FOOD AND DRINK MalnutritionMatters

Robyn Collery, Older Persons Specialist Dietitian & Clinical Educator in Care Homes, Nutrition and Dietetics Department, at Gateshead Health NHS Foundation Trust, explains how you should be formalising your approach to the prevention, identification and management of malnutrition within your care organisation.


MALNUTRITION October this year saw UK Malnutrition

Awareness Week, a national effort to raise awareness of the causes and consequences of malnutrition, particularly in the older population here in the UK. Unfortunately, there is still a prevalent misconception that malnutrition is not a problem in this country, and that becoming thin and frail is a natural and expected part of ageing. This is a particularly dangerous myth which can jeopardise the health of our older people.

Unfortunately, 30-42% of people who are admitted to care homes are either malnourished or at risk of malnutrition, figures from British Association for Parenteral and Enteral Nutrition (BAPEN) revealed. Malnutrition contributes to physical and functional decline, and can result in increased infections, wounds and other healthcare complications, as well as a worsening of quality of life. It is vitally important to identify people who are at risk of malnutrition early, and to treat people who are already malnourished effectively. It’s also important for care homes to put strategies in place to prevent malnutrition.

In my job, I help care homes develop the strategies and processes they need to support staff in nutritional care. Ideally, the responsibility for providing good nutritional care for residents should not fall to one person and a range of team members should be actively engaged in both the care of malnourished residents, the early identification of residents who are at risk, and preventative strategies across the setting.

Of course, the care home sector is under enormous pressure at the moment in particular as a result of the coronavirus outbreak but, with more admissions likely to come from already vulnerable people following COVID-19 infection or having become isolated during lockdown, the malnutrition problem is one that we cannot ignore.


One of the most fundamental things that every care home should do is to screen residents on admission. Malnutrition is not always obvious when somebody is in front of you but a simple screening with the Malnutrition Universal Screening Tool (MUST) will identify risk status immediately.

Every resident should be screened every month, regardless of their previous risk status. Things can change very quickly, and the sooner a problem is spotted the better. For anybody who is found to be ‘at risk,’ whether on first admission or

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a bit later down the line, the advice is the same, a clear care plan should be drawn up that takes into account their specific nutritional needs. If you want to find examples of care plans for people who are at different risk levels, head to the Malnutrition Pathway website.

If you are not familiar with ‘MUST’, it is a really easy tool to get going with. There are fantastic introductory resources on the BAPEN website and the simplicity means that really any one of your team members can complete screening, it doesn’t have to be a member of your senior nursing team. I think one of the best things about it is the ‘MUST’ calculator which can be used on mobile devices.


On first admission, alongside ‘MUST’ screening, I would recommend an early consultation on food and drink preferences. It is vitally important to sit down with a resident (and their family if possible) to explore what they like.

I think it can be easy to forget that this extends to drink preferences too and this is hugely important to avoid dehydration. I don’t know about you, but if I’m offered a cup of tea and somebody hands me one that’s super milky, I’m going to say thank you, but not drink it as I like my tea strong! Why would that be any different when you’re a care home resident? It’s also true that there is a bit of an assumption that tea, coffee or hot chocolate are the main options. But residents can enjoy juice and squash, fizzy drinks, and milkshakes too. Someone who is well hydrated is more likely to eat, and actually some of these drinks, or hot drinks with full fat milk, can help get some extra calories in too. So, think outside the box!


If you are reviewing your approach to malnutrition prevention it is important to think about mealtime management. It can sometimes be difficult to create a calm, relaxing environment for mealtimes of course, but the more that can be done to achieve this the better. We know that reducing stress at mealtimes and encouraging social eating can have a positive impact on intake.

I love to hear about care homes where activity managers have managed to incorporate food and drink into their activities. Enjoying social food as part of an activity is important, but I’ve also heard about wonderful tasting events, which are all going to contribute to a positive food atmosphere.

Oral healthcare is hugely important. Things like oral thrush and poor dentition can have a big impact on people’s ability to eat

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