Evaluation of the Influence of Nutritional Training for Staff Working with Dementia Patients in a Dementia LTC Facility

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Introduction/Purpose: Dementia is a significant public health challenge in the United States. In 2017, the CDC attributed more than 260,000 deaths in the US to dementia as an underlying disease (Douglas et al., 2020). Dementia is a general term for the progressive decline in cognitive and behavioral functions that interfere with a person’s ability to remember, think, and make decisions. It often leads to complex nutritional problems and admission to a long-term care facility. The prevention of nutritional problems related to dementia is a challenging task, and improvements are needed to promote health and quality of life and to decrease physical and mental decline that may lead to premature death. Dementia patients experience behavioral, emotional, and physical changes that make eating and drinking more complex, resulting in dehydration, weight loss, or weight gain. Therefore, effective strategies in providing adequate nutritional intake can lead to a better quality of life and potentially decrease the rate of premature death among dementia patients living in a long-term care facility is needed. The aim of this evidence-based practice (EBP) change was to evaluate the use of a Person-Centered Nutritional Care Protocol (PCNC) for patients with dementia in a long-term care facility (LTCF) and the impact on patient’s weight gain or loss over six weeks. Nutrition care includes assessment of nutritional need, provides supportive interventions that ensure sufficient intake of energy, protein, vitamins, and essential nutrients that are culturally appropriate in a safe environment that promotes both independence and function. Providing the ADRC Eating and Drinking Well with Dementia: A Guide for Care Staff was implemented as the PCNC protocol by the LTCF. The nutritional protocol provided LTCF staff a tool outlining supportive interventions to optimize nutritional support for dementia patients in a LTCF. 5 Methods: A retrospective chart review of the recorded weights was collected for 16 weeks prior to implementation of the protocol and six weeks following the implementation of the nutritional protocol. Additional data collection included the number of times in one day that the ADRC Eating and Drinking well with Dementia protocol was followed during the first six weeks of implementation. Results: The nutritional protocol was used 96.82% daily by the LTCF staff during the first six weeks. When comparing the end of the six weeks weight loss and weight gain with the sixteen weeks prior nutritional protocol found a statistical significance was found using a t-test. A retrospective chart review was completed to record the previous four months' weights, and postimplementation weight was collected for data analysis. A t-test was used to compare pre and post weights. The t-test for dependent samples determined whether the patients' weight changed at the end of the period of interest. After calculations, the mean value of 2.72, a standard deviation of 1.77 were acquired. A t-test for dependent samples was 7.77. The level of significance from the table of critical values of the t-test was determined. The degree of freedom, in this case, is equal to 25 - 1 = 24. In the line for the degree of freedom of 24, the values of the t – criterion are found. The value is more significant than 3.745 for a significance level of 0.001. The level of significance is less than 0.001. Based on this, patients' weight at the beginning and end of the period differs with an error probability of less than 0.1%. A percentage of inpatient average weight gain was identified at the end of the project. It constituted 1.5% weight gain (see Appendix 2 and Appendix 3 to view average patient weight dynamics in five months). 6 Therefore, the results of the project demonstrate statistically significant patient weight change after protocol implementation. Discussion: The hope was that providing LTCF staff a tool for nutritional guidance would provide dementia patients at this LTCF optimal nutrition. The evidence from this project supports that the PCNC protocol did have a statistically significant effect on the weights of patients with dementia in the long-term care facility and supports the continuation of the protocol. Conclusions: The results of this project served as evidence that using a PCNP can provide LTCF staff daily guidance in promoting optimal nutrition to patients with dementia. The results served as the foundation for a new nutrition training protocol in a facility hosting the project to foster the staff training process in the facility to achieve improved outcomes in patients with dementia. The care staff were instructed to use the nutritional protocol daily to provide adequate nutrition for dementia patients. The care protocol was implemented 96.82 % of the time when serving food to patients during all six weeks of the project realization. An increase of 1.5% in average patient weight post the PCNC protocol implementation did support the continuation of the protocol.