Nutritional Status and Nutritional Management Implementation for Residents with Disabilities in Welfare Facilities: A Nationwide Survey in Japan.

Abstract

In Japan, fees for nutritional management (NM) was introduced in April 2009 to improve nutritional care for persons with disabilities residing in welfare facilities. The present study aimed to clarify (1) the nutritional status as well as eating-related functions and behaviors of such residents and (2) status of incorporating claim fees for NM and oral maintenance in facilities supporting persons with disabilities. This cross-sectional study approached 2,510 welfare facilities for persons with disabilities across Japan. Anonymous questionnaire surveys were conducted in August 2018. Among the 1,543 responses, 1,538 (61.3%) were valid for analysis. The median number of residents in a facility was 50. Among all residents (n=80,322), 16.9% were underweight (body mass index [BMI]<18.5) and 14.5% were obese (BMI≥25.0). Of the residents, 38.9% adjusted food form and 15.2% had eating behavior-related problems. In total, 723 (47.0%) and 54 (3.5%) facilities, claimed the fees for NM and oral maintenance, respectively. The main reasons for not implementing the claim fees for NM was the lack of time for nutritional care and management (NCM; 30.2%), absence of a registered dietitian (29.3%), and difficulty in assessing swallowing function (24.1%). Our results revealed that the implementation rates of claim fees for NM and oral maintenance were low despite most respondents having problems with the double burden of malnutrition and necessity of oral care, suggesting the importance of securing time for NCM, appointing registered dietitians, and evaluating swallowing function.