Nutrition as Medication: from research to implementation

Google translate: Malnutrition and weight loss are rampant in long-term care facilities (LTCFs). Yet their consequences are serious, including an increased risk of mortality and morbidity such as pressure ulcers and respiratory infections. This reality was exacerbated during the pandemic. LTC workers report that those with COVID-19 have seen their nutritional status deteriorate rapidly. At the same time, the unaffected residents also exhibited significant and undesirable weight loss. Interventions to prevent weight loss should aim to increase energy and protein intake. The use of oral nutritional supplements is a popular way to achieve this goal. However, the actual consumption of these products is rather low. Since 2017, an intervention nicknamed NAM for "Nutrition as Medication" has been developed and tested in ESLD by our team. This procedure suggests prescribing small doses of an oral nutritional supplement (30 or 60 ml) which are administered as a medication. The effectiveness of NAM has been studied. Preliminary results show a high administration rate (93-95%), a significant improvement in nutritional status and a decrease in pressure ulcers among residents. As a follow-up to these results, a guide was drawn up describing the NAM intervention, the principles that frame it, and the strategy suggested for a successful establishment in a LTCF. The NAM intervention appears to be a promising practice that could limit or even prevent the deterioration of the nutritional status of residents, whether or not they have COVID-19. However, the studies were carried out before the onset of the pandemic and the implementation guide therefore does not take this context into account. Thus, in order to better equip LTCs during the new wave of COVID-19, our team proposes the dissemination and scaling of the NAM intervention in LTCFs. Specifically, we propose to: 1) support the implementation of NAM within two Montreal LTCFs; 2) assess the implementation of NAM in terms of prescription and administration of treatment; 3) identify the facilitating and constraining factors for the implementation of the NAM; 4) identify the effects of NAM as perceived by workers and relatives / residents; and 5) revise the NAM implementation material.]