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Chia-chi Chang - One of the best experts on this subject based on the ideXlab platform.
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Development and psychometric evaluation of the Chinese Feeding Difficulty Index (Ch-FDI) for people with dementia
PloS one, 2015Co-Authors: Megan F Liu, Beverly L. Roberts, Nae-fang Miao, I-hui Chen, Yen-kuang Lin, Chia-chi ChangAbstract:Aims To develop and evaluate the psychometric properties of a Chinese Feeding Difficulty Index (Ch-FDI) which assesses Feeding difficulties in people with dementia (PwD). Research Design and Method Scale items were developed using literature review based on Model of Feeding Difficulty. Content validity was evaluated and items were modified by expert panel. Following translation and back-translation, the Ch-FDI was piloted on residents with dementia. The reliability was tested by inter-rater reliability and test-retest reliability. Internal reliability was established by calculating Cronbach's α coefficient. The concurrent validity was evaluated by correlating with similar scale, the Edinburgh Feeding Evaluation in Dementia (EdFED). The exploratory factor analysis (EFA) with varimax rotation and parallel analysis (PA) was performed to test construct validity. Method Participants were recruited from long-term care facilities in Taiwan. A total of 213 residents with dementia participated in this study during May, 2010 to February, 2011. Results Content validation, translation and psychometric testing were completed on the 19 items of the Ch-FDI. The translated scale was piloted on 213 residents with dementia of Feeding Difficulty who were recruited from eight long-term care facilities in Taiwan. The reliability was supported by the internal consistency of Cronbach's α of 0.68 and a test-retest coefficient of 0.85. The content validity, face validity, concurrent validity, and construct validity were used. Conclusions The Ch-FDI is a newly developed scale with fair psychometric properties aimed to measure Feeding difficulties among residents with dementia in long-term care facilities in Taiwan. Using this reliable and valid tool can help healthcare providers to assess Feeding problems of PwD and provide Feeding assistance in order to promote quality of care during mealtime in long-term care facilities.
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Prevalence and factors associated with Feeding Difficulty in institutionalized elderly with dementia in Taiwan.
The journal of nutrition health & aging, 2011Co-Authors: Chia-chi ChangAbstract:Objectives The purpose of this study was to establish the prevalence rate of Feeding Difficulty and to understand the factors associated with it among people with dementia.
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malnutrition and Feeding Difficulty in taiwanese older with dementia
Journal of Clinical Nursing, 2011Co-Authors: Chia-chi Chang, Beverly L. RobertsAbstract:Aims and objectives. To determine differences in the physical and psychological factors and Feeding Difficulty between people who are well-nourished and malnourished and to determine the predictors of risk of malnutrition and malnutrition in Taiwanese residents with dementia. Background. Malnutrition is a common problem among nursing home residents but frequently is unrecognised. Nutritional status of older people is associated with cognitive impairment and patients with dementia have high risk for malnutrition because of difficulties in eating. Design. A cross-sectional design was used to determine predictors of risk of malnutrition and malnutrition. Methods. Subjects were recruited from five Taiwanese long-term care facilities. Data were collected using Mini Nutritional Assessment Screening Form, body mass index, Short Portable Mental Status Questionnaire, Barthel index, Edinburgh Feeding Evaluation in Dementia scale and eating time. Results. Eighty-three subjects participated. According to the Mini Nutritional Assessment Screening Form cut-point scores, 75 (90·4%) residents with dementia had risk of malnutrition. However, using the World Health Organization (WHO) body mass index cut-point of <18·5, the prevalence rate of malnutrition was 19%. Using logistic regression, gender (odds ratio: 38·627, 95% CI: 1·927–774·407) and eating time (odds ratio: 0·814, 95% CI: 0·689–0·962) were significant predictors of risk of malnutrition. However, only gender (odds ratio: 6·12, 95% CI: 1·05–35·662) was a significant predictor of malnutrition using the WHO body mass index cut-point. Conclusions. The prevalence of the risk for malnutrition was high in residents with dementia in Taiwanese nursing homes. Feeding Difficulty, activities of daily living dependence, cognitive impairment, number of medications and age increased with malnutrition while shorter eating times were associated with poorer nutrition. However, when the factors were considered together, only being female and eating time were significant risk factors for malnutrition. Being female was the only significant factor of malnutrition. Relevance to clinical practice. Monthly monitoring of weight and assessment with Mini Nutritional Assessment Screening Form are essential to early identification of emerging malnutrition and implementation of interventions. Providing nutritional supplements and energy and protein-dense food may be needed for good nutrition and more time for eating or Feeding assistance may delay malnutrition or even improve nutritional status.
