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Technology and health care for the elderly medical research studies

Focus on strategic priorities that have significant social impact.

CAT 2013-28

Nutrition Care Pathway for Hospitalized Older Adults: Content validation and feasibility testing

The objective of this project was to create and validate innovative clinical tools that will guide acute care practitioners in the nutritional care of patients on medical and surgical wards, of which the majority are acutely ill older adults (> 65 years of age).

Research Results


  • An evidence-informed, consensus-based algorithm, the Integrated Nutrition Pathway for Acute Care (INPAC) was developed and face validated. Dissemination and knowledge translation are underway with the CFN- SIG2014F-08 More-2-Eat project
  • The Mealtime Audit Tool (MAT, see below) and My Meal Intake Tool (MMIT, see below) have been developed, and tested for reliability and validity. These two tools are developed for practice and research and will support improved care processes by identifying barriers to food intake and poor food intake
  • Educational materials and guidance documents have been created to support dissemination and knowledge translation
  • A knowledge, attitude, and practice survey for direct care providers focused on nutrition care has been developed and tested for inter-rater reliability. This survey will be used in the More-2-Eat project as a secondary outcome variable

Publications, presentations and webinars

About the Project

In 2013 investigators completed a national study on the prevalence of malnutrition in over 1000 patients, in 18 acute care hospitals, across 8 provinces. Prevalence of malnutrition on admission to medical and surgical wards was 45%, with older patients more likely to be malnourished. Practices for the most part were not systematic with respect to identification, treatment and monitoring of nutritional state. Knowledge gaps and poorly defined roles among the interdisciplinary team perpetuated poor practices.

To enhance care and improve clinical outcomes, an improvement strategy is needed to promote quality practices. The current guidelines recommend nutrition risk screening for all patients at admission, followed by assessment and treatment by a dietitian for those identified to be at risk for malnourishment. However, they are not adhered to and are unsustainable. A nutrition care pathway based on guidelines, evidence, and best practice that is feasible and sustainable is required.

Several steps will be taken to create and validate this pathway, including experts, patients and families and diverse health professionals. Communication tools such as patient/family nutrition care discharge summaries will be developed and tested for feasibility in 5 hospitals. The resulting validated, feasible nutrition care pathway and support materials will be the basis of a future implementation study and will be translated to diverse acute care settings with our knowledge partners. Improved clinical practices resulting from implementation of the pathway will benefit patient outcomes and hospital outputs, especially for the acutely ill older adult.

ObjectivesCurrent evidence and best practices will be used to develop and content validate: (1) a flexible and feasible integrated nutrition care pathway for acute care (INPAC) template for best practice nutrition care in Canada and (2) communication and audit tools (e.g. Mealtime Audit Tool) that support the NCP.

Project Team

Principal Investigator:

Heather Keller, PhD, RD, FDC -- University of Waterloo


Johane Allard, MD, FRCPC -- University Health Network

Paule Bernier, PDT, MSc -- Jewish General Hospital

Donald Duerksen, MD -- St. Boniface General Hospital

Leah Gramlich, MD -- Alberta Health Services/University of Alberta

Khursheed Jeejeebhoy, MD, PhD, FRCPC -- St. Michael's Hospital

Manon Laporte, PDT, MSc, CNSC -- Réseau de santé Vitalité Health Network

Project Contact: Dr. Heather Keller --

CAT 2013-28

Key words: nutrition; clinical pathway; validation; translation