Good nutrition is essential to aging well. Promoting health and quality life are common goals as we age and eating well is foundational to achieving these ends.
In the case of living in a long term care facility, adequate and appropriate food intake can assist older adults with continuing to be able to participate in the activities of the facility, to walk independently and be free from illness and infections. Older adults who are frail and receiving help with grocery shopping and cooking can stay longer in their own homes than if these services were unavailable to them. Seniors with chronic diseases like heart disease or osteoporosis can achieve better health by managing their diet and exercising. Helping older adults to achieve nutritional health has been at the heart of Dr. Keller’s research.
Dr. Keller has demonstrated the magnitude of nutrition as a potential problem for older adults. In care facilities, she investigated how prevalent malnutrition was and the factors associated with poor nutrition. She identified that much of the malnutrition that was occurring was preventable, attributed to the eating environment. Factors included the type and quality of food provided, the assistance the older adult required and did or did not receive, the setting of the meal, the training of staff involved in providing assistance, and the lack of close monitoring and team response to nutrition issues as they arose. Dr. Keller is working on several initiatives in this area including mealtime satisfaction, enhanced food products, improving the mealtime experience, and nutrition care through implementation of screening programs in acute care.
Research Briefs
Menu Planning in Long Term Care
Facility-Based Research Articles
Bocock MA, Keller HH. (2009). Hospital diagnosis of malnutrition: A call for action. Can J Diet Pract Res 70(1), 37-41,
Bocock MA, Keller HH, Brauer PM. (2008). Defining malnutrition risk for older home care clients. Can J Diet Pract Res 69(4), 171-76.
Keller HH, Gibbs-Ward A, Randall Simpson JA, Bocock MA, Dimou E. Meal rounds: a simple and effective way to improve the quality of nutrition services. J Am Med Directors Assoc 2006; 7(1):40-45.
Bowman J, Keller HH. (2005). Assessing nutritional risk of long-term care residents. Can J Diet Practice Res, 66(3), 155-161.
Gibbs-Ward A, Keller HH. (2005). Mealtimes as Active Processes in Long-Term Care Facilities. Can J Diet Res, 66(1), 5-11.
Keller HH. (2004). Identifying nutrition problems in senior patients. Geriatrics and Aging, 7(4), 62-65.
Keller HH, Gibbs A, Boudreau L, Goy R, Brown H, Pattillo M. (2003). Prevention of weight loss in dementia with comprehensive nutritional treatment. J Am Geriatrics Soc, 51, 945-951.
Keller HH, Hirdes JP. (2000). Using the Minimum Data Set to determine the prevalence of nutrition problems in an Ontario population of chronic care patients. Can J Diet Pract Res, 61(4), 165-171.
Keller HH. (1997). Nutrition problems and their association with patient outcomes in a geriatric rehabilitation setting. J Nutr Elder, 17(2),1-13.
Keller HH. (1997). Association between functional ability and nutritional status in institutionalized older men: a pilot study. Can J Rehab 10(3), 193-204.
Keller HH. (1995). Weight gain impacts morbidity and mortality in institutionalized olderpersons. J Am Geriatrics Soc, 43, 165-169.
Keller HH. (1994). Practical guidelines for staff management of undernutrition in a long-term care population. Nursing Home Medicine, 2(7), 40-49.
Keller HH. (1993). Malnutrition in institutionalized elderly: how much and why? J Am Geriatrics Soc, 41, 1212-1218.
Dr. Keller has also looked at nutrition in older adults living in the community. She has developed SCREEN© a short, self-administered nutrition risk screening tool to assist seniors with receiving needed services to promote their nutrition. An internet version of this tool Nutri-eSCREEN is available for self-managment. Dr. Keller has used SCREEN to demonstrate the nutrition challenges that older adults face, as well as the importance of nutrition to their health and quality of life.
Research Briefs
Mortality, Nutrition and Aging Well
Quality of Life, Nutrition and Aging Well
BMI Change Predicts Mortality in Community Living Older Adults
Dependency on Others for Food Purchasing and Preparation is Associated with Poorer Nutrient Intake
Promoting Food Intake—How Can It Be Improved?
Nutrition Promotion
Low Income Seniors Describe What Influences their Access to Food
Community-Based Nutrition Risk Research Articles
More C, Keller HH. (2008). Community Nutrition Policy for Seniors in Canada. Can J Diet Pract Res.69(4), 198-200.
Keller HH, Dwyer JJM, Edwards V, Senson C., Edward HG. (2007). Food security in older adults: community service provider perceptions of their roles. Can J Aging 26(4), 317-328.
Keller HH, Dwyer JJM, Censon S, Edwards V, Edward HG. (2006). A social ecological perspective of the influential factors for food intake described by low-income seniors. J Hunger Environ Nutr. 1(3), 27-44.
Hays JC, Keller HH, Ostybe T. (2005). The effects of nutrition-related factors on four-year mortality among a biracial sample of community-dwelling elders in the North Carolina Piedmont. J Nutr Elderly, 25 (2), 41-68.
Keller HH. (2005). Reliance on others for food-related activities of daily living. J Nutr Elderly 25 (1), 43-59.
