Efficiency at the resident's level of the NABUCCOD nutrition and oral health care training program in nursing homes

Abstract

Objectives: To assess the impact of a nutrition and oral care training program on nursing home (NH) policies and residents.

Design: Cross-sectional surveys before/after intervention.

Participants: One hundred thirty-eight NHs participated in the initial training.

Intervention: Training sessions for staff, director, and medical practitioners for nutritional and oral care in NH.

Measurements: Two waves of self-assessments over a 6- to 8-month interval described NH policies (Institution questionnaire), quality of care in newly admitted residents (Admission questionnaire), and in those present for more than 6 months (Stay questionnaire).

Results: Questionnaires were completed at both waves in 24 NHs (17.8%) for Institution, in 42 NHs including 646 residents for Admission, and in 34 NHs including 287 residents for Stay. There was no significant difference in bed capacity and resident dependency between NHs, which performed both assessments, and nonresponders. No change was observed for Institution. Malnutrition screening was carried out in almost all residents. Two risk factors were better screened after training: pressure ulcers (39.4% to 49.1%, P = .014) and dysphagia (33.5% to 41.0%, P = .049). Oral examination improved quantitatively (38.5% of residents to 48.5%) and qualitatively: risk factors for malnutrition and dysphagia were better sought (loss of posterior teeth (P < .0001), asialia (P < .0001), and candidosis (P = .002)). Similar improvements were seen in Stay assessments. Actions to counteract weight loss or low dietary intake records were not found in one third of resident records.

Conclusions: Training program improved staff knowledge with positive results at the level of residents but no significant changes were seen within NH policies.

Keywords: Oral health; nursing homes; quality improvement.