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Malnutrition and Feeding Difficulty in Taiwanese older with dementia
Journal of clinical nursing, 2011Co-Authors: Chia-chi Chang, Beverly L. RobertsAbstract:To determine differences in the physical and psychological factors and Feeding Difficulty between people who are well-nourished and malnourished and to determine the predictors of risk of malnutrition and malnutrition in Taiwanese residents with dementia. Malnutrition is a common problem among nursing home residents but frequently is unrecognised. Nutritional status of older people is associated with cognitive impairment and patients with dementia have high risk for malnutrition because of difficulties in eating. A cross-sectional design was used to determine predictors of risk of malnutrition and malnutrition. Subjects were recruited from five Taiwanese long-term care facilities. Data were collected using Mini Nutritional Assessment Screening Form, body mass index, Short Portable Mental Status Questionnaire, Barthel index, Edinburgh Feeding Evaluation in Dementia scale and eating time. Eighty-three subjects participated. According to the Mini Nutritional Assessment Screening Form cut-point scores, 75 (90·4%) residents with dementia had risk of malnutrition. However, using the World Health Organization (WHO) body mass index cut-point of <18·5, the prevalence rate of malnutrition was 19%. Using logistic regression, gender (odds ratio: 38·627, 95% CI: 1·927-774·407) and eating time (odds ratio: 0·814, 95% CI: 0·689-0·962) were significant predictors of risk of malnutrition. However, only gender (odds ratio: 6·12, 95% CI: 1·05-35·662) was a significant predictor of malnutrition using the WHO body mass index cut-point. The prevalence of the risk for malnutrition was high in residents with dementia in Taiwanese nursing homes. Feeding Difficulty, activities of daily living dependence, cognitive impairment, number of medications and age increased with malnutrition while shorter eating times were associated with poorer nutrition. However, when the factors were considered together, only being female and eating time were significant risk factors for malnutrition. Being female was the only significant factor of malnutrition. Monthly monitoring of weight and assessment with Mini Nutritional Assessment Screening Form are essential to early identification of emerging malnutrition and implementation of interventions. Providing nutritional supplements and energy and protein-dense food may be needed for good nutrition and more time for eating or Feeding assistance may delay malnutrition or even improve nutritional status. © 2011 Blackwell Publishing Ltd.
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Feeding Difficulty in older adults with dementia.
Journal of clinical nursing, 2008Co-Authors: Chia-chi Chang, Beverly L. RobertsAbstract: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.
Roger Watson - One of the best experts on this subject based on the ideXlab platform.
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commentary on chang c c roberts bl 2008 Feeding Difficulty in older adults with dementia journal of clinical nursing 17 2266 2274
Journal of Clinical Nursing, 2008Co-Authors: Roger WatsonAbstract:I was very pleased to accept this article (Chang & Roberts 2008) for publication in JCN. Not only does it make copious reference to my own work, which led to the development of the Edinburgh Feeding Evaluation in Dementia scale (EdFED) (Watson 1996), it also refers to the work of others who have taken this scale and applied it in further research (Amella 2002) and even translated it into Chinese (Lin & Chang 2003). In fact, the translation into Chinese was done with the help of the first author of the this article (Chang) and this translated version has seen considerable application in further research in Taiwan, with several articles in press demonstrating the utility of the EdFED scale and its crosscultural validity. Chang and Roberts (2008) analyse the concept of Feeding Difficulty in dementia and explain that it is only with a clarification of concepts surrounding Feeding Difficulty that the antecedent factors that lead to Feeding Difficulty in older adults can be addressed. To date, as evidenced by my own review (Watson and Green 2006), the evidence that we can do anything consistently to address the Feeding Difficulty of older people with dementia and improve their Feeding is scant. This is a lamentable state of affairs given the prevalence of the problem, the distress it causes patients and relatives and the time involved in trying to help older people with dementia to eat. One not addressed by Chang and Roberts (2008) was the ethical issues surrounding Feeding older people with dementia and this is something that less easily crosses cultural boundaries. There has to be a point at which continuing to feed an older person with dementia, who is resistive to Feeding, becomes pointless – but when is that point reached? In the UK tube Feeding of people with dementia is very uncommon; it was more common in the USA, despite lack of evidence to support its use and some evidence that it may hasten death. In Taiwan, where I am a frequent visitor, I have witnessed tube Feeding of older people with dementia. The motivation for continued – and sometimes forced – Feeding of older people with dementia is often that of ‘life at all costs’ against a philosophy of ‘quality vs. quantity’ of life. There is reluctance by some people and in some cultures, often for religious reasons, to accept that dementia is a terminal condition and the clinical backdrop is one of continual decline, albeit at different rates. I hope that Chang and Roberts take this work forward and I hope that there is a future strand of research that explicitly addresses the crosscultural issues related to end-of-life in older people with dementia and which seeks to produce humane and culturally acceptable standards.
