Stop blaming nurses for malnutrition in older people

Focus instead on the widespread myths in the community about healthy eating

Focus instead on the widespread myths in the community about healthy eating

Picture: iStock


Staff in health and care settings usually take the brunt of the blame when the media reports on malnutrition among older people. 

There has been an increase in recorded deaths from malnutrition, and figures from NHS Digital show adult hospital admissions with a primary or secondary diagnosis of malnutrition have tripled in the past decade.

Undoubtedly, there are challenges in practice that must be addressed to ensure older people are getting enough to eat and drink in hospitals, care homes and in their own homes.

Causes of malnutrition in older people

Despite high-level guidance and policy, awareness of undernutrition and dehydration and its causes remains insufficient among health and care staff. However, this is not the whole story; in one way it's a red herring as it takes our eye off the other issues involved in undernutrition.

One in ten people aged over 65 are at risk and most of these older people live at home and are often not in touch with healthcare services.

A huge – and largely unacknowledged – problem is the lack of awareness among older people themselves and their families.  

Attitudes to weight loss in later life

The Malnutrition Task Force is an independent group of experts working in health, social care and local government to address preventable malnutrition in older people. As part of Malnutrition Awareness Week in October 2019, we undertook a survey of British adults’ attitudes to weight loss in later life, which revealed that:  

  • 75% of British adults feel that it’s normal to lose appetite and weight and look thin and frail as we age.
  • 78% would not be comfortable mentioning weight loss to a neighbour.
  • 48% would be uncomfortable speaking to an older relative or friend about weight loss.
  • 50% feel that it’s good to stick to low fat products throughout life even if underweight.

Healthy eating messages may not be right for older people

The responses to the survey help to explain why there are so many older people living with malnutrition or at risk of developing it.  

People incorrectly believe that weight loss and frailty in later life is normal, and are confused by healthy eating messages that suggest that no snacks and lots of fruit, vegetables and low-fat products are best for everyone. In fact, this may not be the right message for people as they age.

‘We need to think about nutrition and hydration at every contact with older people and their families’

People who are bringing up children and keeping an eye on older relatives may be giving out a single message on healthy eating that is not appropriate for an older person.

There is little point in eating a plate of salad if that is all you can manage that day; regular small meals and snacks should be tried instead.  

Advice for older people at risk of undernutrition or malnutrition

  • Try eating small meals and snacks six times a day rather than three bigger meals
  • Move to full-fat milk, yoghurt and cheese
  • Have milky drinks and a biscuit between meals
  • If chewing is difficult, try soft foods such as scrambled eggs
  • Eat protein at every meal, for example, fish, meat, eggs, diary, beans, rice, grains, lentils, chickpeas, hummus
  • Keep mini pork pies, sausage rolls or falafel in the fridge


How can nurses prevent undernutrition?

As health and care professionals, we need to think about nutrition and hydration at every contact with older people and their families.  We need to promote self-screening and encourage conversations about things we find difficult.

There are easy-to-use tools and information that can help people to start conversations and recognise the signs and risks of malnutrition.

For example, the Nutrition Wheel, developed primarily for non-clinical people, aims to identify whether someone is at increased risk of undernutrition by asking four simple questions, while the PaperWeight Armband helps carers and professionals to start a conversation on the subject of malnutrition.  

Malnutrition in older people can be prevented but it means looking beyond hospitals and care settings and ensuring people have the right information about nutrition and ageing, and early support, in the community.

Lesley Carter is a registered nurse and programme lead for the Malnutrition Task ForceLesley Carter is a registered nurse, head of health influencing for Age UK and programme lead for the Malnutrition Task Force



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Malnutrition Task Force


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