Author: Siobhan McKenna

The GM Nutrition & Hydration Programme has been developed and piloted across GM to deliver a non-clinical community intervention for identifying and addressing malnutrition and dehydration in the 65+ population.
READ the bullet points.

The programme vision is to ensure the dignity, health and well-being of older people are met by understanding and promoting their hydration needs by:
- Educating
- Raising Awareness
- Engaging with services and organisations who in their daily tasks, come into contact with older adults.

The prevalence of malnutrition is more commonplace than we might expect.
14% of people living in the community are suffering from or at risk of malnutrition. It usually develops over the medium to long term and often goes unidentified and therefore untreated until it becomes a serious problem and people are admitted to hospital or a care home because their health and independence have deteriorated.
At the point of admission to hospital the prevalence rises to a third and on admission to care homes it is as much as 35% of people who are at risk. We can see, therefore, the direct link between malnutrition, consequences for the individual’s health, wellbeing and quality of life and cost to the health and care services.
We have a wide range of services that interact with older people who may notice if someone is looking thin or has lost weight, however, it is not common for this to be raised as an issue – partly due to the myth that losing weight is a natural part of ageing and partly due to lack of knowledge of how to support.
The GM Nutrition and Hydration programme was established to reverse this situation– by providing simple tools and resources so that everyone working with or caring for older people have the knowledge they need to identify malnutrition and to enable the person to take a self-care approach to stimulating weight gain.

We anticipate that older adults will be at increased risk of malnutrition as a result of direct and indirect consequences of the COVID-19 pandemic, either by contracting the virus or as a result of barriers to good nutrition due to social distancing measures, isolation and shielding.

Evidence from delivery of the programme shows that simple conversations about the importance of nutrition and hydration can make a big difference.
In many cases malnutrition is entirely preventable, if we intervene early and proactively:
We can do this by:
Firstly, giving simple advice – to encourage a person to eat little and often and fortify food.
Use gentle encouragement and offer support – ask if someone is getting out to the shops, can they establish a mealtime routine, what do they really like to eat, are cupboards well stocked if they don’t feel like going out?
Social support and prompting – are they connected with family, friends or services who can provide social or practical support

What are the signs to look out for if you may have concerns about someone you care for or support?
This slide illustrates examples of visual as well as verbal prompts (verbal prompts are useful if supporting clients/persons over the phone)
Visual signs might include:
- Loss of muscle mass – thin arms and legs (although this can sometimes be masked by layers of clothing)
- Loose clothes such as collars, belts, waistbands, shoes or slippers
Verbal prompts may include comments such as
- Feeling cold all the time
- Feeling tired
- Low mood
- Poor appetite
- Lack of motivation to cook, shop or prepare foods

If you should have concerns about someone consider asking the key questions on the slide or indirectly start a conversation about how someone is feeling, how they are managing to get their shopping etc?
You can view a short film clip via the link of the slide which demonstrates how to use the PaperWeight Armband and simple conversations to encourage people to eat and drink well.

Encourage colleagues, carers and family members to try the paperweight armband, this is a simple, non-clinical tool used to gauge whether someone may be at risk of malnutrition. The armband is simply wrapped around the middle of the upper arm (non-dominant arm) and if the armband can be fastened together and can be moved freely up and down this suggests that someone is underweight and at risk of malnutrition.
It may then be appropriate to offer simple advice to help a person make simple changes to their eating habits to help them manage or increase their weight, using a food first approach.
An independent evaluation of the programme, by the University of Manchester, has shown positive outcomes as a result of using the PWA and simple conversations to address malnutrition risk.
In a study of older adults 65+ who were identified as at risk and given simple food first advice, at 12 weeks follow up 81% had a positive outcome. Often it was 1 or 2 simple changes that made a huge difference.

1. Eat little and often – some people may be over faced by a big meal so they should try having smaller portion sizes, encourage snacks between their meals. 6 small meals or snacks are as good as 3 big meals.
2. Add cream, butter, cheese and milk powder to meals and snacks. This helps to increase energy without increasing portion size.
3.Adding skimmed milk powder to food and drinks can be a very easy way to get extra calories and nutrients.
4. Consider protein foods, these will add extra nutrition eggs, beans, lentils, meat and fish can all help.
5. Ready meals and pre-prepared sauces can help to make meal preparation easier. There are lots of meal delivery services available. Also, tinned and frozen fruit and veg is just as good as fresh.
6. Eating with others can really help improve appetite and make mealtimes enjoyable.

Many of us don’t drink enough, particularly as we get older.
Approximately 20% of older adults may be dehydrated at any one time, with a further 28% having impending dehydration.
READ the slide and EXPLORE different methods of encouraging older people to drink more, in a person-centred approach, looking at what works for the individual.
DISCUSS each bullet point and why an older person might not be drinking enough, with some solutions.

In summary simple tips and advice to help improve appetite and nutrition and hydration:

READ the slide - final key messages

READ the slide – the resource descriptions in RED are only to be given to older people, if there is a concern (undernourished / poor appetite / losing weight), they are NOT to be given to older people of an average / above average weight. The other resources are for all older people over 65.
All RESOURCES are available at:
https://www.ageuk.org.uk/salford/about-us/improving-nutrition-and-hydration/our-resources/

E-learning tool takes around an hour or so to complete and can help to extend your learning and knowledge of how to prevent malnutrition and dehydration. Designed initially for use in care homes, however relevant to all health and social care staff working with older adults.
Further information about the GM Nutrition & Hydration Programme and associated resources are available via the AGE UK Salford website.