Keller HH, Ostbye T. (2005). Body Mass Index (BMI), BMI Change and Mortality in Community Dwelling Seniors without Dementia. J Nutr Health Aging, 9(5), 316-20.
Keller HH. (2004). Nutritional risk and quality of life in vulnerable older adults. J Nutr Health Aging, 8(4), 245-252.
Keller H.H., Ostbye T., and Goy R. (2004). Nutritional risk predicts quality of life in elderly community-living Canadians. J Gerontology: Medical Sciences, 59A(1), 68-74. Abstract
McKenzie JD, Keller HH. (2003). Who are the users of vitamin-mineral and herbal preparations among community-living older adults? Can J Aging, 22(2), 167-175.
Keller H.H., Ostbye T. (2003). Nutritional risk and time to death; predictive validity of SCREEN© (Seniors in the Community Risk Evaluation for Eating and Nutrition). J Nutr Health Aging, 7(2), 274-279. Abstract
Keller HH, McKenzie JD. (2003). Nutritional risk in vulnerable community-living seniors. Can J Diet Prac Res, 64, 195-201.
Keller HH. (2001). Meal-based and non-meal based community services: Comparison of nutritional risk and health of vulnerable seniors. J Nutr Elderly, 21(2), 23-38.
McKenzie JD, Keller HH. (2001). Vitamin-mineral supplementation and use of herbal preparations among community-living older adults. Can J Pub Health, 92(4), 286-290.
Keller H.H., Ostbye, T. (2000). Do nutrition indicators predict death in older adults with cognitive impairment? Can J Pub Health, 91(3), 220-224. Abstract
Keller, H.H., Ostbye, T., Bright-See E. (1999). Dietary habits of seniors with some activity limitations. Can J Diet Prac Research, 60, 214-221. Abstract
Keller H..H, Ostbye T., Bright-See E., Campbell M.K. (1999). Activity limitation and food intake in community-living seniors. Can J Aging, 18(1), 47-63.
Keller HH, Ostbye T, Bright-See E. (1997). Predictors of dietary intake in Ontario Seniors. Can J Pub Health, 88(5), 305-309
In addition to demonstrating that nutrition problems are prevalent in the community, especially in frail older adults, Dr. Keller identified that little was known about trying to help seniors living in the community eat better. Secondary prevention services can benefit a large proportion of the older adult population and are cost efficient. These programs focus on nutrition education and helping older adults to achieve healthy eating. Dr. Keller used SCREEN as a mechanism for raising awareness of nutrition problems in select groups of seniors, and demonstrated how this knowledge can be used to plan nutrition education programs. Evergreen Action Nutrition (EAN) was developed using a community-based approach. A manual, Tastes of Life, has been created to assist others interested in the program with replicating activities.
Research Briefs
Evergreen Action Nutrition Overview
Food Workshops
Men’s Cooking Groups
Community-Based Intervention Research Articles
Manilla, B., Keller, HH, Hedley, M. (accepted March 2009). Food tasting as a nutrition education format for older adults. Canadian Journal of Dietetic Practice and Research
Markle-Reid, M., Keller H.H., Browne, G. (in press). Health promotion in the community living older adult. H. Fillit, K. Rockwood, K. Woodhouse (eds.) Brocklehurst Textbook of Geriatric Medicine and Gerontology, 7th Ed.
Keller HH. Promoting food intake in older adults living in the community: a review. App Phys Nutr Met 2007;32: 991-1000.
Keller HH. (2006). Meal programs improve nutritional risk: A longitudinal analysis of community-living seniors. J Am Diet Assoc 106(7), 1042-1048.
Keller HH, Hedley MR, Wong SS-L, Vanderkooy P, Tindale J, Norris J. (2006). Community organized food and nutrition education: participation, attitudes, and nutritional risk in seniors. J Nutr Health Aging 10(1), 15-20.
HH, Hedley MR, Hadley T, Wong S, Vanderkooy P. (2005) Food Workshops, Nutrition Education and Older Adults: a process evaluation. J Nutr for Elderly, 24(3), 5-23. Abstract
Keller H.H. Gibbs A, Wong S, Vanderkooy P, Hedley M. (2004). Men can cook! Development, implementation, and evaluation of a senior men’s cooking group. J Nutr Elderly, 24(1), 71-87. Abstract
Hedley M.R., Keller H.H., Vanderkooy P.D., Kirkpatrick S. I. (2002). Evergreen Action Nutrition: Lessons learned planning and implementing nutrition education for seniors using a community organization approach. J Nutr Elderly, 21(4), 61-73.
Keller H.H., Hedley, M.R. (2002). Nutritional risk of community-living seniors: prevalence of nutrition problems and priorities for action. J Comm Health, 27(2), 121-132. Abstract
Resources
The Tastes for Life… nutrition for older adults education program is a result of experiences gained from Evergreen Action Nutrition. This community-based project helped to identify how community collaboration can occur to promote food intake and provide nutrition education of older adults living in the community. A leader’s guide has been developed based on these experiences and is provided on this website in pdf format.
Tastes for Life Leader’s Guide
If you would like to purchase a hard copy of this resource please contact:
Evergreen Seniors Centre
683 Woolwich Street,
Guelph, ON, N1H 3Y8
phone: 519-823-1291
fax: 519-823-8972
