Table 4.

Description of Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN II) questionnaire [68]

Explanation	SCREEN II has 14 items asking questions about weight change over 6 months, appetite, and swallowing difficulty (coughing choking, and pain swallowing food/fluids), meal skipping and satisfaction with the quality of food prepared by others. Shorter versions with only three items are now available (weight loss, appetite, and swallowing difficulty).
Parameters	Weight change, appetite, swallowing difficulty, meal skipping, satisfaction with quality of food prepared by others.
Scoring system	✓
Rationale	Focuses on modifiable physical and psychosocial factors that may affect food intake in older persons.
Agreed upon definition and characteristics for what the condition is that is being screened for	✓
Criterion for risk	✓, No scoring specifically stated.
Prevalence using tool	✓
Validity (criterion, construct, predictive), reliability and other test characteristics	Earlier versions of the SCREEN I and SCREEN II instruments were validated using a definition of malnutrition of < 20 BMI kg/m2 or unintentional weight loss of 5–10% but they yielded poor results (sensitivity 31%, specificity 98%) suggesting that they were not appropriate for older community-living adults [70, 71]. Therefore, additional testing was done and sensitivity scored at 84%, specificity 62%, positive predictive value 84%, and negative predictive value 62% (at a cut point score of 53) on SCREEN II. Test–retest reliability and inter-rater reliability were all improved (intraclass correlation coefficient 0.83) [68]. Criterion validity of SCREEN II has been evaluated in validation studies among both Canadians and New Zealanders living in the community, sensitivity ranged from 84 to 90% and specificity ranged from 62 to 86% depending on the study [72]. Wham et al. tested SCREEN II against clinical assessment by a trained dietitian; in older community dwelling New Zealander octogenarians who were assessed as at low to high risk by dietitians with access to medical history, anthropometrics and intakes. SCREEN II scores assessed 12 months prior to the distribution of the questionnaire were significantly correlated (re = 0.76, p < 0.01) with dietitian risk ratings; using a new cutoff of < 49 (for high nutrition risk) sensitivity was 90% and specificity 86% [73]. Construct validity of 3 items (weight loss, appetite, and swallowing difficulty) on SCREEN II (14 items) and on SCREEN II abbreviated version (AB) (8 items) were tested in a mailing to octogenarian Canadian men living in the community who had been assessed earlier in the Manitoba Follow-up Study (a longitudinal study) and compared to current self-reports of health status (F = 14.7, P = 0.001), diet healthiness (ρ = .17, P = 0.002), and importance of nutrition in successful aging (p = 0.10, P = 0.03). All were significantly correlated with the 3-item score [74]. Predictive validity of 3 items from SCREEN II and SCREEN II AB were used in the large, longitudinal, population-based Canadian Community Health Survey of Healthy Aging. Participants were followed through acute care hospitalizations and death records. Using Cox proportional hazards models, at 2-year follow up those classified at nutritional risk had higher risks of acute care hospitalization (HR 1.2 95%; CI 1.1–1.4) and death (HR 1.6 95%; CI 1.3–2.0) after adjusting for confounders [75]. SCREEN II was also linked with mortality in another study [76].