Research Institute for Aging
Research Institute for Aging


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Changing nutrition care across Canada and around the world

Feb 2, 2021 | Food & Nutrition, Impact Stories

December 2020

Food is central to our overall health and quality of life. Nutrition becomes even more important during times of recovery and healing, yet many older people in hospital don’t get the nutrients they need. Schlegel Research Chair Heather Keller is a global leader in nutrition and aging, and her work has changed the way hospitals around the world think about and use food for recovery.

Many hospital patients are older adults, who are often already at a greater risk of malnutrition. Keller spearheaded research as co-chair of the Canadian Malnutrition Task Force to look at the effects of current nutrition care practices in hospitals.

The findings were eye opening. Many patients were malnourished (up to 45%), and nutritional status often declined during hospital stay. Some didn’t get the support they needed to eat the food they’d been given.

Malnutrition also increased health care costs. The research found malnourished patients stay two to three days longer in hospital than nourished patients; malnutrition also increases the chance of being readmitted within 30 days. Increased length of stay alone contributed to an additional $2B in health care spending per year.

Keller and her team recognized that strategic changes in nutrition care practices could greatly benefit patients and be a better use of existing health care resources. She led the development of the Integrated Nutrition Pathway for Acute Care (INPAC) that guides staff through nutrition screening and appropriate follow-up care.

INPAC provides guidance for hospitals to quickly screen patients and determines their nutritional status at admission. Those that are found to be at risk have additional assessments and then fall into one of three categories for tailored nutrition support.  This process ensures no one who is malnourished goes undiagnosed, and those that need specialized support from a registered dietitian receive it.

Better nutrition care is happening in hospitals across Canada because of this work. Five Canadian hospitals were involved in the original trial of INPAC and this expanded to include 10 hospitals and 21 medical and surgical units. The research team created a suite of resources to support others in implementing INPAC in their own care settings.

The success of this new approach to nutrition care is also gaining international recognition. Organizations in the United States and Australia have begun using similar pathways to improve nutrition, and ultimately overall health, for their patients.

“Meaningful health care change takes time,” says Keller.  “Without the dedicated support of this Chair position with the RIA, this work over the past decade would have been impossible. I am thrilled to see this research being applied in practice and benefitting some of our most vulnerable citizens.”

Keller was appointed as a Schlegel Research Chair and joined the RIA in 2012, and has been renewed for her third five-year term until 2026.  This appointment is in partnership with the University of Waterloo, where Keller is a professor in Kinesiology.Keller’s national and global impact on nutrition screening and care will continue to grow as her work continues. Her success is a prime example of how the RIA drives cutting-edge research and innovation to solve real-world problems and enhance quality of life and care for older adults everywhere.

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