Malnutrition is a common health problem. It is estimated that around one in ten people over the age of 65 are malnourished or at risk of malnutrition (Malnutrition Task Force, 2024, PDF).

There are certain groups of people who are at higher risk of malnutrition, such as those living with chronic conditions, those with mental health needs and those who are approaching the end of life.

Those undergoing major surgery or having experienced trauma may also be at risk.

Signs and effects of malnutrition may include:

• unplanned or unexplained weight loss
• feeling tired, lacking energy
• an increased risk of illnesses or infections
• poor concentration
• difficulty keeping warm
• low mood/depression
• having a BMI under 18.5
• reduced/weaker muscle and tissue mass
• risk of pressure ulcer development
• delayed wound healing
• decreased mobility and stamina
• increased respiratory difficulties
• poor libido (sex drive) and fertility problems
• increased chance in developing post-operative complications.

Nursing staff must:

• listen to patients, their relatives and carers
• understand how ageing affects nutritional needs
• understand how illness and medication affect appetite and nutritional needs
• become food aware, meals are just as important as medication
• assess patients for signs or risk of malnourishment in health and social care settings and in the community
• assess skin integrity on admission and at regular intervals
• work with the patient, families and members of the MDT to address malnutrition
• ensure that the appropriate diet is being provided in health and social care settings
• provide advice and support to families and carers about diet
• make sure mealtimes are protected.

Seeking advice from specialist colleagues is important as appropriate. NICE has produced guidance to help health professionals identify those who are malnourished, or at risk of malnutrition.

The BAPEN e-Learning Portal has a range of free e-Learning modules with case studies covering malnutrition, nutrition support and nutritional screening using ‘MUST’.

What can you do if you suspect or detect malnutrition?

You should assess people being admitted to your care. If necessary, use a validated screening tool, such as the Malnutrition Universal Screening Tool (MUST).

 MUST is a five-step tool that can be used by health professionals in hospitals, or in the community, to accurately identify those who are at risk from malnutrition.

Supporting someone’s hydration is a simple but essential part of good care. When people are unwell, they often struggle to drink enough on their own, which puts them at real risk of dehydration and its serious consequences. Caregivers play a crucial role in noticing when someone needs help, recognising early warning signs, and creating opportunities for regular, safe fluid intake. 

Many people do not drink enough and this is particularly true of people who are unwell. Ask yourself: can the person see, reach for, lift and hold a drink? If the answer to this is no, then they need your help to stay hydrated.

It is important to monitor regularly for signs of dehydration.

Signs of dehydration include:

• thirst
• feeling dizzy/light headed
• sleepiness/tiredness
• dry, sticky mouth
• headache
• passing small amounts of dark, concentrated urine
• low blood pressure/hypotension
• rapid pulse/tachycardia.

• recording input/output where appropriate
• weighing
• blood testing
• physical assessment
• ask the person if they are thirsty
• oral mucosa
• blood pressure monitoring.

Dehydration can lead to:

• constipation
• infections
• delayed healing
• delirium
• falls
• acute kidney injury
• death.

• The suggested amount of fluid is 2.5 litres a day unless there are clinical considerations.
• Encourage people to drink small amounts throughout the day and more at meal times or with medication.
• Offer a choice of appropriate drinks.
• Ensure that clean, fresh water is accessible.
• Where appropriate, encourage family members and carers to assist the person to drink.
• Ensure that appropriate aids are available to encourage the person to drink.