Nutrition as Medicine: from research to implementation

Google translate: Malnutrition and weight loss are endemic in long-term care facilities (LTCFs). Yet their consequences are serious, including an increased risk of mortality and morbidity such as pressure sores and respiratory infections. This reality has been exacerbated during the pandemic. LTCF responders report that those with COVID-19 have seen their nutritional status deteriorate rapidly. At the same time, 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 dubbed NAM for "Nutrition as Medication" has been developed and tested in LTCH by our team. This intervention suggests prescribing small doses of an oral nutritional supplement (30 or 60 ml) which are administered as a medicine. The effectiveness of NAM has been studied. Preliminary results show a high delivery rate (93-95%), a significant improvement in nutritional status and a decrease in pressure ulcers among residents. Following these results, a guide was written describing the NAM intervention, the principles that frame it, and the suggested strategy for successful implementation in an 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, with the aim of better equipping LTCFs during the new wave of COVID-19, our team proposes the dissemination and scaling up of the NAM intervention in LTCFs. Specifically, we propose to: 1) support the implementation of NAM within two Montreal ESLDs; 2) to evaluate the implementation of the NAM in terms of prescription and administration of the treatment; 3) identify facilitating and constraining factors for NAM implementation; 4) identify the effects of NAM as perceived by workers and relatives/residents; and 5) review NAM implementation hardware.]