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.

Background

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, Zoltik, 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:

• age-related physiological changes, such as reduced appetite and senses (e.g. taste and smell)
• altered digestion because of disease and/or medications
• reduced mobility, causing difficulties with food shopping and meal preparation
• financial constraints, eating alone and the absence of help with shopping and cooking
• psychological factors, such as depression, grief and loneliness
• availability and affordability of public transportation, location of grocery stores and geographic isolation (Statistics Canada, 2013)

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 of the implementation of SCREEN©;
• nutritional risk assessment using SCREEN© scores of older adults in the SDHU area;
• community scan of nutrition services offered to older adults in the SDHU area

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:

• review the accessibility of resources and support services;
• determine facilitators and barriers to the implementation of SCREEN©; and
• learn more about what is needed to better address the nutritional needs of older adults in the SDHU area

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.

Results

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.

Practice

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:

• Links with agencies working with isolated older adults should continue to be explored and enhanced.
• Continue to support health care providers with their use of SCREEN©. Consider exploring opportunities to increase uptake of SCREEN© by health care providers through the SDHU Clinician Engagement Committee.
• Train a Health Promotion Worker (HPW) from the Nutrition and Physical Activity Action Team in the administration of SCREEN©. The HPW can travel throughout the SDHU district to reach older adults and regularly check in with the SCREEN© lead at the SDHU to ensure consistency in practice.
• Minimize the number of resources in the SCREEN© Administrator binder, continue with the SCREEN© Administrator duotang and folder and consider revising key documents to reflect better practices used in health literacy for older adults.
• Consider developing promotional materials for health care providers and others involved with SCREEN©.

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:

• The Good Food Box(GFB) program, in particular the Wellness Good Food Box program, which is a GFB that includes pre-cut vegetables and fruit, making it easier for customers to prepare and eat vegetables and fruit.
• Healthy Food in Corner Stores(consider enhancing results of “Food Mapping” project to identify locations).
• Mobile Markets(consider enhancing results of “Food Mapping” project to identify locations).
• Congregate/Community dining, in particular ensure isolated older adults can access these programs.
• Transportationto and from food programs and grocery stores.
• To assist all older adults in consuming more vegetables and fruit, opportunities to support community based food literacy programming (e.g. cooking with the Good Food Box) for older adults should expand.

Policy

• To create a community that is safe, accessible and affordable for everyone, it is recommended that the SDHU Board of Health play a role in the development of a “Seniors Strategy” for the City of Greater Sudbury. This includes consideration of the report “Finding the Right Fit: Age-Friendly Community Planning” developed by the Ontario Seniors Secretariat and the Accessibility Directorate of Ontario and exploring feasible options for other municipalities in the SDHU district.
• The SDHU Board of Health will continue to support the use of SCREEN© to ensure population health assessment and monitoring/surveillance of older adult nutritional status across the SDHU district occurs and the data are disseminated to key stakeholders.
• The SDHU Board of Health will continue to support and enhance programming directed to creating healthy supportive environments for all including consideration for, but not limited to:
• Unified oral health programming
• Safe, affordable, accessible and well-serviced housing for older adults that includes a well-equipped common space for cooking and eating.

Research

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

Contact

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)
resourcecentre@sdhu.com

Citation

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

Copyright

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.

References

Johnson, C.S. (2003). The association between nutritional risk and falls among frail elderly. Journal of Nutrition, Health and Aging, 7, 247-50.

Keller, H. (2012). Getting started with SCREENing: Your guide to implementing SCREEN©Community Implementation Guide. Bringing Nutrition SCREENing to Seniors.University of Waterloo: Waterloo, ON.

Keller, H.H. (2007a). Promoting food intake in older adults living in the community: a review. Applied Physiology, Nutrition and Metabolisim, 32, 991-1000.

Keller, H.H., Haresign, H., Brockest, B. (2007). Process Evaluation of Bringing Nutrition Screeing to Seniors in Canada (BNSS). Canadian Journal of Dietetic Practice and Resarch, 68, 2.

Ontario Injury Prevention Resource Centre. (2008). Falls across the lifespan: Evidence-based practice synthesis document.Toronto: Ontario Injury Prevention Resource Centre.

Ontario Senior’s Secretariat. (2013). Finding the Right Fit Age-Friendly Community Planning.Retreived from: http://www.seniors.gov.on.ca/en/resources/AFCP_Eng.pdf

North East Local Health Integration Network. (2008). Health Service Provider Profiles. North Bay, ON: Author.

Statistics Canada. (2013). Health profile. Released April 15, 2013. Retrieved from http://www12.statcan.gc.ca/health-sante/82-228/details/page.cfm?Lang=E&Tab=1&Geo1=HR&Code1=3561&Geo2=PR&Code2=01&Data=Rate&SearchText=sudbury&SearchType=Contains&SearchPR=01&B1=All&Custom=.

Statistics Canada. (2011). Manitoulin, Ontario (Code 3551) and Ontario (Code 35) (table). Census Profile. 2011 Census. Statistics Canada Catalogue no. 98-316-XWE. Ottawa. Released October 24, 2012. SDHU, Ontario. 2012 community profiles. 2006 census. Ottawa: ON. Retrieved from http://www12.statcan.gc.ca/census-recensement/2011/dp-pd/prof/index.cfm?Lang=E.

Statistics Canada. (2010). Population Projections for Canada, Provinces and Territories: 2009-2036. Minister of Industry: Ottawa, ON: Retrieved from http://www.statcan.gc.ca/pub/91-520-x/91-520-x2010001-eng.pdf.

Sudbury & District Health Unit. (2008). Demographic profile: Sudbury & District Health Unit. Sudbury, ON: Author.

Sudbury & District Health Unit. (2009). Falls among older adults 2003-2007. Sudbury, ON: Author.

Thompson, N.J., & McClintock, H.O. (2000). Demonstrating your program’s worth. A primer on evaluation for programs to prevent unintentional injury. Atlanta, GA: National Center for Injury Prevention and Control. Retrieved from http://www.cdc.gov/ncipc/pub-res/dypw/01_Overview.htm.

Zoltick, E.S., Sahni, S., McLean, R.R., Quach, L., Casey, V.A., Hannan, M.T. (2011). Dietary protein intake and subsequent falls in older men and women: the Framingham study. Journal of Nutrition Health & Aging, 15, 147-152.

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This item was last modified on June 12, 2015