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Undernutrition, weight loss and Feeding Difficulty in elderly patients with dementia: a nursing perspective
Reviews in Clinical Gerontology, 1997Co-Authors: Roger WatsonAbstract:The problems of undernutrition, weight loss and Feeding Difficulty are more prevalent in elderly people than in their younger counterparts and are particularly prevalent in patients with dementia. These aspects of dementia challenge several members of the multidisciplinary team caring for elderly people with dementia, including geriatric and psychogeriatric physicians, dietitians and nurses.
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Feeding Difficulty in elderly patients with dementia: Confirmatory factor analysis
International journal of nursing studies, 1997Co-Authors: Roger Watson, Ian J. DearyAbstract:Abstract 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.
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Construct validity of a scale to measure Feeding Difficulty in elderly patients with dementia
Clinical Effectiveness in Nursing, 1997Co-Authors: Roger WatsonAbstract:This short report describes the construct validity of the Edinburgh Feeding Evaluation in Dementia Scale #2 (EdFED #2), which has been developed for the measurement of Feeding Difficulty in elderly people with dementia. This scale has previously been reported upon (Watson 1994; Watson 1996). As the cognitive function of an elderly person with dementia declines there is a concomitant decline in the ability to carry out activities of daily living and this includes the ability to feed themself (Volicer et al 1987). It is clear that nurses are uncertain about how to characterize the Feeding Difficulty that is experienced by elderly people with dementia (Osborn & Marshall 1993). As a result it is difficult to make assessments and, thereafter, to make appropriate interventions to alleviate the Feeding Difficulty. The EdFED scale was developed in an effort to address these problems and also to gain a better understanding of the pattern of Feeding Difficulty in elderly people with dementia.
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A longitudinal study of Feeding Difficulty and nursing intervention in elderly patients with dementia
Journal of advanced nursing, 1997Co-Authors: Roger Watson, Ian J. DearyAbstract: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.
Hyunhwa Hong - One of the best experts on this subject based on the ideXlab platform.
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development and effects of a coping skill training program for caregivers in Feeding Difficulty of older adults with dementia in long term care facilities
Journal of Korean Academy of Nursing, 2018Co-Authors: Hyunhwa HongAbstract:Purpose We developed and tested the effects of a coping skill training program for caregivers in Feeding Difficulty among older adults with dementia in long-term care facilities. Methods A non-equivalent control group pretest-posttest design was used. The subjects comprised 34 caregivers (experimental group: 17, control group: 17) and 40 older adults with dementia (experimental group: 20, control group: 20). The developed program was delivered in 4-hour sessions over 6 weeks (including 2 weeks of lectures and lab practice on Feeding Difficulty coping skills, and 4 weeks of field practice). Data were collected before, immediately after, and 4 weeks after the program (January 3 to April 6, 2016). The data were analyzed using t-test and repeated measures ANOVA using SPSS/WIN 20.0. Results Compared to their counterparts in the control group, caregivers in the experimental group showed a significantly greater improvement in Feeding knowledge and Feeding behavior, while older adults with dementia showed greater improvements in Feeding Difficulty and Body Mass Index. Conclusion The study findings indicate that this coping skill training program for caregivers in Feeding Difficulty is an effective intervention for older adults with dementia in long-term care facilities.
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Development and Effects of a Coping Skill Training Program for Caregivers in Feeding Difficulty of Older Adults with Dementia in Long-Term Care Facilities
Journal of Korean Academy of Nursing, 2018Co-Authors: Hyunhwa HongAbstract:We developed and tested the effects of a coping skill training program for caregivers in Feeding Difficulty among older adults with dementia in long-term care facilities. A non-equivalent control group pretest-posttest design was used. The subjects comprised 34 caregivers (experimental group: 17, control group: 17) and 40 older adults with dementia (experimental group: 20, control group: 20). The developed program was delivered in 4-hour sessions over 6 weeks (including 2 weeks of lectures and lab practice on Feeding Difficulty coping skills, and 4 weeks of field practice). Data were collected before, immediately after, and 4 weeks after the program (January 3 to April 6, 2016). The data were analyzed using t-test and repeated measures ANOVA using SPSS/WIN 20.0. Compared to their counterparts in the control group, caregivers in the experimental group showed a significantly greater improvement in Feeding knowledge and Feeding behavior, while older adults with dementia showed greater improvements in Feeding Difficulty and Body Mass Index. The study findings indicate that this coping skill training program for caregivers in Feeding Difficulty is an effective intervention for older adults with dementia in long-term care facilities. © 2018 Korean Society of Nursing Science.
