Nutrition is a fundamental part of care, one that directly influences patient recovery, outcomes, and overall system performance. Yet nutrition risk and malnutrition remain persistent challenges across healthcare settings, particularly among older adults, impacting recovery times, length of stay, and quality of life. 

Through our valued partnership with Nestlé Health Science, we had the privilege of speaking with Professor Heather Keller (RD, PhD, FDC, FCAHS), Schlegel Research Chair in Nutrition & Aging at the University of Waterloo and an internationally recognized expert in geriatric nutrition. Her research has helped shape leading practices in nutrition screening, foodservice delivery, and patient-centred nutrition care across Canada. 

This Nutrition Month, Professor Keller shares insights on why prioritizing nutrition care is critical to improving patient outcomes, and how healthcare organizations and foodservice leaders can implement practical, evidence-based strategies to better support patients and communities. 

1. As the Schlegel Research Chair in Nutrition & Aging, you’ve spent years studying how nutrition influences health across care settings. From your perspective, what does Nourish to Flourish mean, especially when considering the needs of older adults within Canada’s healthcare system?  

‘Nourish to Flourish’ is about individuals having sufficient food and fluid intake to meet their nutritional needs and where possible, to optimize their health. If we think specifically about older adults in the hospital setting, these patients need to be sufficiently nourished so that they can leave hospital and return to their lives, hopefully in a better state than when they were admitted. Unfortunately, we know this is not always the case, with a good portion of patients spending more than 7 days in hospital. Many also return to the community still malnourished. Flourishing to me means taking an individual, person-centred approach to reaching the priority goals for each specific older adult -- while in hospital and as they transition out to the community.  

2. Despite strong evidence, nutrition risk and malnutrition are still often under-identified in many care settings. Why do you think this continues to happen, and why is it so important to address now?  

Staff in all health care settings are stretched, meeting the day-to-day demands of providing quality care. Starting new screening procedures to identify malnutrition requires changing processes and this requires some slack in the system to identify what needs to be changed and how it will be changed—so it takes time and effort. Malnutrition continues to occur before hospitalization and extends the hospital stay, affecting patient flow within a hospital. It is paramount that anything we can do to improve patient flow within acute care be implemented. Nutrition screening for every patient, is one of those processes of care with proven benefit to the patient and the system.  

3. Your work with initiatives like Nutrition Care in Canadian Hospitals and More-2-Eat has demonstrated the impact of early nutrition screening. What actions should organizations take to better identify nutrition risk before it leads to poorer outcomes?  

We have investigated what is important to making nutrition screening as easy a process as possible in Canadian hospitals. We know, for example, electronic charting and forcing the nutrition screening field to be completed will result in better screening rates. Keeping the screening tool simple is another strategy. The Canadian Nutrition Screening Tool has two simple questions that do not require measurements. Automating the referral to the dietitian is the final step in the screening process, again a step that is facilitated with electronic medical charting.  

4. How do food quality, choice, and the overall mealtime experience influence food intake and nutrition outcomes in hospital settings?  

We know that when a patient eats less than 50% of their tray, they are more likely to have an extended hospital stay and slower recovery. Being able to provide food that patients want to eat, that meets their preferences is an important start to ensuring food intake is more than 50% of what is offered. Food needs to taste and look good as well as be nutritious. We need to see food as a necessary therapy while in hospital. In addition to good food, it is the opportunity to choose what you would like to eat, and the time and capacity to eat it. Hospitals can be busy places and eating in your bed is not the best experience. Consider how patients can be assisted to sit at their tables and eat, ensure they have the food tray and packages opened and a little bit of social interaction with the person who is leaving the tray to support their interest in eating.  

5. If nutrition and foodservice leaders remember just one message this Nutrition Month, what would you want it to be?  

We need to nourish our patients so they can flourish. We can do better and we must do better - for our patients, their care, and our healthcare system. 

We extend our sincere thanks to Nestlé Health Science for their ongoing collaboration, expertise, and commitment to advancing nutrition care in Canada. Their contributions help ensure our members have access to leading knowledge, guidance, and resources to support high-quality, patient-centered care.