 4 factor models, however, showed significantly better fit than the 2 factor model. The 4 factor model introduced a latent variable of “oral difficulty” with feeding which merits further investigation. This study demonstrates the possibility of developing reliable and validated scales for the assessment of feeding difficulty in elderly patients with dementia.     

Strategies for feeding patients with dementia

OVERVIEW: Despite the high prevalence of dementia among elderly patients in hospitals and nursing homes and the strong association between dementia and feeding difficulty, few sources adequately address effective feeding interventions. Basing their discussion on the conceptual model that grew out of a previously published systematic literature review, the authors address a wide range of assessment and intervention practices specific to various observed behaviors that may aid in feeding patients with dementia.     

Eating difficulty in older people with dementia

Difficulty with feeding is a common problem among people with dementia and may pose ethical problems for the care team if decisions about continued feeding arise. Thorough assessment can help with successful management and a team approach, with the full involvement of relatives, is advocated.     

Feeding difficulty in older adults with dementia

Aims and objectives. To use concept analysis to identify characteristics of feeding difficulty and its antecedents and consequences that provide direction for assessment and management. Background. Feeding difficulty is often recognised as a common problem for older adults and is associated with weight loss, poor nutrition and risk for aspiration pneumonia. The cognitive impairment found in persons with dementia impairs the ability of these adults to complete motor and perceptual tasks required for eating and often prevent the older adult from accepting help with feeding from caregivers. Design. Systematic review. Methods. In 2006, literature searches using keywords (feeding, eating, nutrition, malnutrition, feeding assessment, dementia, ageing and concept analysis, dementia and feeding and excluding enteral feeding, tube feedings, PEG and enteral nutrition) were done in Medline, CINHAL, AGELINE and Social Science Full Text. Seventy relevant articles in English were found. After a review of the relevant articles, concept analysis was used to develop a definition of feeding difficulty, its defining characteristics and to delineate feeding difficulty from its antecedents and consequences. Results. Feeding difficulties arise at the interface between the caregiver strategies to assist the older adult with getting food into the mouth and chewing and swallowing food. A model of feeding difficulty delineates the antecedents and consequences of feeding difficulties. Conclusions. The conceptual model of feeding difficulties provides a strong and clear organising structure for research that can be used to developed evidence based guidelines for practice. Relevance to clinical practice. The conceptual model provides directions for assessment of feeding difficulties and their antecedents. The model can be used to identify interventions that address antecedents of feeding difficulty (risk factors) and different types of feeding difficulties.     

Tube feeding in patients with advanced dementia: knowledge and practice of speech-language pathologists

Context

Speech-language pathologists (SLP) are often called on to evaluate eating difficulties in patients with dementia.

Objectives

To assess factors associated with SLPs’ knowledge and recommendations about feeding tubes in patients with advanced dementia.

Methods

A mail survey was administered to a probability sample of 1500 SLPs from the American Speech-Language-Hearing Association mailing list; 731 usable surveys were received (response rate = 53.7%). Self-perceived preparedness, knowledge, and care recommendations were measured. Knowledge items were scored as “evidence based” or not according to the best evidence in the literature.

Results

Only 42.1% of SLP respondents felt moderately/well prepared to manage dysphagia. Only 22.0% of respondents recognized that tube feeding is unlikely to reduce risk of aspiration pneumonia whereas a slight majority understood that tube feeding would not likely prevent an uncomfortable death (50.2%), improve functional status (54.5%), or enhance quality of life (QOL) (63.2%). A majority (70.0%) was willing to consider recommending oral feeding despite high risk of aspiration. Logistic regression analyses indicated that those willing to consider this recommendation gave the most evidence-based responses to knowledge questions about tube feeding outcomes: aspiration pneumonia (odds ratio [OR] = 1.75, 95% confidence interval [CI] = 1.07–2.87), functional status (OR = 1.43, 95% CI = 1.0–2.06), QOL (OR = 2.19, 95% CI = 1.52–3.17), and prevent uncomfortable death (OR = 1.97, 95% CI = 1.37–2.88). Logistic regression analyses also indicated that those with more experience evaluating patients with dementia gave the most evidence-based response to two knowledge questions: aspiration pneumonia (OR = 2.64, 95% CI = 1.48–4.72) and prevent uncomfortable death (OR = 2.03, 95% CI = 1.35–3.05) whereas those with higher self-perceived preparedness in managing dysphagia in dementia had less knowledge in two areas: aspiration pneumonia (OR = 0.57, 95% CI = 0.38–0.84) and QOL (OR = 0.72, 95% CI = 0.51–1.01).

Conclusion

Misperceptions among SLPs about tube feeding in advanced dementia are common, especially in relation to risk of aspiration. Knowledge about tube feeding outcomes was positively associated with experience and inversely associated with self-perceived higher preparedness in evaluating patients with dementia.     

Percutaneous endoscopic gastrostomy: an effective strategy for gastrostomy feeding in patients with dementia

Percutaneous endoscopic gastrostomy (PEG) is an accepted technique for longterm enteral feeding. Its use has increased because of its simplicity and low complication rate. The demands for gastrostomy insertion have risen and now encompass indications where the long-term outcomes are uncertain. Dementia has become one of the commonest indications for gastrostomy feeding. This article reviews the justification for PEG feeding in dementia and suggests a practical approach for this difficult clinical situation. The clinical strategy described in this paper can be applied to other neurodegenerative diseases and provides a framework for improving a PEG service.     

Measuring anxiety in surgical patients using a visual analogue scale

Since the early days of surgery patients have been anxious about undergoing operations. This feeling remains common today despite advances in medicine and surgical techniques. Numerous studies have shown the effect anxiety has on the human body. It is the responsibility of healthcare professionals to ensure that any patient undergoing an elective surgical procedure is both physically and psychologically prepared. However, with increasing demands on the health service to be more efficient, little time is set aside to meet the psychological needs of the surgical patient. This article focuses on the use of a visual analogue scale to identify pre-operative anxiety in patients, so that healthcare practitioners can implement strategies to reduce anxiety and improve the person's overall experience.     

自我情绪评定量表在老年痴呆人群中的应用

目的 探讨自我情绪评定量表（ Self-Assessment Manikin , SAM ）在老年痴呆人群中的应用。方法 选取老年痴呆患者 128 例,进行痴呆严重程度分级,给予情绪图片刺激后,进行 SAM 量表评定。 结果 轻、中度痴呆患者能有效完成 SAM 量表测试,愉悦度整体低于常模,唤醒度和优势度要普遍高于常模,其中低愉悦、低唤醒水平图片的优势度和常模比较,差异有统计学意义（ P<0.05 ）;低优势度水平图片的唤醒度得分与常模值比较,差异有统计学意义（ P<0.05 ）,其他差异无统计学意义（ P>0.05 ）。 老年痴呆患者对不同维度不同水平的情绪图片的三维度评分散点图显示三者是存在明显关联的,愉悦度和唤醒度散点图分布呈“ V ”型;愉悦度和优势的散点分布图呈斜线型。 SAM 的自我情绪总体评分影响因素依次为照顾者身份、配偶情况、痴呆严重程度、医疗费用等。 结论 SAM 量表能成功的应用在我国轻、中度老年痴呆患者人群中,能在一定程度上客观反映老年痴呆患者对情绪刺激后的主观体验。