Because seniors have an increased risk for impaired nutritional states, there has been an interest in readily identifying these individuals as soon as possible. Dr. Keller has developed a brief questionnaire that has undergone extensive validation and reliability testing. This index has the potential for applicability in research, education, screening in community programs, and therapeutic interventions. SCREEN© (Seniors in the Community Risk Evaluation for Eating and Nutrition) can be self-or interviewer-administered (telephone or face-to-face) and can be used in a variety of settings.
Inter-rater, intra-rater and test-retest reliability have been completed and self- and telephone administrations have been compared. Additionally, preliminary evidence indicates that SCREEN© can monitor changes in eating behaviour post treatment or education. SCREEN© has been validated against the criterion of a dietitian’s clinical judgement of risk, based on comprehensive nutrition assessments. Predictive validity (18-month mortality and quality of life) and construct validity have also been documented.
In addition to identifying seniors who would benefit from further nutrition assessment and treatment, SCREEN© also acts as an “awareness raising” tool. The Bringing Nutrition Screening to Seniors project identified that many older adults just needed a check on what they were eating to stimulate behaviour change. A pilot randomized control trial identified that screening and brief written educational resources could change nutrition knowledge and risk behaviour, as measured by SCREEN©.
Risk factors included in this index fall within three nutrition risk attributes – risk factors for food intake, food intake, and weight change. There are two versions available, both valid and reliable, with slightly different questions. SCREEN I© consists of 15 items, whereas SCREEN II© consists of 14 with sub-questions for the weight change and meal preparation items.
Risk factor questions:
Appetite
Frequency of eating
Chewing difficulties
Swallowing difficulties
Diet restrictions
Eating alone
Money for food purchases (only SCREEN I©)
Cooking difficulties
Shopping difficulties
Food intake questions:
Vegetable and fruit consumption
Meat and alternative consumption
Use of milk and milk products
Fluid intake
Weight Questions:
Weight change (increase or decrease)
Weight perception (only SCREEN II©)
Intentional weight change (only SCREEN II©)
Examples of questions on SCREEN©:
How much fluid do you drink in a day?
Examples are water, tea, coffee, herbal drinks, juice, and soft drinks, but not alcohol.
Eight or more cups
Five to seven cups
Three to four cups
About two cups
Less than two cups
Do you cough, choke or have pain when swallowing food OR fluids?
Never
Rarely
Sometimes
Often or always
On average, self-administration takes five minutes. Interview administration in a face-to-face context may be needed for seniors who are frail. Adequate cognition on the part of the older adult is required and proxy completion is not recommended. This nutrition risk screening tool can be used with: older adults living in supportive housing if they are responsible for meal preparation; and those recently admitted to acute or ambulatory care. Seniors in residential care, long-term care facilities or chronic care hospitals have different risk factor profiles and nutrition risk should be identified with tools other than SCREEN©.
Self-management is now available! Older adults can use an internet version of SCREEN II © and identify what they are doing well and where they can improve with their nutrition. Results are linked to high-quality websites and other resources that support behaviour change. Please visit Nutri-eSCREEN
A SCREEN©Toolkit is available which provides useful background material and advice to promote ethical administration in any setting.
The following slide deck on nutrition risk screening and SCREEN© will help you review the basics and can be used in educating others. A comprehensive slide deck for training is available with the copyright licence.
Paper versions of SCREEN© are available in: French, English, Swedish (all versions) and Spanish, Punjabi, Chinese, Arabic, Urdu, and Italian for interviewer versions. SCREEN© and the Toolkit are copy right protected. Users can purchase a copyright licence that will allow the unlimited use of SCREEN© and its support materials in your setting. The licensing fee offsets the cost of further research and development of the SCREEN© program. Please visit Flintbox to obtain more information and purchase a copyright license for your site or community.
New Zealand has been using SCREEN II© in a community-based pilot project which involved screening and referral to services. Nutrition risk was identified in 53% of seniors and 90% found the program useful for raising awareness, getting service and helping to change eating behaviours.
Statistics Canada used the abbreviated version of SCREEN II© for the Canadian Community Health Survey (2008).
In 2008, seven partner agencies from the SouthWest LHIN in Huron and Perth Counties were awarded Aging at Home funding to develop a “Wellness for Seniors” program focusing on education, fitness and nutrition.
As part of this initiative, the SCREEN nutritional risk assessment tool developed by Dr. Heather Keller from the University of Guelph, became an integral part of the program.
