Pergamon I,,/. J. Nurs. Stud.. Vol. 33, No. 4. pp. 385~-393, 1996 CopyrIght i!> 1996 Elsevier Scmce Ltd. All rights reserved Printed in Great Britain 002&7489’96 $15.00+0.00 0020-7489(95)00058-5 The Mokken scaling procedure (A&P) applied to the measurement of feeding difJiculty in elderly people with dementia ROGER WATSON, B.Sc., Ph.D., R.G.N., C.Biol., M.I.Biol. Depurtmcni of Nursing Studies. The University of Edinburgh, 40 George Square, Edinburgh EH8 9LL, U.K. Abstract-Feeding difficulty increases as the condition of dementia progresses. Compensating for this difficulty in feeding is time consuming for lay and pro- fessional carers and is the cause of many practical and ethical problems. The current work reports on an analysis by meansof Mokken scaling, of the pattern of accumulation of feeding difficulty-described as obstinacy or passivity-in a sample of 182 elderly people with dementia in a psychogeriatric setting. The existence of a cumulative, unidimensional scale was demonstrated which may have some clinical value. Further lines of investigation to validate the scale are suggested.Copyright 0 1996 Elsevier Science Ltd. Introduction Normal mental functions decline as the condition of dementia progresses(Kurita et al., 1993; Teri et al., 1988). Specifically, the advanced stagesof dementia are characterised by a decline in the ability of sufferers to self-care in the activities of daily living (Volicer et al., 1987). Perhaps one of the most distressing of theseinabilities for sufferers and carers is that of feeding (Norberg et al., 1980a), and this aspect of the terminal stages of dementia raises many practical and ethical issues for families and professionals caring for elderly people (Akerlund and Norberg, 1985; Miles, 1985). Feeding difficulty in elderly patients with dementia is probably one of the factors which contributes to the poor nutritional state of many elderly people suffering from this condition 385