Journal zyxwvutsrqpon of Advanced Nursing, zyxwvutsrqp 1994, zyxwvuts 19, 257-263 Measuring feeding difficulty in patients with dementia: developing a scale zyxw Roger Watson BSc PhD zyxwvuts RGN CBiol MIBiol Lecturer, Department zyxwvutsrq of Nursing Sfudies, The University of Edinburgh, 40 George Square, Edinburgh EH8 9LL, Scotland Accepted for publication 14 June 1993 WATSON R. (1994) Measuring feeding difficulty in patients with dementia: developing a scale Feeding &culty in elderly people with dementia is well documented and the need for research in this area of nursing care has been raised by several authors. One hundred and twelve elderly people with dementia were entered into a study of feeding d&culty. Data were gathered by means of a questionnaire administered to the nurses caring for the patients. The aspects of f e e h g difficulty which were investigated were based on reports of relevant behaviour in the literature and included refusal to eat, turning the head away, refusing to open the mouth, spitting, allowing food to drop out of the mouth and not swallowing. It was possible to arrange these different aspects of feeding difficulty under three headings: (a) refusal to eat, (b) spitting, and (c) inability to swallow, and to analyse the pattern of accumulation of these feeding difficulties by means of Guttman scale analysis. According to this analysis, the feeding Uculties investigated form a cumulative and unidimensional pattern. The implications of this pattern and the possibilities for further research are discussed. ]ournal zyxwvu of Advanced Nursing 19, 257-263 INTRODUCTION Elderly people suffering from dementia have nutritional problems (Berlinger zyxwvutsr & Potter 1991) and also display changes in eating behaviour as the condition progresses (Backstrom et al. 1987). In the advanced stages of dementia, difficulties with feeding are common and the case for research in this area of caring for elderly people has been advanced by several authors (Backstrom et al. 1987, Fairbum & Hope 1988a,b, Norberg et al. 1988, Watson 1990). A range of di6ticulties and behaviour related to feeding has been described in elderly people suffering from dementia, including difficulty in moving food from a plate to the mouth (Athlin et al. 1989);difficulty with swdow- ing (Norberg et al. 1980a, Siebens et al. 1986, Athlin & Norberg 1987a, Michaelsson et al. 1987, Sanders 1990); behaviour indicating a refusal to eat (Norberg et al. 1980a, Athlin & Norberg 1987a, Michaelsson et al. 1987); spitting (Norberg et al. 1980b, Siebens zyx et al. 1986, Athlin & Norberg 198713);leaving the mouth open so that food falls out (Siebens et al. 1986, Michaelsson et al. 1987); inability to self-feed; and complete refusal to eat (Miller 1971, Kkerlund & Norberg 1985, Alford 1986, Singh et al. 1988, Sanders 1990). Research into the feeding difficulty of elderly people with dementia is needed in order to help nurses to identify the problems of individual patients and to make appropriate interventions. These interventions may be aimed at helping an individual to eat in order to improve independence, dignity and nutritional status. On the other hand, there may be circumstances where feeding is inappropriate, such as in the terminal stages of dementia. 25 7