Published studies have shown that about 45% of patients in Canadian hospitals, including Vancouver General Hospital, are malnourished upon admission. Once in hospital, patients benefit from newly established screening guidelines and nutrition interventions to aid in their overall recovery.

But what happens once patients are discharged back to home? Although close to 80% of VCH Home Health clients are referred directly from hospital, currently no routine nutrition screening is conducted by nursing and allied health staff upon initial visits.  Therefore, Vancouver Community Home Health dietitians decided to study the prevalence of malnutrition in the elderly population of Home Health clients.

The Dietitian Team – Their Research

The dietitian team focused its research on the North-East area of Vancouver – home to the second-largest population of elderly people in the city. They theorized at least 45% of Home Health clients would be either at risk of malnutrition or malnourished, based on the existing in-hospital literature.

The community based dietitians trained nursing and allied health staff at Evergreen Community Health Centre to conduct face-to-face interviews and to complete a short nutrition screen during initial home visits with consenting,  newly-referred, and  non-palliative Home Health clients,  aged 65 years and above.

The selected nutrition screening tool, Nestle’s Mini Nutritional Assessment (MNA), is one of the most validated nutrition screening tools for older adults. Relatively short and easy to administer, each question has a numeric score which when tallied up, places the client in one of three categories:

1) normal nutrition status,

2) at risk of malnutrition, or

3) malnourished.

What the Home Health Registered Dietitians Found

Of the 611 MNAs distributed, 564 (92%) were returned and 226 Home Health clients met the inclusion criteria. Among this group an astonishing 64% were found to be at risk of malnutrition or malnourished. This is considerably greater than what was originally hypothesized, highlighting the need to implement a routine community nutrition screening tool. These findings were presented at the 2017 Dietitians of Canada Conference and published in the Canadian Journal of Dietetic Practice and Research.

What’s Next?

Sharing these findings with management and staff of Vancouver Community Home Health has raised tremendous awareness about the importance of nutrition screening. Plans are underway to take this research to an operational level. By including a nutrition screening tool upon referral to community, all Home Health clients will be screened for malnutrition and identified to ensure that a timely nutrition referral to the Dietitian is made.

Supported by the literature, this change in practice will help to lower hospital re-admissions, shorten hospital length of stay, improve patient care, and reduce healthcare costs associated with malnutrition. This clearly supports VCH Authority’s True North Goals of “innovate for sustainability” and “Promote better health for our communities.”

For more information on the studies, contact Leila Goharian, MSc. RD. CDE., Registered Dietitian- Community Home Health Care
Evergreen Community Health Centre