Review of Food Intake Difficulty Assessment Tools for People With Dementia

Western Journal of Nursing Research

Spencer, J. C., Damanik, R., et al. (2021).

Western Journal of Nursing Research, 43(12), 1132-1145.

This sytematic review investigates the reliability and validity of nursing assessment tools for evaluating observed feeding and swallowing difficulties in adults with dementia. 

Illawarra Health and Medical Research Institute (IHMRI) Clinical Translation Grant Scheme (Australia)

1990 to 2019

All study designs

16

The following psychometrics were noted regarding nurse-led assessment tools for evaluating observed feeding and swallowing difficulties in adults with dementia:<br /> <ul> <li><strong>Edinburg Feeding Evaluation in Dementia (EdFED) Scale #1:</strong>&nbsp;A limited number of studies reported that the EdFED had high content validity, scalability, and reproducibility, however, researchers found the scale to be unidimensional, necessitating the creation of the EdFED Scale #2.</li> <li><strong>EdFED Scale #2:</strong> Findings demonstrated high scalability, high test-retest reliability, substantial intra-rater reliability, and fair inter-rater reliability. Fair construct validity and substantial internal consistency were additionally noted. The EdFED Scale #2 score had a greater correlation to problem feeding behaviors than functional eating ability.&nbsp;</li> <li><strong>EdFED Questionnaire (EdFED-Q):</strong> Questions 5-10 of the EdFED-Q, which was used to develop scale #1 and #2 of the EdFED, demonstrated an internal reliability of 0.865. High internal consistency, moderate to substantial levels of content and construct validity were noted for all translated versions (e.g., Taiwanese, Chinese, Italian, Spanish, Canadian French) of the full questionnaire. Inter-rater reliability was not reported for the Canadian French version, however, all other translated versions reported substantial to near perfect inter-rater reliability. For the Taiwanese and Italian translation, rest-retest reliability was near perfect, while scalability ranged from slight to moderate.&nbsp;</li> <li><strong>Feeding Behaviour Index (FBI):</strong> Findings demonstrated inter-rater reliability of 88% and moderate internal consistency. Validity was not reported for the FBI.&nbsp;</li> <li><strong>Feeding Difficulty Index (FDI):</strong> High content validity and substantial inter-rater and test-retest reliability were noted, with moderate correlation between FDI scores and EdFED scores.&nbsp;</li> </ul> Due to an overall paucity of research, further research is indicated. Of note, while all included studies investigated nurse-administered feeding assessment tools, the use of these measures are within SLP scope. Findings should be interpreted with caution.