copyright h.h. keller 2004. all rights reserved. 1 screening for nutritional risk in seniors
TRANSCRIPT
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
Copyright H.H. Keller 2004. All rCopyright H.H. Keller 2004. All rights reserved. ights reserved.
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
Copyright H.H. Keller 2004. All rCopyright H.H. Keller 2004. All rights reserved. ights reserved.
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
Copyright H.H. Keller 2004. All rCopyright H.H. Keller 2004. All rights reserved. ights reserved.
44
RISK FACTORS
Isolation
Cooking/Shopping
Money
Illness/medication
MALNUTRITION
Emaciated
Poor immunity
Decreased strength
SCREENING ASSESSMENT
Copyright H.H. Keller 2004. All rCopyright H.H. Keller 2004. All rights reserved. ights reserved.
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
Copyright H.H. Keller 2004. All rCopyright H.H. Keller 2004. All rights reserved. ights reserved.
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
Copyright H.H. Keller 2004. All rCopyright H.H. Keller 2004. All rights reserved. ights reserved.
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
Copyright H.H. Keller 2004. All rCopyright H.H. Keller 2004. All rights reserved. ights reserved.
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
Copyright H.H. Keller 2004. All rCopyright H.H. Keller 2004. All rights reserved. ights reserved.
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.
Copyright H.H. Keller 2004. All rCopyright H.H. Keller 2004. All rights reserved. ights reserved.
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
Copyright H.H. Keller 2004. All rCopyright H.H. Keller 2004. All rights reserved. ights reserved.
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
Copyright H.H. Keller 2004. All rCopyright H.H. Keller 2004. All rights reserved. ights reserved.
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?
Copyright H.H. Keller 2004. All rCopyright H.H. Keller 2004. All rights reserved. ights reserved.
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
Copyright H.H. Keller 2004. All rCopyright H.H. Keller 2004. All rights reserved. ights reserved.
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
Copyright H.H. Keller 2004. All rCopyright H.H. Keller 2004. All rights reserved. ights reserved.
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”
Copyright H.H. Keller 2004. All rCopyright H.H. Keller 2004. All rights reserved. ights reserved.
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
Copyright H.H. Keller 2004. All rCopyright H.H. Keller 2004. All rights reserved. ights reserved.
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
Copyright H.H. Keller 2004. All rCopyright H.H. Keller 2004. All rights reserved. ights reserved.
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
Copyright H.H. Keller 2004. All rCopyright H.H. Keller 2004. All rights reserved. ights reserved.
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
Copyright H.H. Keller 2004. All rCopyright H.H. Keller 2004. All rights reserved. ights reserved.
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
Copyright H.H. Keller 2004. All rCopyright H.H. Keller 2004. All rights reserved. ights reserved.
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/