For residents in a residential care home, optimal nutritional status can help them maintain physical, psychological and mental health. Carers in residential care homes should routinely screen and monitor the nutritional status of the residents. By doing so, they can identify residents who have eating problems and suboptimal nutritional status at an early stage, and a care plan or dietary management can be initiated before the condition deteriorates. Nutrition screening therefore serves the objective of prevention.

Warning signs of malnutrition

1. Unintentional weight loss

• Weigh residents on a monthly basis for monitoring of any abrupt changes. If weight loss is more than 5 percent in one month, 7.5 percent in 3 months or 10 percent in 6 months, malnutrition may be suspected.
• Calculate Body Mass Index (BMI) from body height and body weight, and then use the BMI classification for reference.

• Body mass index (BMI) =	Body Weight in kg
  	(Height in m) x (Height in m)

  
  

  Body Weight Classification	BMI (kg/m²)
  Underweight	< 18.5
  Normal	18.5-22.9
  Overweight	23.0-24.9
  Obese	>25

  
  (Source: World Health Organization Western Pacific Region 2000, reference for adults only)

2. Reduced food intake (including food and fluid)

• Ensure adequate nutrients intake. Carers should pay close attention to the dietary intake of residents to assess if it meets the recommendations of the Healthy Food Pyramid for food choices and portions.
• Observe residents’ food intake portion. If 1/4 or more of the food is left unfinished in all 3 main meals for 7 consecutive days, malnutrition may be suspected.
• If daily fluid intake of any resident is less than 6 cups, including water, tea, soup, fruit juice, milk, etc, inadequate fluid intake may be suspected.

3. Difficulty in chewing

• Decreased food intake will result if residents have poor chewing. If the situation persists, inadequate nutrient intake will further result in poor nutritional status. Therefore, carers should pay attention to the oral health of residents and routinely assess their oral conditions.
• Carers should observe if the texture modified diets provided, such as minced and puree diets, are too monotonous. It may limit food choices and result in inadequate nutrient intake.

4. Difficulty in swallowing

• Carers should observe the swallowing ability of residents and identify whether the swallowing difficulty is caused by age-related degeneration, or diseases like stroke or Parkinson’s disease. If swallowing difficulty arises, assessment from a doctor or a speech therapist should be sought for appropriate provision of texture modified diet.

5. Impaired ability of self-care (including dependent feeding)

• Partial or complete loss of the ability of self-care, including feeding, as induced by functional deterioration, weakness, diseases like stroke, or joint problems would affect appetite and food intake of the residents. An optimal management is to reserve the ability of self-feeding as much as possible. Always allow sufficient time for eating.
• Consult an occupational therapist for an assessment and advice on the use of appropriate feeding aids to enhance the self-feeding ability of residents when necessary.

After an initial assessment, carers should keep records for necessary follow-up actions or for reference in the next round of assessment. If malnutrition is identified, carers should try to find out the causes and initiate a management plan. Refer to "Common Eating Problems of Elders" in this web for more information (Remind the web agent to create a hyperlink for this) Remember to consult medical professionals for a thorough assessment and appropriate management plan if the problems persist.

Consult medical professionals or a dietitian for advice before any nutrition supplement is considered for a resident. Professional suggestions on the use of nutrition supplements can prevent imbalanced nutrient provision.

For any concerns, seek help from medical professionals for further assessment.