Seniors in the Community: Risk Evaluation for Eating and Nutrition

Ontario’s older adult population is growing at a rapid rate. Eating well is essential for good health in older adults.

Eating well is essential for good health and plays an integral part in falls prevention.


By the year 2036, Ontario’s older adult population will more than double to 4.1 million. It is important we prepare for this demographic shift, as it will help to ensure we have a safe, accessible and affordable community for everyone (OSS, 2013).

Part of this preparation must include consideration of healthy eating for older adults. Eating well is essential for good health and plays an integral part in falls prevention (Johnson, 2003, Zoltick, 2011). In northern Ontario, rates of fall-related emergency department visits and hospitalizations are 40% higher than provincial averages (SDHU, 2009). Significantly higher rates of fall-related injuries were observed within older age groups, particularly after age 75 (SDHU, 2009).

Optimal nutritional status in older adults can help in the prevention of morbidity and disability, improve health outcomes and maintain autonomy, leading to an increased quality of life (Keller, 2007a). Identifying nutrition problems early enables appropriate intervention of nutrition-related problems before disability or illness occur and can support healthy living for older adults (Keller, 2007b). Screening for nutrition risk can play an important role in falls prevention in older adults and can also contribute to the prevention or delay of hospitalizations, and reduce length of stay and need for home health services when hospitalization does occur (Keller, 2012).

Older adults are prone to nutrition risk due to a number of factors, including:

In 2008/2009, 34% of Canadians aged 65 or older (more than 4.1 million) were at nutritional risk (Statistics Canada, 2013).

Since 2011, the Sudbury & District Health Unit has been facilitating the use of SCREEN© (Seniors in the Community: Risk Evaluation for Eating and Nutrition) by community agencies. SCREEN© is a validated, 14 question tool designed to identify nutrition risk in community dwelling older adults. It examines risk factors for food intake and weight change. Individuals at risk are given educational information and encouraged to visit a health care provider. For those not at risk, relevant education materials are shared (Keller, 2012).

Along with the identification of possible nutrition concerns, nutrition SCREENing can also be an important tool for advocating for improved services for older adults (Keller, 2012). To inform this advocacy work, data collection must occur. In late 2012 and early 2013, the SDHU led the implementation of SCREEN© and reviewed its implementation. The data collected during this time helped paint a picture of nutrition risk in seniors. As part of the implementation, we asked key questions to assist in better understanding how SCREEN© is working in our community.

The process evaluation identified the facilitators and barriers to implementing SCREEN© in the community. The evaluation also identified what is working well and what we can do to better support the nutrition needs of older adults in the SDHU area.

Implementation Review

The implementation review consisted of three phases, including:

Process evaluation

Process evaluations assess how well the plans, procedures and activities of a given plan are working and allow for adjustments as required (Thompson & McClintock, 2000). Evaluating processes is critical when examining the work of a new program or initiative. The purpose of this process evaluation was to identify facilitators and barriers to the implementation of SCREEN© and to the accessibility of nutrition services in the SDHU area. The results of the process evaluation will identify areas of improvement in order to improve the implementation of SCREEN© throughout the community.

The process evaluation consisted of telephone interviews with a sample of SCREEN© administrators who were actively SCREENing older adults in the SDHU area. The administrator interviews were conducted to:

Nutritional risk assessment

This project also sought to better understand the nutrition status of older adults in the SDHU area in order to increase our understanding of their nutrition service needs. To do this, a subsample of SCREEN© scores were analyzed. It is recognized that this is not a representative sample of the SDHU area.

Community Scan

This project also included a scan of current nutrition services for older adults. The purpose of the community scan was to identify community services and programs in the SDHU area targeted at the nutritional needs of older adults in the community.


Process Evaluation

The results of the process evaluation indicate that the questionnaire and referral materials are conducive to an efficient SCREENing process, as well as the SCREEN© location and the overall time it took to SCREEN© in general. Although the administrators felt the overall process was working well, additional formatting of the referral materials was recommended. Also, additional advertising and targeting methods would help to encourage additional participation from non-active members of community programs and may identify more at-risk individuals.

Nutritional Risk Assessment

The results of the SCREENing found 25% of older adults in the SDHU area to be at nutritional risk, which could indicate the need to determine how older adults can be better served in the community.

Community Scan

The community scan provided a list of nutrition services, location and description of services offered throughout the SDHU district. The scan provides a picture of what is offered in the community and what gaps there may be in services. Further exploration is required

Implications for Practice, Policy and Research

This section provides a number of recommendations for practice, policy and future research based on the findings of this evaluation.


To ensure consistency with the use of SCREEN© and to reach all older adults, including individuals who may be harder to reach such as isolated older adults, the following should be considered:

The SDHU should work with community partners and the private sector to make it easier for older adults to access healthy, affordable and culturally diverse food through existing retail and innovative approaches, such as:



Expand the Community Scan carried out in this project to gain a better understanding of all nutritional programs available for older adults throughout the SDHU district. Consider further food mapping projects that consider healthy eating programs, retail locations and transportation options to identifying gaps in services.

Authors (In alphabetical order)

Stephanie Collins, Sudbury & District Health Unit
Bridget King, Sudbury & District Health Unit
Suzanne Lemieux, Sudbury & District Health Unit


For more information or to receive an electronic copy of the full report, contact:

Information Resource Centre
Sudbury & District Health Unit
1300 Paris Street
Sudbury, ON P3E 3A3
Telephone: 705.522.9200, ext. 350 (toll free 1.866.522.9200)


Sudbury & District Health Unit. (2013). Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN©): Implementation Review. Sudbury, ON: Author.


This resource may be reproduced, for educational purposes, on the condition that full credit is given to the Sudbury & District Health Unit. This resource may not be reproduced or used for revenue generation purposes.


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This item was last modified on May 3, 2024