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Feeding Difficulty and its influencing factors of elders with dementia in long term care facilities
The Korea Academia-Industrial cooperation Society, 2015Co-Authors: Hyunhwa HongAbstract:The purpose of this study was to investigate Feeding Difficulty and its influencing factors of elders with dementia in long-term care facilities. Participants were 158 elders with dementia residing in three nursing facilities. Data were collected from Aug. 18 to Sep. 12 in 2014. The Feeding Difficulty in dementia scale, Korean version-Activities of Daily Living and Mini-Mental State Exam-Korean version were used as instruments. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation and stepwise multiple regression by SPSS 17.0. Mean Feeding Difficulty score was 0.62±0.43(range of 0-2). The highest Feeding Difficulty item was "patient require close supervision while Feeding". The variables influencing the Feeding Difficulty was ADL(β=.312), cognitive function(β=-.172) which explained about 20.0% of total variance. The results suggest the need of developing Feeding Difficulty coping strategy according to dietary behavior phase, In addition, the development and testing the educational program for caregivers to help Feeding Difficulty of the elders with dementia in long-term facility are recommended.
Hirotomo Saitsu - One of the best experts on this subject based on the ideXlab platform.
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De novo MEIS2 mutation causes syndromic developmental delay with persistent gastro-esophageal reflux.
Journal of Human Genetics, 2016Co-Authors: Atsushi Fujita, Yoshinori Tsurusaki, Noriko Miyake, Nobuhiko Okamoto, Hirotomo Saitsu, Bertrand Isidor, Hugues Piloquet, Pierre Corre, Mitsuko Nakashima, Naomichi MatsumotoAbstract:MEIS2 aberrations are considered to be the cause of intellectual disability, cleft palate and cardiac septal defect, as MEIS2 copy number variation is often observed with these phenotypes. To our knowledge, only one nucleotide-level change-specifically, an in-frame MEIS2 deletion-has so far been reported. Here, we report a female patient with a de novo nonsense mutation (c.611C>G, p.Ser204*) in MEIS2. She showed severe intellectual disability, moderate motor/verbal developmental delay, cleft palate, cardiac septal defect, hypermetropia, severe Feeding difficulties with gastro-esophageal reflux and constipation. By reviewing this patient and previous patients with MEIS2 point mutations, we found that Feeding Difficulty with gastro-esophageal reflux appears to be one of the core clinical features of MEIS2 haploinsufficiency, in addition to intellectual disability, cleft palate and cardiac septal defect.
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a de novo deletion of 20q11 2 q12 in a boy presenting with abnormal hands and feet retinal dysplasia and intractable Feeding Difficulty
American Journal of Medical Genetics Part A, 2011Co-Authors: Yoko Hiraki, Michiko Hayashidani, Yoshiko Terada, Sachiko Nishina, Yoshinori Tsurusaki, Nobuhiko Okamoto, Hirotomo Saitsu, Gen Nishimura, Akira Nishimura, Noriko MiyakeAbstract:Proximal interstitial deletions involving 20q11–q12 are very rare. Only two cases have been reported. We describe another patient with 20q11.21–q12 deletion. We precisely mapped the 6.5-Mb deletion and successfully determined the deletion landmarks at the nucleotide level. Common clinical features among the three cases include developmental delay, intractable Feeding difficulties with gastroesophageal reflux, and facial dysmorphism including triangular face, hypertelorism, and hypoplastic alae nasi, indicating that the 20q11.2–q12 deletion can be a clinically recognizable syndrome. This is also supported by the fact that the three deletions overlap significantly. In addition, unique features such as arthrogryposis/fetal akinesia (hypokinesia) deformation and retinal dysplasia are recognized in the patient reported herein. © 2011 Wiley-Liss, Inc.
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A de novo deletion of 20q11.2-q12 in a boy presenting with abnormal hands and feet, retinal dysplasia, and intractable Feeding Difficulty.
