A multicentric retrospective pilot study on the clinical, nutritional, economic and organizational impact of an integrated protocol for dysphagia management within nursing homes in Italy.

Introduction: Dysphagia is a critical challenge in nursing homes, associated with malnutrition, aspiration pneumonia, and increased mortality. This study evaluates the impact of an integrated protocol combining instant homogenized meals, nutritional monitoring, and continuous staff training across five Italian nursing homes. Material and methods: A multicentric retrospective observational pilot study was conducted on 99 frail residents. The cohort was characterized by high functional dependence (88% total dependence) and severe nutritional vulnerability (99% malnutrited or at risk). Clinical evolution was compared between the 120 days preceding (pre-implementation) and the 120 days following the adoption of the protocol (post-implementation). Parameters analyzed included anthropometric data, bioelectrical impedance analysis (BIA), biochemical tests, adverse events (pneumonia, pressure ulcers), and economic/organizational impact in the post-implementation period (measured in two nursing homes). Results: In the post-implementation phase, an attenuation of weight decline was observed compared to the preceding period. BIA parameters showed favorable changes: phase angle increased significantly ( Discussion: Process standardization may enhance resident safety and operational efficiency, although these exploratory findings require confirmation in controlled prospective studies. These findings support managing dysphagia as a multidimensional clinical and organizational pathway rather than a simple texture modification strategy.