Nutrition as Medication: from research to implementation

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 ulcers and respiratory infections. This reality has been exacerbated during the pandemic. LTCF stakeholders report that those affected by COVID-19 have seen their nutritional status deteriorate rapidly. At the same time, non-affected residents have also experienced 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 common means of achieving this objective. However, actual consumption of these products is rather low. Since 2017, an intervention nicknamed NAM for <> has been developed and tested in LTCFs by our team. This intervention suggests prescribing small doses of an oral nutritional supplement (30 or 60 ml) that are administered like 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 reduction in pressure ulcers among residents. In follow-up to these results, a guide was written describing the NAM intervention, the principles that frame it, and the suggested strategy for successful implementation in an ESLD. 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 conducted 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 ESLDs during the new wave of COVID-19, our team proposes the dissemination and scaling up of the NAM intervention in ESLDs. Specifically, we propose to: 1) support the implementation of NAM in two Montreal ESLDs; 2) evaluate the implementation of NAM in terms of prescription and administration of treatment; 3) identify the facilitating and constraining factors of NAM implementation; 4) identify the effects of NAM as perceived by stakeholders and relatives/residents; and 5) review the NAM implementation material.