American journal of medical genetics. Part A, 2011Co-Authors: Yoko Hiraki, Michiko Hayashidani, Yoshiko Terada, Sachiko Nishina, Yoshinori Tsurusaki, Nobuhiko Okamoto, Gen Nishimura, Akira Nishimura, Hirotomo SaitsuAbstract:Proximal interstitial deletions involving 20q11-q12 are very rare. Only two cases have been reported. We describe another patient with 20q11.21-q12 deletion. We precisely mapped the 6.5-Mb deletion and successfully determined the deletion landmarks at the nucleotide level. Common clinical features among the three cases include developmental delay, intractable Feeding difficulties with gastroesophageal reflux, and facial dysmorphism including triangular face, hypertelorism, and hypoplastic alae nasi, indicating that the 20q11.2-q12 deletion can be a clinically recognizable syndrome. This is also supported by the fact that the three deletions overlap significantly. In addition, unique features such as arthrogryposis/fetal akinesia (hypokinesia) deformation and retinal dysplasia are recognized in the patient reported herein.
Beverly L. Roberts - One of the best experts on this subject based on the ideXlab platform.
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Development and psychometric evaluation of the Chinese Feeding Difficulty Index (Ch-FDI) for people with dementia
PloS one, 2015Co-Authors: Megan F Liu, Beverly L. Roberts, Nae-fang Miao, I-hui Chen, Yen-kuang Lin, Chia-chi ChangAbstract:Aims To develop and evaluate the psychometric properties of a Chinese Feeding Difficulty Index (Ch-FDI) which assesses Feeding difficulties in people with dementia (PwD). Research Design and Method Scale items were developed using literature review based on Model of Feeding Difficulty. Content validity was evaluated and items were modified by expert panel. Following translation and back-translation, the Ch-FDI was piloted on residents with dementia. The reliability was tested by inter-rater reliability and test-retest reliability. Internal reliability was established by calculating Cronbach's α coefficient. The concurrent validity was evaluated by correlating with similar scale, the Edinburgh Feeding Evaluation in Dementia (EdFED). The exploratory factor analysis (EFA) with varimax rotation and parallel analysis (PA) was performed to test construct validity. Method Participants were recruited from long-term care facilities in Taiwan. A total of 213 residents with dementia participated in this study during May, 2010 to February, 2011. Results Content validation, translation and psychometric testing were completed on the 19 items of the Ch-FDI. The translated scale was piloted on 213 residents with dementia of Feeding Difficulty who were recruited from eight long-term care facilities in Taiwan. The reliability was supported by the internal consistency of Cronbach's α of 0.68 and a test-retest coefficient of 0.85. The content validity, face validity, concurrent validity, and construct validity were used. Conclusions The Ch-FDI is a newly developed scale with fair psychometric properties aimed to measure Feeding difficulties among residents with dementia in long-term care facilities in Taiwan. Using this reliable and valid tool can help healthcare providers to assess Feeding problems of PwD and provide Feeding assistance in order to promote quality of care during mealtime in long-term care facilities.
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malnutrition and Feeding Difficulty in taiwanese older with dementia
Journal of Clinical Nursing, 2011Co-Authors: Chia-chi Chang, Beverly L. RobertsAbstract:Aims and objectives. To determine differences in the physical and psychological factors and Feeding Difficulty between people who are well-nourished and malnourished and to determine the predictors of risk of malnutrition and malnutrition in Taiwanese residents with dementia. Background. Malnutrition is a common problem among nursing home residents but frequently is unrecognised. Nutritional status of older people is associated with cognitive impairment and patients with dementia have high risk for malnutrition because of difficulties in eating. Design. A cross-sectional design was used to determine predictors of risk of malnutrition and malnutrition. Methods. Subjects were recruited from five Taiwanese long-term care facilities. Data were collected using Mini Nutritional Assessment Screening Form, body mass index, Short Portable Mental Status Questionnaire, Barthel index, Edinburgh Feeding Evaluation in Dementia scale and eating time. Results. Eighty-three subjects participated. According to the Mini Nutritional Assessment Screening Form cut-point scores, 75 (90·4%) residents with dementia had risk of malnutrition. However, using the World Health Organization (WHO) body mass index cut-point of <18·5, the prevalence rate of malnutrition was 19%. Using logistic regression, gender (odds ratio: 38·627, 95% CI: 1·927–774·407) and eating time (odds ratio: 0·814, 95% CI: 0·689–0·962) were significant predictors of risk of malnutrition. However, only gender (odds ratio: 6·12, 95% CI: 1·05–35·662) was a significant predictor of malnutrition using the WHO body mass index cut-point. Conclusions. The prevalence of the risk for malnutrition was high in residents with dementia in Taiwanese nursing homes. Feeding Difficulty, activities of daily living dependence, cognitive impairment, number of medications and age increased with malnutrition while shorter eating times were associated with poorer nutrition. However, when the factors were considered together, only being female and eating time were significant risk factors for malnutrition. Being female was the only significant factor of malnutrition. Relevance to clinical practice. Monthly monitoring of weight and assessment with Mini Nutritional Assessment Screening Form are essential to early identification of emerging malnutrition and implementation of interventions. Providing nutritional supplements and energy and protein-dense food may be needed for good nutrition and more time for eating or Feeding assistance may delay malnutrition or even improve nutritional status.
