1. Copyright H.H. Keller 2004. All rights reserved. 1 Screening for Nutritional Risk in Seniors

2. Copyright H.H. Keller 2004. All rights reserved. 2 Definitions Screening: the examination of asymptomatic people in order to classify them as likely or unlikely to have the disease that is the object of screening Screening: the examination of asymptomatic people in order to classify them as likely or unlikely to have the disease that is the object of screening

3. Copyright H.H. Keller 2004. All rights reserved. 3 Definitions Assessment: comprehensive approach, to define nutritional status that uses medical, nutrition and medication histories; physical examination; anthropometric measurements; and laboratory data Assessment: comprehensive approach, to define nutritional status that uses medical, nutrition and medication histories; physical examination; anthropometric measurements; and laboratory data

4. Copyright H.H. Keller 2004. All rights reserved. 4 RISK FACTORS Isolation Cooking/Shopping Money Illness/medication MALNUTRITION Emaciated Poor immunity Decreased strength SCREENING ASSESSMENT

5. Copyright H.H. Keller 2004. All rights reserved. 5 Why are we screening for nutritional risk? Benefits to early identification, prevention Benefits to early identification, prevention Serious consequences to malnutrition Serious consequences to malnutrition Treatment believed to benefit and reduce serious consequences, especially when implemented early Treatment believed to benefit and reduce serious consequences, especially when implemented early Management of resources Management of resources

6. Copyright H.H. Keller 2004. All rights reserved. 6 What is SCREEN ? Seniors in the Community: Risk Evaluation for Eating and Nutrition TM

7. Copyright H.H. Keller 2004. All rights reserved. 7 Development & Validation of SCREEN Development - Review of the literature for concept - Development of question items - Expert review and ranking of importance - Senior review for wording, concepts Validation - Compared SCREEN score to a dietitian’s rating of risk - Rating of risk based on diet, weight and medical history - Compared to other factors such as perceived health, health status etc. for convergent validity

8. Copyright H.H. Keller 2004. All rights reserved. 8 Reliability of SCREEN Reliability identifies if the questionnaire will provide the same answers on repeat administration. - test-retest reliability has been completed for both versions of SCREEN - Intra-rater and inter-rater reliability has been completed on SCREEN II

9. Copyright H.H. Keller 2004. All rights reserved. 9 Sensitivity: A health index has high sensitivity if it correctly identifies those who have the condition/problem. Specificity: A health index has high specificity if it correctly identifies those who do not have the condition/problem.

10. Copyright H.H. Keller 2004. All rights reserved. 10 Comparison of SCREEN Versions VersionSensitivitySpecificityTest-Retest Reliability Inter-rater Reliability SCREEN I (<50 cut-point) 94%32%ICC=0.57N/A SCREEN I (≤ 45 cut-point) 81%55%ICC=0.57N/A SCREEN I abbreviated (< 32 cut-point) 96%62%ICC=0.72N/A SCREEN II (< 54 cut-point) 84%62%ICC=0.84ICC=0.83 SCREEN II abbreviated (<43 ) 84%58%ICC=0.84ICC=0.79

11. Copyright H.H. Keller 2004. All rights reserved. 11 What is “Ethical” Nutrition Screening? Target screening to the right people Target screening to the right people Identify nutrition problems and appropriate courses of action (e.g., assessment, resources) Identify nutrition problems and appropriate courses of action (e.g., assessment, resources) Referral/resource framework that meets needs Referral/resource framework that meets needs Follow-up post screening Follow-up post screening

12. Copyright H.H. Keller 2004. All rights reserved. 12 Bringing Nutrition Screening to Seniors How feasible is nutrition risk screening in the community?

13. Copyright H.H. Keller 2004. All rights reserved. 13 Demonstration Communities 5 Canadian Communities, 1220 seniors 5 Canadian Communities, 1220 seniors Geographically diverse Geographically diverse Rural/urban mix Rural/urban mix Potential for a variety of models for nutrition screening Potential for a variety of models for nutrition screening

14. Copyright H.H. Keller 2004. All rights reserved. 14 Details on Participants Average age 74 years Average age 74 years Majority (75%) were women Majority (75%) were women 60% lived alone 60% lived alone 47% had less than a high school education 47% had less than a high school education Majority not connected to nutrition services Majority not connected to nutrition services 50% “vulnerable” seniors 50% “vulnerable” seniors

15. Copyright H.H. Keller 2004. All rights reserved. 15 Details on Nutritional Risk 42% nutritional risk 42% nutritional risk Gradient with education Gradient with education Gradient with living situation Gradient with living situation No difference by gender or age No difference by gender or age “Vulnerable” seniors more likely to be “at risk” “Vulnerable” seniors more likely to be “at risk”

16. Copyright H.H. Keller 2004. All rights reserved. 16 What do seniors say about screening? 85% indicated “helpful” 85% indicated “helpful” Awareness Awareness Strengths/weaknesses Strengths/weaknesses Got services Handouts Concern of professional SCREEN easy to use and relevant SCREEN easy to use and relevant

17. Copyright H.H. Keller 2004. All rights reserved. 17 Screen Administrators The screen administrator is the person who completes the screen process with seniors completes the screen process with seniors completes questionnaire completes questionnaire discusses score with senior & need for services discusses score with senior & need for services makes referrals makes referrals provides follow-up provides follow-up

18. Copyright H.H. Keller 2004. All rights reserved. 18 Who can be a screen administrator? In the Bringing Nutrition Screening to Seniors Project, there were diverse administrators: senior peers senior peers health professionals, other professionals health professionals, other professionals receptionists, volunteers receptionists, volunteers students students

19. Copyright H.H. Keller 2004. All rights reserved. 19 Training of Screen Administrators All screen administrators will have different skill sets, abilities, and talents. Different levels of training may be required for different types of administrators. Key concepts include: understanding the difference between screening and assessment understanding the difference between screening and assessment understanding the nutritional needs of seniors & common barriers to good nutrition understanding the nutritional needs of seniors & common barriers to good nutrition understanding how SCREEN should be completed understanding how SCREEN should be completed

20. Copyright H.H. Keller 2004. All rights reserved. 20 Keys to Success in Screening A champion within the site/community A champion within the site/community Screening is considered a priority activity with allocated resources Screening is considered a priority activity with allocated resources Adequate training and monitoring of screen administrators Adequate training and monitoring of screen administrators Clear referral/service use plans Clear referral/service use plans Clear monitoring plan Clear monitoring plan

21. Copyright H.H. Keller 2004. All rights reserved. 21 How to start screening? Visit the BNSS website for: - Fact sheets - Implementation Guide - Educational Resources for Seniors - Sample Community Action Plans www.dietitians.ca/seniors/