Department of Dentistry and Oral Health, CHU of Bordeaux, Bordeaux, France; Department of Oral Public Health, UFR of Odontology, Bordeaux Segalen University, Bordeaux, France; EA 4136 Handicap and Nervous System, Bordeaux Segalen University, Bordeaux, France; Agricultural Social Security (Mutualite Sociale Agricole) of Dordogne, Lot et Garonne, Perigueux, France.
University Bordeaux, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France; INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France.
J Am Med Dir Assoc. 2014 Apr;15(4):290-5. doi: 10.1016/j.jamda.2013.11.005. Epub 2014 Jan 2.
To assess the impact of a nutrition and oral care training program on nursing home (NH) policies and residents.
Cross-sectional surveys before/after intervention.
One hundred thirty-eight NHs participated in the initial training.
Training sessions for staff, director, and medical practitioners for nutritional and oral care in NH.
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).
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.
Training program improved staff knowledge with positive results at the level of residents but no significant changes were seen within NH policies.
评估营养和口腔护理培训计划对养老院（NH）政策和居民的影响。
干预前后的横断面调查。
138 家 NH 参加了初始培训。
为 NH 中的员工、主任和医务人员提供营养和口腔护理培训课程。
在 6 至 8 个月的时间内进行了两轮自我评估，描述了 NH 政策（机构问卷）、新入住居民的护理质量（入院问卷）以及入住超过 6 个月的居民（入住问卷）。
在机构问卷中，24 家 NH（17.8%）完成了两轮调查，42 家 NH 包括 646 名居民完成了入院问卷，34 家 NH 包括 287 名居民完成了入住问卷。进行了两次评估和未应答的 NH 之间，床位容量和居民依赖程度没有显著差异。机构没有变化。几乎对所有居民进行了营养不良筛查。培训后，有两个风险因素得到了更好的筛查：压疮（39.4%至 49.1%，P =.014）和吞咽困难（33.5%至 41.0%，P =.049）。口腔检查在数量上有所改善（38.5%的居民增加到 48.5%），并且质量上也有所改善：更好地寻找了营养不良和吞咽困难的风险因素（后牙缺失（P <.0001）、流涎（P <.0001）和念珠菌病（P =.002））。在入住评估中也观察到了类似的改善。在三分之一的居民记录中，没有发现针对体重减轻或低饮食摄入的记录采取的行动。
培训计划提高了员工的知识水平，在居民层面上取得了积极的结果，但 NH 政策没有明显变化。
