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Malnutrition among older adults with dysphagia is common. Texture-modified foods (TMFs) are an essential part of dysphagia management. In long-term care (LTC) facilities, health professionals have implemented TMFs, but their application has not been fully elucidated, making them heterogeneous.
We aim to explore the implementation of TMFs in LTC facilities, particularly focusing on the role of health professionals in nutritional care involving TMFs (eg, deciding the type of food, preparing and giving the food, and evaluating the outcomes).
A scoping review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodological approach will be performed. A comprehensive search for published literature will be systematically performed in PubMed, CINAHL, MEDLINE, ProQuest, PsycINFO, and Science Citation Index (Web of Science). Data screening and extraction will be performed by 2 reviewers independently. The studies included will be synthesized, summarized, and reported, following the preferred reporting items of the Mixed Methods Appraisal Tool. Our review will consider the following study designs: mixed methods, quantitative, and qualitative. Studies with patients who are not older adults will be excluded.
Data extraction will be completed by February 2023. Data presentation and analyses will be completed by April 2023, and the final outcomes will be completed by June 2023. The study findings will be published in a peer-reviewed journal.
Our scoping review will consider studies related to TMF interventions for older adults in LTC residential facilities, with no exclusion restrictions based on country, gender, or comorbidities. Studies on interventions that address TMF-related issues, such as deciding the type of food, preparing and giving the food, and evaluating the outcomes, are qualified for inclusion.
OSF Registries 79AFZ; https://osf.io/79afz
PRR1-10.2196/44201
Malnutrition is prevalent among the older adult population. The prevalence of malnutrition among older adults has been reported to be between 1.3% to 47.8% in the community [
Although standardized terminology and international terminology for TMF have been established [
Previous studies have reported on the implementation of TMF in LTC facilities [
An international framework for the implementation of TMF has been developed [
The objective of our scoping review is to explore the implementation of TMF in LTC facilities, particularly focusing on the role of health professionals in nutritional care involving TMF.
Our scoping review will address the following research question, mainly focusing on the role of health professionals in nutritional care involving TMF (eg, deciding the type of food, preparing and giving the food, and evaluating the outcomes): how is the implementation of TMF in LTC facilities?
Our scoping review will consider studies describing the implementation of TMF in LTC residential facilities. Older adults will be defined in our study as those aged ≥60 years [
Health professionals have implemented TMF in LTC facilities. Health professionals undertake remunerated work for which formal education is required (eg, nurses, dietitians, physicians, speech therapists, and paramedical workers). They are classified based on the International Standard Classification of Occupation [
The concept of interest is any implementation of TMF. TMFs and thickened drinks are commonly used to reduce choking risks and aspiration [
We will select studies set in LTC facilities. LTC facilities are designed institutions that provide formal (paid) accommodation and include health or social LTC facilities [
Mixed methods, quantitative, and qualitative study designs are eligible for inclusion in our review. We will include studies published from database inception to the date of the search. Documents will be considered eligible only if the full text is available. Only articles available in English, Japanese, and Bahasa Indonesia will be considered for inclusion due to limited resources that do not allow for the screening and translation of studies in other languages. The search process will include a filter for participants aged ≥60 years.
The final scoping review will be reported based on the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) [
The comprehensive search of bibliographic databases will use PubMed, CINAHL, MEDLINE, ProQuest, PsycINFO, and Science Citation Index (Web of Science). Our search strategies will use the following process [
Example of the search strategy for PubMed (date of search: September 2022).
Search query number | Query | Records retrieved, n |
1 |
|
5,963,158 |
2 |
|
464,315 |
3 |
|
12,282 |
4 | Query 1 |
6,178,105 |
5 | Query 4 |
1145 |
6 |
|
315,421 |
7 | Query 5 with the following filters: English, Indonesian, and Japanese | 1064 |
8 | 783 | |
9 |
|
1173 |
Reference management software (Mendeley [Elsevier]) will be used to manage the retrieved sources and identify duplicate references. The full-text version of an article will be reviewed if the article’s eligibility is unclear based on the abstract. Two independent reviewers will screen the full texts of selected studies based on the inclusion criteria. The exclusion of references will be recorded and reported in the scoping review. Any disagreements between reviewers will be resolved through discussion or with the help of a third reviewer.
The extraction of qualitative data will be carried out in 2 stages. First, the reviewers will read the studies and identify different opinions in the paper, such as original statements from the study participants (ie, first-order constructs) and their interpretations by the researchers or authors (ie, second-order constructs) [
A thematic analysis approach will be used to synthesize the data. The data synthesis will consist of the following three stages: (1) synthesizing, (2) summarizing, and (3) reporting the papers reviewed. The stages will follow the preferred reporting items of the Mixed Methods Appraisal Tool [
Data extraction will be completed by February 2023. Data presentation and analyses will be completed by April 2023, and the outcomes will be completed by June 2023. The main results of our investigation will be presented in a narrative form, focusing on research results to date regarding TMF implementation by health professionals. Additional data on publication years, countries, study designs, populations, and settings will be presented in diagrams or in tabular format.
The results from our scoping review will explore the implementation of TMF in LTC facilities, particularly focusing on the role of health professionals in nutritional care involving TMF (eg, deciding the type of food, preparing and giving the food, and evaluating the outcomes). Health professionals play a vital role in TMF-related intervention and decision-making within LTC facilities. To our best knowledge, our study will be the first review of the implementation of TMF in LTC facilities, and it will mainly focus on the role of health professionals in nutritional care involving TMF.
We propose that the results of our study will support the development of existing feeding policies in LTC facilities, especially by identifying current knowledge on the role of health professionals in TMF implementation. Several literature reviews have been performed regarding TMF [
The implementation of TMF is tightly related to the quality of care in LTC facilities. Older adults' safety while eating is an essential part of standard safety care in LTC facilities [
A limitation of our study might be the concepts of LTC facilities among countries and papers. The country-specific terminology about LTC facilities that has been used relates to goals, providers, activities, and target groups [
To our knowledge, our review will be the first systematic scoping review to provide knowledge about the implementation of TMF in LTC facilities, particularly focusing on the role of health professionals in nutritional care involving TMF. Our study will address the evidence-practice gap regarding nutritional sustenance in LTC facilities. The policy makers, decision makers, and health professionals in LTC facilities have insight on TMF implementation. This knowledge may help to improve the design and implementation of future TMFs in LTC facilities. The review will also seek to identify further research gaps and the possible need for further study on TMF.
The proposed data extraction form.
Peer-review reports in Indonesian and English from the Kementerian Pendidikan, Kebudayaan, Riset, Dan Teknologi - Universitas Airlangga - Lembaga Penelitian Dan Pengabdian Masyarakat / Institute for Research and Community Service (Surabaya, Indonesia).
long-term care
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews
texture-modified food
We thank Dr Zhao Ni (Yale School of Nursing, Yale University, Connecticut, United States), for his guidance and support.
All data that have been generated or analyzed during the study are included in this published research protocol (and its supplementary information files). The main outcome analyses are being conducted at the time of publication of this protocol, but specific data sets might be available from the corresponding author upon reasonable request.
DWS and GEA wrote the manuscript and designed figures. RI, FF, MT, and ER contributed to drafting the protocol and were responsible for the conception of the study. All authors read the paper, provided feedback, and approved the paper for submission.
None declared.