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Malnutrition and Feeding Difficulty in Taiwanese older with dementia
Journal of clinical nursing, 2011Co-Authors: Chia-chi Chang, Beverly L. RobertsAbstract:To determine differences in the physical and psychological factors and Feeding Difficulty between people who are well-nourished and malnourished and to determine the predictors of risk of malnutrition and malnutrition in Taiwanese residents with dementia. Malnutrition is a common problem among nursing home residents but frequently is unrecognised. Nutritional status of older people is associated with cognitive impairment and patients with dementia have high risk for malnutrition because of difficulties in eating. A cross-sectional design was used to determine predictors of risk of malnutrition and malnutrition. Subjects were recruited from five Taiwanese long-term care facilities. Data were collected using Mini Nutritional Assessment Screening Form, body mass index, Short Portable Mental Status Questionnaire, Barthel index, Edinburgh Feeding Evaluation in Dementia scale and eating time. Eighty-three subjects participated. According to the Mini Nutritional Assessment Screening Form cut-point scores, 75 (90·4%) residents with dementia had risk of malnutrition. However, using the World Health Organization (WHO) body mass index cut-point of <18·5, the prevalence rate of malnutrition was 19%. Using logistic regression, gender (odds ratio: 38·627, 95% CI: 1·927-774·407) and eating time (odds ratio: 0·814, 95% CI: 0·689-0·962) were significant predictors of risk of malnutrition. However, only gender (odds ratio: 6·12, 95% CI: 1·05-35·662) was a significant predictor of malnutrition using the WHO body mass index cut-point. The prevalence of the risk for malnutrition was high in residents with dementia in Taiwanese nursing homes. Feeding Difficulty, activities of daily living dependence, cognitive impairment, number of medications and age increased with malnutrition while shorter eating times were associated with poorer nutrition. However, when the factors were considered together, only being female and eating time were significant risk factors for malnutrition. Being female was the only significant factor of malnutrition. Monthly monitoring of weight and assessment with Mini Nutritional Assessment Screening Form are essential to early identification of emerging malnutrition and implementation of interventions. Providing nutritional supplements and energy and protein-dense food may be needed for good nutrition and more time for eating or Feeding assistance may delay malnutrition or even improve nutritional status. © 2011 Blackwell Publishing Ltd.
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Feeding Difficulty in older adults with dementia.
Journal of clinical nursing, 2008Co-Authors: Chia-chi Chang, Beverly L. RobertsAbstract: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.
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Cultural perspectives in Feeding Difficulty in Taiwanese elderly with dementia.
Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing, 2008Co-Authors: Chia-chi Chang, Beverly L. RobertsAbstract:Objective: To investigate factors related to Feeding Difficulty that is shown in the interaction between nursing assistants and elderly residents with dementia. Methods: Forty-eight residents and 31 nursing assistants were observed during meal times in a congregate dining room of a Taiwanese nursing home specializing in dementia care. Residents' eating behaviors, the dining environment, interactions between the nursing assistant and the residents, and Feeding strategies used by nursing assistants were observed. Nutritional data for residents were collected from medical charts. The EdFED Scale #2 and interviews of nursing assistants provided information about Feeding Difficulty. Interviews also provided data on strategies used to address Feeding difficulties. Findings: The most frequent Feeding Difficulty was refusal to eat (37.5%). The strategies used by nursing assistants were limited. Nursing assistants stated they needed more training to address Feeding Difficulty in residents with dementia. Conclusions: Future research should be focused on the interface between the residents and nursing assistants who must identify various Feeding difficulties and select appropriate interventions. Clinical Relevance: Results might provide information that can be used to develop effective interventions and promote high-quality mealtime care in patients with dementia.
