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Validity and reliability of SCREEN II (Seniors in the Community: Risk evaluation for eating and nutrition, Version II)

Abstract

Background:

Nutrition risk screening for community-living seniors is of great interest in the health arena. However, to be useful, nutrition risk indices need to be valid and reliable. The following three studies describe construct validation, test–retest and inter-rater reliability of SCREEN II.

Methods:

Study (1) seniors were recruited from the general community and from a geriatrician's clinic to complete a nutritional assessment and SCREEN II. 193 older adults provided medical and nutritional history, 3 days of dietary recall and anthropometric measurements. A dietitian reviewed all information collected and ranked seniors on risk: 1 (low) to 10 (high risk). Receiver operating characteristic curves were completed. An abbreviated SCREEN II was developed through statistical analysis and expert ranking of the 17 items. Studies (2) and (3) seniors were recruited from the community to self-administer (n=149) or be interviewed (n=97) using SCREEN II twice within 2 weeks. For self-administration one index was completed via mail. Interviewer administration was completed via telephone with two interviewers. Intra-class correlations were calculated.

Results:

(1) Total and abbreviated SCREEN II have increased sensitivity and specificity as compared to SCREEN I in identifying seniors at nutritional risk. (2) Test–retest reliability was adequate (intra-class correlation (ICC)=0.83). (3) Inter-rater reliability was adequate (ICC=0.83).

Conclusions:

SCREEN II appears to be a valid and reliable tool for the identification of risk for impaired nutritional states in community-living older adults, and is an improvement over SCREEN I.

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Acknowledgements

We thank the expertise of Melinda Edmonds, Teresa Hadley, Kathleen Gibson and Alisha Hemeraj, as undergraduate research assistants on this project; the Project Coordinators Amie Gibbs and Gayle Edward and the graduate students involved in these studies (Mary Ann Bocock, Ekaterini Dimou, Karen Fan). Without the dedication of these individuals, this project would not have succeeded. The assistance of the recruitment site management and the seniors themselves is also greatly appreciated. Funding for this project was provided by the Canadian Institutes of Health Research.

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Correspondence to H H Keller.

Additional information

Guarantor: H Keller.

Contributors: RG completed the analyses, SLK provided input to study procedures/questionnaires. HK wrote the manuscript with input from RG and SLK.

Appendix

Appendix

Item stems from SCREEN II

(1a):

Has your weight changed in the past 6 months?** (participant identified gain, loss or maintenance and the amount of weight change (about 5 pounds, 6–10 pounds, more than 10 pounds))

(1b):

Have you been trying to change your weight in the past 6 months?

(1c):

Do you think your weight is…? (perception of overweight, underweight or appropriate weight).

(2):

Do you skip meals?**

(3):

Do you limit or avoid certain foods?

(4):

How would you describe your appetite?**

(5):

How many pieces or servings of fruit and vegetables do you eat in a day?*

(6):

How often do you eat meat, eggs, fish poultry or meat alternatives?

(7):

How often do you have milk products?

(8):

How much fluid do you drink in a day?*

(9):

Do you cough, choke or have pain when swallowing food or fluids?**

(10):

Is biting or chewing food difficult for you?

(11):

Do you use commercial meal replacements or supplements?

(12):

Do you eat one or more meals a day with someone?*

(13a):

Who usually prepares your meals?

(13b):

Which statement best describes meal preparation for you?*

(14):

Do you have any problems getting your groceries?

*Items included in abbreviated version. **Double-weighted for scoring in abbreviated version.

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Keller, H., Goy, R. & Kane, SL. Validity and reliability of SCREEN II (Seniors in the Community: Risk evaluation for eating and nutrition, Version II). Eur J Clin Nutr 59, 1149–1157 (2005). https://doi.org/10.1038/sj.ejcn.1602225

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