title: Measuring mealtime difficulties: eating, feeding and meal behaviours in older adults with dementia.
abstract: OBJECTIVE
  The purpose of this integrative review is to examine the instruments currently available for clinical use specifically to assess mealtime difficulties, a concept subsuming the domains of eating, feeding and meal behaviours in older adults with dementia; and to determine the quality and practicality of those instruments for use in clinical practice.
  
  
  BACKGROUND
  Dementia is a leading cause of death globally and the 5th leading cause of death in the USA for adults over 65. Nutritional status is vital to well-being, therefore, instruments to measure eating, feeding and meal behaviours are important. Instruments measuring these behaviours can be used to plan effective interventions to alleviate the behaviours and improve oral intake.
  
  
  METHODS
  Integrative review.
  
  
  METHODS
  Database searches of EBSCOHost, PubMed, CINAHL, ScienceDirect, AgeLine and HaPI using various keyword combinations related to meal, eating and feeding behaviours in dementia as well as keywords related to instruments, scales or measurement. Abstracts and articles were analysed to identify instruments used in research and clinically to measure eating, feeding and meal behaviours in dementia.
  
  
  RESULTS
  Twelve observational instruments were identified and organised into categories of eating, feeding and meal behaviours for older adults with dementia. Instruments were described by concepts measured.
  
  
  CONCLUSIONS
  The majority of instruments identified do not report adequate psychometric testing in the literature. One instrument is identified reporting extensive testing for reliability and validity and has been recommended for clinical practice--The Edinburgh Feeding Evaluation in Dementia (EdFED) scale.
  
  
  CONCLUSIONS
  The EdFED has been identified as a valid and reliable instrument for measuring feeding difficulties and is available for use in clinical practice. In using the EdFED, interventions can be planned to monitor feeding difficulties and promote nutritional status of older adults with dementia.
authors.affiliation: Medical University of South Carolina, College of Nursing, Charleston, SC 29425, USA. aselage@musc.edu
authors.forename: Melissa B
authors.initials: MB
authors.lastname: Aselage
mesh_terms: D003704:Dementia / Q000503:physiopathology*; D004435:Eating; D006801:Humans