Nutrition Support - Malnutrition
RAG rating
Document type
Patient information
Hertfordshire and West Essex ICB
Output type
Pharmacy / Prescribing

Care homes & ONS - Relatives and friends information

 How healthcare staff support care homes to treat malnutrition: Relative/carer information

As you may be aware, your relative/friend is at high risk of malnutrition because they have a low body weight and/or have lost weight without trying to.

How is malnutrition treated?

Healthcare staff are working with carers, caterers, nurses and managers at the home to help support your relative/friend’s nutritional intake using a food-based approach. This is one of the most important treatments for malnutrition.

A food-based approach means encouraging nutritious drinks and between meal snacks, and "fortifying” food using extra, nutrient-dense household ingredients. "Food fortification” should provide a range of nutrients including calories, protein, vitamins and minerals. "Fortifying” food enables someone with malnutrition to improve their nutritional intake without the need to increase the amount they eat, so it still works even when someone’s food intake is quite small. The "fortified” food still looks and tastes good and will still be enjoyable.

Food and mealtimes are vital for us for lots of reasons, beyond simply providing nutrition. Sharing food with others is part of what makes us human, so supporting people to continue to eat with others can help people to enjoy mealtimes and can help improve nutritional intake.

What will be monitored?

Your relative/friend should be weighed more frequently to keep a close eye on their weight. Staff may complete food record charts for a short time (usually 3 – 5 days) to monitor how much, when and what sort of things they eat and drink. The care staff will review this to make sure the changes made are still appropriate for your relative/friend.

What about oral nutritional supplements?

Oral nutritional supplements are prescribed medicines that can come in a variety of forms, the most common of which are milkshakes. Just like ordinary food, they provide a range of nutrients including calories, protein, vitamins and minerals – but there is nothing in them which cannot be obtained from food.

Some people may need oral nutritional supplements in addition to food, but these products are much less likely to be needed for people living in care homes compared with people living in their own homes. This is because in care homes catering staff can produce homemade supplements using ordinary household ingredients, which often contain the same or more nutrition than prescribed products. Homemade versions are often also tastier because they are freshly made.

A prescription of oral nutritional supplements does not guarantee an improvement in nutritional intake or weight gain and is no more likely to achieve these aims or any other improvements in health and wellbeing than when a "food based” approach is used.

My relative has swallowing problems and has been advised to take thickened fluids – what should they have?

For people who are at high risk of malnutrition and who have been advised to have thickened fluids due to diagnosed swallowing difficulties, pre-thickened oral nutritional supplements exist. These may be helpful for residents with swallowing difficulties compared with trying to thicken homemade products.

Who can I contact for more information?

Staff at the home work closely with healthcare staff and should be able to answer any questions you have regarding your relative/friend. If you require further information, please ask a member of staff from the home.

Version number
Developed by
Approved by
Date approved / updated
March 2023
Review date
The recommendation is based upon the evidence available at the time of publication. This recommendation will be reviewed upon request in the light of new evidence becoming available.
Superseded version