• Improving nutrition and hydration in Norfolk and Waveney

    Did you know 1 in 10 older people is malnourished? Losing weight is one of the first signs of malnutrition.

We are asking everyone to start having simple conversations about eating, drinking, appetite and weight loss. This could help people especially older people and their carers to understand the options available to them and could break the cycle that could be leading to weight loss or dehydration. Losing weight is not a normal part of aging!

Include questions like:

  • What’s on the menu tonight?
  • Are you eating and drinking well?
  • What kind of things do you like to cook?
  • Have you lost weight without meaning to?
  • Have you had a poor appetite, low energy or low mood?
  • Do your clothes, shoes, jewellery or dentures look or feel loose?

The Nutrition Wheel is a useful resource to support anyone having conversations around malnutrition.

The Nutrition Wheel a wipeable tool designed for use by volunteers, carers and care workers working with older people. Its aim is to identify people at risk of malnutrition through having a conversation.

Another useful tool to assess for malnutrition is the ‘Patients Association Checklist’. The Patients Association Nutrition Checklist is a paper-based tool to identify potential risk of malnutrition and offers guidance, advice and signposting on next steps.

There are two versions available – the patient version, designed for patients to complete themselves, and the staff version, for completion by volunteers, carers and professionals with a person. See the explanatory guide for more details.

For carers or health care professionals, the Malnutrition Universal Screening Tool can be used to help identify malnutrition.

A useful video guide to using this tool has been produced in collaboration with the Malnutrition Task Force.

Ask red flag questions and signpost to their GP as required:

  • Have you noticed sudden weight loss? (10% of your body weight in 3 months)
  • Do you have difficulties swallowing food or drinks?
  • Do you get pain in your stomach when you eat?
  • Has there been a recent persistent change in moving your bowels to loose stools and/or increased frequency?

Follow up where possible, asking questions such as:

  • How’s your appetite now?
  • Have you tried any tips from the information I gave you?
  • Have you noticed any change in your weight or energy levels?

The NHS, British Dietetic Association and Malnutrition Task Force all provide more information about malnutrition.


Milkshake Brief Interventions

Once the risk of malnutrition is identified, here are some things you could do to overcome this:

Try following a FOOD FIRST approach to boost the nutritional value of foods and drinks without increasing the portion size:

  • Fortified diet: adding extra energy and protein to meals/snacks to increase nutrient density.
  • Nutrient-dense snacks:  a little and often approach for those with a small appetite.
  • Nourishing drinks: nutrient-dense drinks that can be tailored to people’s preferences.

Further resources can be found on the Knowledge Anglia Dietetics and Nutrition page and Food First page.

Included on these pages are:


Other considerations

  • Consider social, physical or financial support needs – signpost or refer to local community support 
  • Useful information on eating well for less can be found here.
  • Support for substance and alcohol misuse in Norfolk and Waveney (Norwich/Norfolk/Norfolk & Waveney/Suffolk) – including information on national helplines and food banks.
  • Consider wellbeing support such as the Wellbeing Service, where you can self-refer
  • Engage support networks like family, friends or carers to support the person to make changes to their diet and lifestyle
  • Encourage them to visit the dentist if their oral health is a concern


Training and education

  • Training and education for NHS staff working in hospitals; primary care and for staff working in care homes visit is available here.
  • For anyone working in a care home with older people, the Older People's Essential Nutrition (OPEN) toolkit has been developed as part of the Wessex AHSN Nutrition in Older People Programme and is available to support staf in the health, social care and voluntary sectors.
  • A range of resources and training, including a 40-minute training video for those supporting older people at risk of malnutrition which includes identifying malnutrition and how to improve someone’s diet.

The information on this page is not suitable for individuals with specific diets such as diabetes, following a renal diet or those with lactose intolerance or a milk protein allergy. For individuals requiring a texture modified diet, follow guidelines which have been recommended by their Speech and Language Therapist.

For more information please download the documents below.


For more information please download the documents below


Other useful websites

If you have any concerns regarding your condition, please ask your doctor, or any other health care professional, to refer you to the Dietetic service.