The Prevalence And Associated Factors Of Abnormal Eating Behaviors In Dementia Patients:a Cross-sectional Study

BackgroundParallel to the rapid aging of Chinese population,the population of patients with dementia in China is also rapidly increasing,reached 9.5 million in 2015,and it is estimated to reach 16 million by 2030.People with dementia have been found to have a high prevalence of abnormal eating behavior(AEB),such as dysphagia,appetite change,or preference for sweet tastes.AEB in patients with dementia can be modulated by dementia subtypes,cognitive function,dementia severity and ethnic culture.AEB can not only cause aspiration,malnutrition and even death of dementia patients,but also lead to the increase of eating-related caregiving disturbance,caregiver distress as well as caregiver burden.At present,there is a lack of valid assessment tools to comprehensi’vely evaluate the AEBs in Chinese dementia patients.Few studies have comprehensively assessed the prevalence and associated factors of AEBs in Chinese dementia patients.And the specific types of AEBs leading to the eating-related caregiving disturbance in dementia patients are still unclear,which calls for further research.Objectives1.To develop the Chinese version of Abnormal Eating Behavior Questionnaire(AEBQ),test its reliability and validity,then identify the prevalence and characteristics of AEBs in Chinese dementia patients.2.To investigate the associated factors of AEBs,and identify the influence of different types of AEBs on eating-related caregiving disturbance in a sample of dementia patients in mainland China.Methods1.After obtaining the authorization of the original questionnaire,forward and backward translation as well as cultural adaptation were conducted to form the Chinese version of AEBQ.By convenient sampling,129 dementia patients recruited from a nursing home and a psychiatric hospital in Guangzhou were investigated,in order to test the internal consistency,test-retest reliability,structure validity and concurrent validity of the Chinese version of AEBQ.Meanwhile,the prevalence and characteristics of AEB in Chinese dementia patients were also analyzed.2.The correlation between the item scores of AEBQ and the characteristics of participants was analyzed.Then the factors affecting the prevalence of each eating-related factors in dementia patients were identified.Moreover,the influence of each eating-related factors on eating-related caregiver disturbance was analyzed,in order to identify the types of AEBs leading to caregiving disturbance.Results1.The Cronbach’s ^a for the frequency,severity and total score of the Chinese version of AEBQ were 0.73,0.73 and 0.74,respectively,suggesting an acceptable internal consistency of the questionnaire.The intraclass correlation coefficient(ICC)for the frequency,severity and total score of the Chinese version of AEBQ were 0.88,0.90 and 0.88,respectively,suggesting an excellent test-retest reliability of the questionnaire.The exploratory factor analysis yielded 6 factors,accounting for 55.1%of the total variance.In addition,a strong correlation(r = 0.60,P<0.001)between the AEBQ and the "appetite and eating changes" item of Neuropsychiatric Inventory-Nursing Home Version(NPI-NH)was observed,suggesting a good concurrent validity of the questionnaire.Overall,86.8%of dementia patients showed some AEBs,among which the most common problems were eating dependency,dysphagia and decrease in appetite.The prevalence of AEB differed according to dementia severity.In mild stage of dementia,dysphagia has already occurred.In moderate stage,eating dependency,dysphagia and increase in appetite were prominent.While in patients with severe dementia,eating dependency,dysphagia and decrease in appetite commonly appeared.2.The deterioration of dementia severity significantly increased the risk of"eating dependency" in dementia patients(OR = 9.27),and significantly predicted the prevalence of "decrease in appetite"(OR = 2.98),"decline in table manners"(OR =2.43),and "swallowing problems"(OR=1.82)."Swallowing problems’ was not only associated with dementia severity and cognitive function,but also strongly affected by history of stroke(OR = 12.62).History of stroke was moderately correlated to the scores of "difficulty in swallowing liquids"(r = 0.42,P<0.001)and "coughing or choking when swallowing"(r = 0.41,P<0.001),but not related to "difficulty in swallowing food"(P>0.05).The use of antipsychotics can significantly reduce the risk of "decline in table manners"(OR = 0.21),but can increase the prevalence of"decrease in appetite"(OR = 3.15).In addition,there was a strong correlation between the eating-related caregiving disturbance and the total score of the AEBQ(r = 0.55,P<0.001).The eating-related problems that were most associated with eating-related caregiving disturbance were "prolongation of mealtime"(r = 0.33,P<0.001)and"decrease in appetite"(r = 0.42,P<0.001).Conclusions1.The Chinese version of AEBQ can be used as a valid tool for the investigation of AEB in Chinese dementia patients.There was a high prevalence of AEB in Chinese dementia patients.Eating dependency,dysphagia and decrease in appetite were the most common eating related problems.The prevalence of AEBs differed according to dementia severity.Targeted intervention should be further researched and implemented in order to improve the eating status and quality of life of dementia patients.2.Different types of AEBs were associated with different background variables.Adequate evaluation of AEBs and targeted interventions based on the associated factors of different AEBs are necessary for patients with dementia,to improve their eating status.Eating-related caregiving disturbance of formal dementia caregivers was closely related to patients’AEBs.The eating-related problems that were most associated with eating-related caregiving disturbance were prolongation of mealtime and decrease in appetite.Therefore,it is necessary to enhance the knowledge and skills training about AEBs and eating assistance for formal dementia caregivers,so as to help them deal with patients’ appetite loss effectively,relieve their time pressure during mealtime care,thereby reduce their eating-related caregiving disturbance,and improve the quality of care for dementia patients.