The conversation around malnutrition: a qualitative study of dietitian and patient perspectives

Malnutrition is prevalent among older adults in Canada and it can be mitigated through personalized dietitian-led counselling. This qualitative study aimed to explore how malnutrition is communicated and perceived, providing insight for future care. This multisite qualitative study was conducted in Alberta and Quebec, Canada. Participants were recruited through purposive sampling to target patients ≥65 years old who spoke French or English, had a malnutrition diagnosis, and received counseling for malnutrition from a dietitian. Dietitians who had worked directly with patients ≥65 years old with a diagnosis of malnutrition were recruited through advertisement. Semi-structured interviews were recorded both in person and over the phone. Data were transcribed verbatim and analyzed using reflexive thematic analysis. Twenty-five patients and 10 dietitians were interviewed, producing five themes (two dietitian themes and three patient themes). First, diagnosing malnutrition: dietitians highlighted challenges in diagnosing malnutrition due to limited support and resources. Second, using the "M" word: dietitians hesitated to use the term "malnutrition" with patients. Third: knowing I'm malnourished: patients reported not being informed of their diagnosis. Fourth, what is malnutrition? Patients revealed the word sounds extreme and unrelatable. Reactions to the diagnosis varied: acceptance, shock, detached, and neutral. Finally, stigma and blame: some patients distanced themselves from the stigma by rationalizing their nutrition problems. Gaps in management of malnutrition were identified. Future research should focus on how to communicate the diagnosis to improve outcomes for malnutrition.