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

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’. Aims 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. Conclusion The identified factors of the SSADE were related to nutritional status, which may suggest acceptable factorial validity. Implications for practice 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.