title: Grouped factors of the 'SSADE: signs and symptoms accompanying dementia while eating' and nutritional status-An analysis of older people receiving nutritional care in long-term care facilities in Japan.
abstract: BACKGROUND
  Behavioural and psychological symptoms of dementia (BPSD) are very common among older people, and previous studies showed that BPSD affects eating behaviour negatively, possibly resulting in undernutrition. In a previous study, we constructed a set of 11 items based on direct observations of older people with dementia during mealtime and named them 'SSADE: signs and symptoms accompanying dementia while eating'.
  
  
  OBJECTIVE
  This study aimed to conduct a factor analysis to clarify the structure of the set of 11 SSADE items and to analyse the relationship of the SSADE with nutritional status.
  
  
  METHODS
  We sampled 259 older people from 14 institutional facilities in Japan. To assess the status of the SSADE, we quantified each item according to its frequency and severity, using a 5-point scale. We also collected information regarding characteristics and nutritional status (body mass index [BMI], dietary intakes, body weight change, serum albumin level). We performed an exploratory factor analysis on the SSADE. In addition, associations between grouped factor scores and nutritional status were analysed.
  
  
  RESULTS
  Exploratory factor analysis indicated four factors. 'Hypoactivity' including 'dietary agnosia' and 'drowsiness' correlated negatively with BMI and serum albumin levels. 'Hyperactivity' including 'agitation', 'delusion', 'wandering' and 'eating too rapidly' correlated negatively with BMI. 'Obsessiveness' including 'food refusal' and 'fad eating' correlated negatively with BMI, dietary intake and body weight change. 'Aberrant behaviours' including 'eating apraxia', 'pica' and 'stealing food' correlated positively with dietary intake.
  
  
  CONCLUSIONS
  The identified factors of the SSADE were related to nutritional status, which may suggest acceptable factorial validity.
  
  
  CONCLUSIONS
  We expected the SSADE to contribute to the prevention and improvement of undernutrition, through the development of a concrete strategy for nutritional care planning by professional teams including dietitians in long-term care facilities.
authors.affiliation: Aomori University of Health and Welfare Graduate School of Health Sciences, Aomori, Japan.|Kanagawa University of Human Services, Kanagawa, Japan.
authors.forename: Kento
authors.identifier: http://orcid.org/0000-0001-6232-8659
authors.initials: K
authors.lastname: Takada
authors.affiliation: Yamato City Hall, Kanagawa, Japan.
authors.forename: Kazumi
authors.initials: K
authors.lastname: Tanaka
authors.affiliation: Yamato City Hall, Kanagawa, Japan.
authors.forename: Mihoko
authors.initials: M
authors.lastname: Hasegawa
authors.affiliation: Kanagawa University of Human Services, Kanagawa, Japan.
authors.forename: Michiko
authors.initials: M
authors.lastname: Sugiyama
authors.affiliation: Aomori University of Health and Welfare Graduate School of Health Sciences, Aomori, Japan.
authors.forename: Nobuo
authors.initials: N
authors.lastname: Yoshiike
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000451:nursing* / Q000523:psychology*; D005163:Factor Analysis, Statistical; D005247:Feeding Behavior / Q000523:psychology*; D005260:Female; D006801:Humans; D007564:Japan; D008134:Long-Term Care; D008297:Male; D009752:Nutritional Status
keywords: factor analysis; nutritional care; signs and symptoms accompanying dementia while eating; the behavioural and psychological symptoms of dementia; undernutrition