Malnutrition is one of the most serious problems facing older Australians and is placing increased pressure on aged care services. With studies indicating fifty per cent of residents in aged care homes are malnourished, staff are faced with the dilemma of increasing nutrition intake for residents who often have small appetites. Although malnutrition is not a normal part of ageing, older people are more susceptible to being malnourished due to physical and mental factors associated with ageing as well as substandard meals provided to them. Serve food that looks like food they are used to. Remember this generation ate meat and three vegetables.. not chicken cacciatore that looks like vomit.
Left untreated, malnutrition results in more admissions to hospital and longer stays, undesirable weight loss, increased risk of falling, increased susceptibility to infection, pressure ulcers, slow healing of wounds and ultimately increased mortality rates.
The good news is, there is lots that can be done to treat and prevent malnutrition. Observing a resident during meal times will provide valuable insight into their eating requirements. The next step is to ensure that appropriate action is taken to address each resident’s needs. Residents may have difficulty feeding themselves due to physical or cognitive impairments, and some residents may require one-on-one feeding assistance; however it is important to consider alternative interventions that will enable the resident to maintain or improve their ability to self feed. Use of modified cutlery, plate guards, two handled mugs and other assistive devices may be implemented before resorting to feeding assistance. A coloured place mat can assist residents with dementia and vision impairment. Finger foods are preferred by some residents and many foods can be presented this way. If a resident has difficulty managing food or fluid once it has entered their mouth, this may indicate poor dentition or swallowing issues (dysphagia). Arrange a dentist and/or speech pathologist consultation if needed. In some cases modifying food and fluid textures for residents with dysphagia or poor dentition will allow them to safely chew and swallow their food without pain or fatigue. 
If a resident is able to feed themselves and their oral intake continues to be poor, gentle prompting, encouragement and redirection during meal times may increase oral intake. If intake does not improve, it must be noted that decreased appetite can be symptomatic of illness or depression. Identification and treatment of depression needs to be addressed if it is present, in addition to mealtime strategies. Any suspected illness or change in the resident’s clinical condition should be followed up with the resident’s GP. Another factor to consider is drowsiness or sleeping through a meal time which may be due to dehydration or sedative medications. Increasing hydration during times of alertness and requesting a medication review may assist in reducing drowsiness. In some cases, meal times for individual residents may need to be adjusted to periods when they are most alert, to optimise food intake.
Unpleasant or chaotic dining room environments have a negative impact on oral intake. This can be especially true for residents with dementia. Minimising distractions such as televisions left on during meal service may enhance the dining experience for residents. The physical layout of the dining room should also be considered; for example, a row of tall potted plants or a tall piece of furniture could screen the dining room area and minimise distraction. Managing malnutrition at times seems complex but often small changes can have a big impact. Food intake is as much about the food itself as it is about associated factors that affect appetite.
Residents, carers, families and health professionals need to work together to identify strategies to improve oral intake. Observe and assess dining environments, presence of illness, and required aids and assistance for each resident. All residents have specific needs and require individual assessment and strategies. Interventions initiated by anyone involved in a resident’s care can make a significant difference to their nutrition outcomes.
from a post by https://www.leadingnutrition.com.au/addressing-malnutrition-aged-care/
