Read Standard 5: Nutrition and hydration

Rationale

Eating and drinking have important social and cultural components. People should have the time and support to eat and drink. Their preferences and needs should be considered in all decisions about their nutrition and hydration. Good oral care ensures that older people with frailty can eat and drink in comfort.⁵⁸

Hydration and nutrition can be impacted by social isolation, financial hardship and poor mobility. It is impacted by co-ordination or swallowing difficulties. People with a cognitive impairment or dementia may need support and prompts to eat and drink.⁵⁹ A person’s dignity and rights should be upheld when they need help to eat and drink.⁶⁰ Diet, hydration and difficulty swallowing may also impact effectiveness of medicines.

The World Health Organization identified nutrition as essential for healthy ageing.⁶¹ Poor quality of diet may lead to loss of muscle mass and immune or cognitive function. It may lead to unintentional weight loss and sarcopenia.⁶²^,63 Excess calories may also be associated with poor quality of diet.

Malnutrition is common in older people with frailty.⁶⁴^-66 Up to one third of people over 65 requiring hospital admission and 40 % of care home residents are at risk of malnutrition.⁶⁷ Identifying malnutrition can have a positive effect on quality of life, recovery, rehabilitation, length of hospital stay and readmission rates.^64,^66,68

When someone is dying, they are likely to eat and drink less. They should be supported to focus on enjoyment of food and the social interaction associated with eating and drinking.

Criteria

5.1

Older people with frailty who experience unexplained weight loss, loss of appetite or symptoms of malnutrition are screened and referred, where required:

for further diagnostics and investigations
to specialist dietetic services
to other relevant services.

5.2

People’s care plans detail their nutrition and hydration needs including:

eating and drinking likes and dislikes
food allergies or intolerances
cultural, ethnic or religious dietary requirements
social and environmental mealtime requirements
relevant physical measurements, such as weight, mid-upper arm circumference or grip strength
swallowing difficulties
the need for help or equipment to support eating and drinking
the need for additional time when eating and drinking.

5.3

People at risk of malnutrition are:

offered advice on nutrient-dense foods and drinks
referred for dietary advice and specialist support in line with local NHS referral criteria.

5.4

People with swallowing difficulties are offered or referred to as required:

modified texture of food and drink⁶⁹
alternative formulation, routes or dosing of medicines
speech and language therapy
support to overcome any physical or postural difficulties.

5.5

People are supported to eat with others, including their family or communities, if they wish.

5.6

Organisations ensure people can maintain good oral health by supporting people:

with tooth brushing
to keep their mouth clean and moist
to access well-fitting dentures
to access regular dental check-ups
through referral to specialist dentistry if required.

5.7

Organisations have an ‘eating and drinking with acknowledged risks’ policy which is fully implemented and regularly reviewed.

5.8

Organisations signpost to partner and third sector agencies that offer specialist support and advice on food, nutrition and hydration.

What does this standard mean for...

What does the standard mean for people?

Your choices and requirements about eating and drinking will be respected.
You will be supported with enough time to eat and drink.
You will have access to equipment that you may need to help you eat and drink.
You will be referred for dietary advice if you need it.
You will receive appropriate assessment and support if you have difficulties with eating, drinking or swallowing.
You will be supported to understand how what you eat and drink impacts on your physical health and wellbeing.
You will be supported to maintain good oral health.

What does the standard mean for staff?

Staff, in line with roles, responsibilities and workplace setting:

are trained to recognise and respond appropriately to signs and symptoms of malnutrition
are trained to recognise and respond appropriately to signs of dehydration
respect and support people’s decisions related to their eating and drinking
support people to make informed decisions about clinically-assisted nutrition and hydration.
support people to maintain good oral health through tooth brushing and preventing dry mouth.

What does the standard mean for the organisation?

Organisations:

have processes to identify and address people’s nutrition and hydration needs
have systems that support appropriate food choices, aiming to avoid malnutrition and dehydration
provide equipment and access to specialist input to support people to eat and drink
enable people to eat and drink with others if they wish
ensure that people have access to well-fitting dentures
have referral pathways to dentistry including specialist dentistry.

Examples of what meeting this standard might look like

Protocols for nutrition and hydration screening and assessments.
Evidence of pathways for equitable access to specialist nutrition and hydration support.
Alternative menus to allow choices about food and drink.
Protected mealtimes with adequate time and support from unpaid carers and care partners.
Registries or databases of community activity groups and organisations which are kept up to date.
Provisions for the right adaptive equipment (such as plates, cups and cutlery) to enable people to be as independent as possible.
Toothbrushing and oral health care programmes in all settings.
Referral pathways to dentistry.