Choosing Healthcare Options by Involving Canada's Elderly: a protocol for the CHOICE realist synthesis project on engaging older persons in healthcare decision-making.

INTRODUCTION: While patient and citizen engagement has been recognised as a crucial element in healthcare reform, limited attention has been paid to how best to engage seniors-the fastest growing segment of the population and the largest users of the healthcare system. To improve the healthcare services for this population, seniors and their families need to be engaged as active partners in healthcare decision-making, research and planning. This synthesis aims to understand the underlying context and mechanisms needed to achieve meaningful engagement of older adults in healthcare decision-making, research and planning. METHODS AND ANALYSIS: The CHOICE Knowledge Synthesis Project: Choosing Healthcare Options by Involving Canada's Elderly aims to address this issue by synthesising current knowledge on patient, family, and caregiver engagement. A realist synthesis will support us to learn from other patient and citizen engagement initiatives, from previous research, and from seniors, families and caregivers themselves. The synthesis will guide development or adaptation of a framework, leading to the development of best practice guidelines and recommendations for engagement of older people and their families and caregivers in clinical decision-making, healthcare delivery, planning and research. ETHICS AND DISSEMINATION: The components of this protocol involving consultation with patients or caregivers have received ethics clearance from the University of Waterloo, Office of Research Ethics (ORE#19094). After completion of the project, we will amalgamate the information collected into a knowledge synthesis report which will include best practice guidelines and recommendations for patient, family and caregiver engagement in clinical and health system planning and research contexts. RESULTS: Will be further disseminated to citizens, clinicians, researchers and policymakers with the help of our partners. TRIAL REGISTRATION NUMBER: CRD42015024749.

Food tasting as nutrition education for older adults.

PURPOSE: The likelihood of experiencing poor nutrition status increases as people age. Sampling new foods may promote a continued interest in food and enjoyment of eating. This pilot study was designed to describe and provide a preliminary evaluation of food-tasting activities integrated into nutrition displays directed at community-living older adults. METHODS: Three consecutive monthly nutrition displays incorporating a food-tasting activity were presented at a Guelph, Ontario, recreation centre for seniors. Seniors had an opportunity to taste two recipes at each of three displays; 226 food samples and 155 copies of recipes were taken. Feedback forms were used to determine participants' interest in making the recipes, and whether tasting influenced their interest in preparing the food. RESULTS: Among 54 participants who completed feedback forms about the program, 75.9% indicated that they intended to prepare one or both of the recipes tasted at the display; 70.4% indicated that they would not or may not have made the recipe without tasting it beforehand. CONCLUSIONS: Dietitians working with community-living older adults could use food tastings to help translate key educational messages into practice, and to encourage eating enjoyment as people age.

Food workshops, nutrition education, and older adults: a process evaluation.

Three years of process evaluation data are presented for Evergreen ActionNutrition food workshops conducted at an older adults' recreation center. Over a three-year period, 475 written evaluations of single and three-session series workshops were completed. Additionally, data were collected from four focus groups of older adult participants (n = 19). Older persons report intention to change behavior based on attendance at a single workshop. Series workshop participants report increased knowledge, confidence in cooking, and motivation to make changes. Focus group participants identified the following as key aspects to success and empowerment of behavior change: relevant information, specifically in the form of recipes; interactive format, including taste-testing; social experience; consistent, high-quality education; and small size of the group. Food workshops or demonstrations can be meaningful nutrition education activities for older adults.

Men can cook! Development, implementation, and evaluation of a senior men's cooking group.

This study reports on the process and outcome evaluation of a community-based nutrition and cooking education program for senior men. As part of Evergreen Action Nutrition, a community-organized, nutrition education program, a registered dietitian led a Men's Cooking Group in a seniors' recreation facility. Written questionnaires were completed by most of the men (n = 19) at the beginning and end of the evaluation year, and ten men participated in personal key informant interviews. The majority of participants gained cooking confidence, increased their cooking activities at home, developed healthy cooking skills, and improved cooking variety through the program. The men also identified social benefits to the program. Overall, this preliminary evaluation suggests that community-based nutrition and cooking education for older men is a beneficial nutrition education activity.

Nutritional risk needs assessment of community-living seniors: prevalence of nutrition problems and priorities for action.

A random mailed survey was sent to 425 members of a seniors recreation center in Guelph, Ontario for the purpose of identifying the prevalence of nutritional risk, specific nutrition problems, and educational format preferences of these seniors. This needs assessment was used to plan an education initiative called "Action Nutrition." SCREEN, a 15-item nutritional risk screening instrument, demographic data, participation in current recreation programs, and frequency of visits to the center were included in this survey. The response rate was 62%, average age was 72 years and 59% were female. Respondents attended on average one activity per month, 60% visited the center at least once per month and 79% read the monthly newsletter. 56.7% of respondents were considered to be at nutritional risk using SCREEN and common problems were: significant weight change in 6 months; low intake of fruits and vegetables and milk products; and restriction of the diet due to health reasons. This survey determined that nutrition problems and risk are prevalent among community-living seniors, justifying the development and implementation of educational initiatives in this setting.

The Development of Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN).

Measuring the nutritional risk of seniors living in the community has become increasingly necessary as more seniors in vulnerable states remain in their own homes. A few assessment tools are available for use in this population. To determine whether a tool is appropriate for a specific purpose, we must understand how it was developed. This article reviews the developmental process for Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN). This process, which combines clinimetric, psychometric, and criterion approaches, may help dietitians and other health researchers develop their own assessment tools. To assist dietitians and others with the systematic development or evaluation of health assessment tools a nine-step template is provided to: 1. determine what is being measured; 2. review the literature for tools; 3. critique tools for their development, validation, and reliability; 4. develop a construct for health measurement; 5. write the items, select items for the scale, and consult experts and a target group; 6. pretest items for readability; 7. pretest in a developmental sample; 8. validate the construct and measurement tool; and 9. ensure test-retest reliability.