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

Copyright H.H. Keller 2004. All rCopyright H.H. Keller 2004. All rights reserved. ights reserved.

11

Screening for Screening for Nutritional Risk in Nutritional Risk in

SeniorsSeniors


22

DefinitionsDefinitions

Screening:Screening: the examination of asymptomatic the examination of asymptomatic

people in order to classify them as likely or people in order to classify them as likely or

unlikely to have the disease that is the object unlikely to have the disease that is the object

of screening of screening


33

DefinitionsDefinitions

Assessment:Assessment: comprehensive approach, comprehensive approach,

to define nutritional status that uses to define nutritional status that uses

medical, nutrition and medication medical, nutrition and medication

histories; physical examination; histories; physical examination;

anthropometric measurements; and anthropometric measurements; and

laboratory data laboratory data


44

RISK FACTORS

Isolation

Cooking/Shopping

Money

Illness/medication

MALNUTRITION

Emaciated

Poor immunity

Decreased strength

SCREENING ASSESSMENT


55

Why are we screening for Why are we screening for nutritional risk?nutritional risk?

Benefits to early identification, Benefits to early identification, preventionprevention

Serious consequences to malnutritionSerious consequences to malnutrition Treatment believed to benefit and Treatment believed to benefit and

reduce serious consequences, reduce serious consequences, especially when implemented earlyespecially when implemented early

Management of resourcesManagement of resources


66

What is SCREEN ?What is SCREEN ?

SSeniors in the eniors in the

CCommunity: ommunity:

RRisk isk

EEvaluation for valuation for

EEating and ating and

NNutritionutrition

TM


77

Development & Validation of Development & Validation of SCREENSCREEN

DevelopmentDevelopment- Review of the literature Review of the literature

for conceptfor concept- Development of question Development of question

itemsitems- Expert review and Expert review and

ranking of importanceranking of importance- Senior review for Senior review for

wording, conceptswording, concepts

ValidationValidation- Compared SCREEN Compared SCREEN

score to a dietitian’s score to a dietitian’s rating of riskrating of risk

- Rating of risk based on Rating of risk based on diet, weight and medical diet, weight and medical historyhistory

- Compared to other Compared to other factors such as perceived factors such as perceived health, health status etc. health, health status etc. for convergent validityfor convergent validity


88

Reliability of SCREENReliability of SCREEN

Reliability identifies if the questionnaire will Reliability identifies if the questionnaire will provide the same answers on repeat provide the same answers on repeat administration.administration.

- test-retest reliability has been completed test-retest reliability has been completed for both versions of SCREENfor both versions of SCREEN

- Intra-rater and inter-rater reliability has Intra-rater and inter-rater reliability has been completed on SCREEN IIbeen completed on SCREEN II


99

Sensitivity:Sensitivity:A health index has high sensitivity if it A health index has high sensitivity if it

correctly identifies those who have the correctly identifies those who have the condition/problem.condition/problem.

Specificity:Specificity:A health index has high specificity if it A health index has high specificity if it

correctly identifies those who do not have correctly identifies those who do not have the condition/problem.the condition/problem.


1010

Comparison of SCREEN Comparison of SCREEN VersionsVersions

Version Sensitivity Specificity Test-RetestReliability

Inter-raterReliability

SCREEN I(<50 cut-point)

94% 32% ICC=0.57 N/A

SCREEN I(≤ 45 cut-point)

81% 55% ICC=0.57 N/A

SCREEN I abbreviated

(< 32 cut-point)

96% 62% ICC=0.72 N/A

SCREEN II (< 54 cut-point)

84% 62% ICC=0.84 ICC=0.83ICC=0.83

SCREEN II abbreviated

(<43 )

84% 58% ICC=0.84 ICC=0.79ICC=0.79


1111

What is “Ethical” Nutrition What is “Ethical” Nutrition Screening?Screening?

Target screening to the right peopleTarget screening to the right people

Identify nutrition problems and appropriate Identify nutrition problems and appropriate courses of action (e.g., assessment, courses of action (e.g., assessment, resources)resources)

Referral/resource framework that meets Referral/resource framework that meets needsneeds

Follow-up post screeningFollow-up post screening


1212

Bringing Nutrition Screening to Bringing Nutrition Screening to SeniorsSeniors

How feasible is nutrition riskHow feasible is nutrition risk

screening in the community?screening in the community?


1313

Demonstration CommunitiesDemonstration Communities

5 Canadian Communities, 1220 5 Canadian Communities, 1220 seniorsseniors

Geographically diverseGeographically diverse

Rural/urban mixRural/urban mix

Potential for a variety of models for Potential for a variety of models for nutrition screeningnutrition screening


1414

Details on ParticipantsDetails on Participants

Average age 74 yearsAverage age 74 years

Majority (75%) were Majority (75%) were womenwomen

60% lived alone60% lived alone

47% had less than a 47% had less than a high school educationhigh school education

Majority not connected to Majority not connected to nutrition services nutrition services

50% “vulnerable” seniors50% “vulnerable” seniors


1515

Details on Nutritional RiskDetails on Nutritional Risk

42%42% nutritional risk nutritional risk

Gradient with educationGradient with education

Gradient with living situationGradient with living situation

No difference by gender or ageNo difference by gender or age

““Vulnerable” seniors more likely to be “at Vulnerable” seniors more likely to be “at risk”risk”


1616

What do seniors say about What do seniors say about screening?screening?

85% indicated “helpful”85% indicated “helpful”

AwarenessAwareness

Strengths/weaknessesStrengths/weaknesses

Got servicesGot services

HandoutsHandouts

Concern of professionalConcern of professional SCREEN easy to use and SCREEN easy to use and

relevantrelevant


1717

Screen AdministratorsScreen Administrators

The screen administrator is the person whoThe screen administrator is the person who

completes the screen process with seniorscompletes the screen process with seniors completes questionnairecompletes questionnaire discusses score with senior & need for servicesdiscusses score with senior & need for services makes referralsmakes referrals provides follow-upprovides follow-up


1818

Who can be a screen Who can be a screen administrator?administrator?

In the In the Bringing Nutrition Screening to Bringing Nutrition Screening to Seniors Project, Seniors Project, there were diverse there were diverse administrators:administrators:

senior peerssenior peers health professionals, other professionalshealth professionals, other professionals receptionists, volunteersreceptionists, volunteers studentsstudents


1919

Training of Screen Training of Screen AdministratorsAdministrators

All screen administrators will have different skill All screen administrators will have different skill sets, abilities, and talents. Different levels of sets, abilities, and talents. Different levels of training may be required for different types of training may be required for different types of administrators. Key concepts include:administrators. Key concepts include:

understanding the difference between screening and understanding the difference between screening and assessmentassessment

understanding the nutritional needs of seniors & understanding the nutritional needs of seniors & common barriers to good nutritioncommon barriers to good nutrition

understanding how SCREEN should be completedunderstanding how SCREEN should be completed


2020

Keys to Success in ScreeningKeys to Success in Screening

A champion within the site/community A champion within the site/community Screening is considered a priority activity Screening is considered a priority activity

with allocated resourceswith allocated resources Adequate training and monitoring of Adequate training and monitoring of

screen administratorsscreen administrators Clear referral/service use plansClear referral/service use plans Clear monitoring planClear monitoring plan


2121

How to start screening?How to start screening?

Visit the BNSS website for:Visit the BNSS website for:- Fact sheetsFact sheets- Implementation GuideImplementation Guide- Educational Resources for SeniorsEducational Resources for Seniors- Sample Community Action PlansSample Community Action Plans

www.dietitians.cawww.dietitians.ca/seniors//seniors/

Documents

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