Frail elderly live better and longer with improved nutrition care

The Challenge: Preventing and treating malnutrition among the elderly

Malnutrition is a pervasive issue in Canada and worldwide in long-term care (LTC) facilities, with the frail elderly suffering from malnutrition at a rate of 40 to 85 percent. Sometimes, the elderly are admitted to LTC in a malnourished state. Other times, multiple medical conditions contribute to nutritional decline in residents. In still other cases, LTC facilities are unable to provide for the unique nutritional needs of this population; the menu may not be varied enough, residents may have undiagnosed difficulty in swallowing, and residents may need more dining assistance than they are receiving. In many cases, malnutrition is preventable and treatable.

The Improvement Project: Using a three-point plan to improve nutrition

Noella Leydon, Director of Food and Nutrition Services for the Saskatoon Health Region (SHR), developed an integrated approach to planning food services policies to improve nutrition among 2,080 people living in 29 LTC facilities. Her EXTRA improvement project had three specific goals: ensure that food and nutrition staff are competent; provide adequate nutrition for all residents; screen for nutrition risk and involve residents and their families in determining the best interventions where problems are found.

The Result: Better nutrition, fewer pressure ulcers 

After completion of a successful pilot project at one facility, Leydon implemented an approach to achieve all three of the project’s specific goals. Successes include: 

  • the completion of Mealtime Assistance Training for 1200 staff 
  • Food Safe Level 1 training on 29 sites 
  • the networking of food service leads at 29 sites 
  • the establishment of fortified menus at seven sites 
  • engagement with the provincial Health Quality Council team and Accreditation Canada on reducing the risk of pressure ulcers (a condition that can be exacerbated by malnutrition) 
  • contribution to the recently-published LTC provincial care guidelines for nutrition care
  • development of a referral process to a dietitian in Saskatoon urban LTC

The Impact: Better coordination of care and improved nutrition among Saskatoon’s LTC facilities

The project initiated the integration and coordination of nutrition care and food services in 29 LTC facilities and has secured permanent funding for a registered dietitian position to support Food Education And Standards Training (FEAST) in rural areas. Current EXTRA Fellows are continuing Leydon’s work by completing their own projects on vulnerable and complex continuing care populations. Now, a patient “value stream” is being developed in the health region specifically to address the needs of these populations.

Noella Leydon image

“One additional Registered Dietitian now acts as a consultant to advance this work. One third of (29) homes in the SHR have moved to a new population-appropriate menu and staff continue to be trained on mealtime assistance. We focus on improvement in the quality of life for LTC residents so that every day is a celebration, every meal is a feast!”
 — Noella Leydon, Director of Food and Nutrition Services, Saskatoon Health Region 

To learn more about this project or the EXTRA program, visit or email us at