Professional Comment

The Importance of Recognising Malnutrition and Dehydration

By dietitian Jane Clarke BSc (Hons) SRD DSc, founder of Nourish by Jane Clarke (

Even as individuals responsible for and aware of our own health, it can be easy to skip a meal or get to the end of the day and realize we’re parched because we haven’t drunk enough fluids. Suddenly, our lack of energy or irritability (dehydration is a common cause of grumpiness) makes sense. Ensuring we have a healthy meal or snack, and a bottle of water to hand as we go about our day, is an easy fix – but it’s not that simple for residents who may not have the autonomy or capability to get their own drink or something to eat.

Being aware of the risks of under-nutrition and dehydration is an important factor in the care of residents, and can make a huge difference to their day-to-day wellbeing, helping to prevent the domino effect that can lead to serious health consequences. Older people admitted to hospital from a residential care setting have been found to be 10 times more likely to be dehydrated than those admitted to hospital from their own home. Taking steps to ensure those in our care are nourished and hydrated and staying alert to warning signs that this isn’t the case, can ensure the best outcomes for the individuals we support.

Educating relatives and asking them to encourage their loved ones to eat and drink (when possible) is also of huge importance. They know more than anyone the personality of their loved one, and are able to spot changes than can signal a potential problem.


Our appetite and desire to eat anything is influenced by so many factors, from physical issues such as pain, sickness and constipation to anxiety, fear and feeling low. The signs of being malnourished – that is, not getting enough essential nutrients, including protein, healthy fats, carbohydrates, vitamins and minerals from food – can be hard to spot, especially if someone is carrying excess weight. But just because some- one doesn’t look thin or as if they are wasting away, doesn’t mean they’re not struggling with insufficient nourishment.

The body needs a regular supply of every nutrient in order to maintain a healthy immune system, which as well as helping to protect from chronic disease, may prevent more minor illnesses, from colds to urinary tract infections, and improve wound healing and recovery from surgery – all key issues for the elderly and vulnerable, which can have a snowball effect if left untreated and lead to the need for greater intervention and treatment. A lack of nutrients can also lead to feelings of weakness and fatigue, confusion and depression – all symptoms to look out for when caring for individuals.

Take a holistic look at the person you care for and their environment as it is often not just a physical issue at play; emotional elements play a significant part in tackling a poor appetite.


Preventable dehydration is often a cause for concern in care settings, exacerbated because older people are more at risk due to the physio- logical changes of ageing, certain diseases and medication (especially diuretics), reduced renal function, diabetes, mental and physical frailty, and swallowing difficulties.

The sensation of thirst also diminishes with age, reducing the desire to drink – it’s also why asking someone if they are thirsty isn’t a reliable indicator of their hydration levels.

Lack of fluids can lead to disorientation and confusion, cause urinary tract infections and constipation (without water, the fibre in foods cannot swell and pass through the gut easily), result in muscle weakness and fatigue, and increase risk of pressure sores and skin conditions. Dizziness can be a consequence, leading to falls.

Signs of dehydration include dry mouth, lips and tongue; drowsiness and confusion; dry, slack skin; and concentrated, strong-smelling urine (it should be odourless and pale in colour).


Closely monitoring and recording what your residents eat and drink, assisting them if mental or physical impairments mean they cannot feed themselves, and enlisting the support of relatives and visitors to encour- age a few mouthfuls and sips, are all essential. And crucially, making mealtimes a pleasurable shared experience, and serving foods that tempt the appetite and stimulate the sensory receptors in the mouth that encourage the brain to anticipate and savour food, will mean defending your residents from the dangers of malnutrition and dehydration will enrich and enhance their wellbeing in so many ways.


Check for practical issues. Do they have a sore mouth, badly fitted dentures, or is the effort of chewing and swallowing preventing them from eating?

Consider mood and food. Some of us don’t like to eat on our own, and when our mood is low and angry, eating can be the last thing we feel like doing. Can you take the time to sit and take the stalks off grapes, peel a clementine, cajole without pestering someone who has a poor appetite, and note if they don’t manage to eat much?

Take your cues from the person when it comes to tempting their appetite. Are there dishes they loved in the past, favourite family recipes, easy-to-eat alternatives to tried-and-trusted meals? The scent, taste, look and feel of food can all trigger a desire to eat and provide the comfort and nourishment they need.

Create a food mood board. Often, memories are linked to foods we loved eating at a precise moment. A personal food mood board made from photos of favourite dishes, people and places can be a great way to communicate and also stimulate a jaded appetite.

Don’t expect someone to eat three full meals a day. They may do better with smaller snacks, or food they can ‘pick at’. Just be sure that they receive the nutrients they need overall.


Agree a daily fluid intake goal for each individual.

Consider what drinks they really enjoy. Diluted fruit juices or cordials, tea and herbal teas (not too hot) and thicker liquids such as smoothies and milkshakes (ideal if the person has problems with choking, exacerbated by thin fluids) are all good alternatives to plain water.

Offer fluids throughout the day and encourage regular small sips rather than expecting the person to drink an entire glass.

As well as liquids, offer hydrating foods such as fresh fruit, soups, jellies, yoghurt and custard.