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\ 1 INTRODUCTION 1.1 What is malnutrition? Malnutrition is a condition which happens when you do not get the correct amount of nutrients in your diet1. NICE describe malnutrition as ‘both a cause and consequence of ill health’2, with people being defined as malnourished by any of the following3: • A body mass index (BMI) of less than 18.5 kg/m². • Unintentional weight loss greater than 10% within the past three to six months. • A BMI of less than 20 kg/m² and unintentional weight loss greater than 5% within the past three to six months. Malnutrition refers to deficiencies or excesses in nutrient intake, imbalance of essential nutrients or impaired nutrient utilization4. The double burden of malnutrition consists of both undernutrition and overweight and obesity, as well as diet-related noncommunicable diseases4. Undernutrition manifests in four broad forms: wasting, stunting, underweight, and micronutrient deficiencies 4. 1.2 What is dehydration? Dehydration is when your body loses more fluids than you take in 5. It is “a state in which a relative deficiency of fluid causes adverse effects on function and clinical outcome. In the elderly being short of fluid is far more common, results from limited fluid intake, and is reflected in raised osmolality” 6. 1.3 Purpose 1.3.1 Why is the topic important? Malnutrition is important due to the prevalence of it in older adults. Malnutrition and Dehydration is both a cause and a consequence of ill health and is a silent and, all too often, hidden problem6. It will affect health and wellbeing, increasing hospital admissions, and can lead to long-term health problems for otherwise healthy and independent older people 6. It is estimated that around one in ten people over the age of 65 are malnourished or at risk of malnutrition 7. According to BAPEN’s 2022 Malnutrition and Nutritional Care Survey, nearly 45% of adults screened across UK health and care settings were identified as being at risk of disease-related malnutrition8. This represents the highest proportion recorded since the survey began in 2019, with previous figures reported as 42% in 2019, 40% in 2020, and 39% in 20218. The prevalence of malnutrition is highest in individuals with cancer, gastrointestinal conditions, respiratory conditions, frailty and neurological disease8. Where an individual lives also plays a significant factor, with those people living in their own homes most at risk of malnutrition, followed by residents in care homes, and patients in hospital 8. It is important to note that dehydration is an equally significant issue. Nationally and locally, there is little data on the reach and extent of dehydration. It appears to be widespread among older people and is one of the most common reasons why an older person is admitted to hospital7. 1.3.2 Costs to the system The cost of malnutrition to the health and care system in England in 2011-2012 was approximately £19.6 billion, an increase from the £13 billion reported in 20078. The cost of treating someone who is malnourished is two to three times more expensive than someone who is not malnourished, with estimated health and social care costs for those that are malnourished or at risk being £7,408 compared to £2,417 for those not at risk8. As adults age, the sensation of thirst diminishes, which means older people are less likely to realise when they’re thirsty9. Dehydration is linked to increases in hospital admissions on a number of factors relating to older people including fall risk and urinary tract infections (UTI’s)9. There is significant research into the link between malnutrition and frailty and falls, with those that are malnourished being at a 64% increased risk of falling10. Falls in the elderly are incredibly costly, with hip fractures alone accounting for 1.8 million hospital bed days and £1.1 billion in hospital costs every year, excluding the high cost of social care11. Evidence has shown that individuals who are inadequately hydrated have a higher risk of developing pressure ulcers, as dehydration decreases cushioning over bony areas12. In addition, insufficient fluid intake limits the delivery of vital nutrients needed for tissue repair12. Each year it is estimated that 110,000 ulcers develop, with an estimated cost to the NHS between 1.4 abd 2.1 billion annually 13. Patients with a pressure ulcer, has an expected hospital stay on 25 days13. From 2018–19 to 2022–23, over 1.8 million hospital admissions involved UTIs, most among people aged 65+14. In 2022/23, more than half of primary UTI admissions (56%) were in this age group, with the highest rates in those aged 80–8414.Treating UTI’s is estimated to have cost NHS hospitals in England an estimated £604 million in 2023-202415. Due to a growing ageing population, these figures are anticipated to continue increasing. 2 MALNUTRITION AND DEHYDRATION 2.1 Signs and symptoms Malnutrition is also referred to an undernutrition, as it is recognised that people can experience malnutrition if overweight, as well as underweight. Recognition of malnutrition can be difficult; however, some signs and symptoms may include 1: • Loss of appetite • Weight loss (observe clothes, rings, jewellery and dentures that may become loose) • Loss of energy, tiredness • Poor concentration • Reduced ability to perform usual tasks • Altered mood Additional signs of dehydration could include5: • Feeling thirsty • Dark yellow, strong-smelling pee • Peeing less often than usual • Feeling dizzy or lightheaded • Tiredness, headache or confusion • A dry mouth, tongue and lips. 2.2 Who is at risk of malnutrition and dehydration It is well evidenced that people over the age of 65 years are at an increased risk of malnutrition, with it estimated that around 1 in 10 people over 65 are malnourished, or at risk of becoming so 16. People who are at risk of malnutrition and dehydration tend to be separated out into three categories 17,18: 2.2.1 Medical risks • Those who have a chronic disease or condition for example cancer or chronic liver disease • Those experiencing ill health for example Crohn’s Disease or long-term conditions such as dementia and chronic obstructive pulmonary disease (COPD). • Medical related mechanical problems such as Dysphagia (difficulty swallowing for e.g following a Stroke) • Those affected by drugs and alcohol 2.2.2 Physical risks • Painful or sore mouth or teeth (dentition), or ill-fitting dentures. • Arthritis – Can limit a person’s ability to shop, prepare, or cook food • Sense of smell or taste- reduces a person’s appetite • Sight loss or Limited mobility- reducing a person’s ability to prepare and cook foods • Reliance on others to help eat or drink 2.2.3 Social risks • Low income or poverty • Limited skills or knowledge in cooking • Feeling isolated or lonely, leading to fewer chances or routines for eating and drinking • Bereavement (loss of someone who may have cooked for them), reduced motivation to cook, and how grief can affect appetite • Cultural or religious needs not always being met in care settings • Personal understanding and attitudes towards weight loss and nutrition • Lack of transport that enables access to shops and other food sources Many of the risk factors for malnutrition also apply to dehydration. Anyone can become dehydrated, however there are some groups that are particularly at risk. These include 18: • Older people • People with long term health conditions • Babies and infants • Athletes In older adults, malnutrition increases vulnerability to illness, which further deteriorates their nutritional status and delays recovery, as reflected below17. Figure 1: The malnutrition Carousel17 Source: BAPEN Despite its prevalence malnutrition is a largely preventable and treatable condition 19. 2.3 Preventing malnutrition Malnutrition can be looked at across the three levels of prevention 2.3.1 Primary21,22 • Enjoying a varied and balanced diet of fruit and vegetables, starchy foods such as bread, rice, potatoes and pasta, milk, diary and non-diary alternatives and sources of protein such as meat, fish, eggs and beans. • Build muscle- exercises that help build or maintain your muscle mass are important for increasing your appetite. Muscle mass is also important in supporting a person’s stability, reducing frailty and the risk of falling. • Accessing meals at home services- if preparing meals is difficult, accessing a meal delivery service could support regular access to food. 2.3.2 Secondary Prevent deterioration within malnutrition or within a primary health condition • Targeted malnutrition advice and support to known/recognised groups, such as people with a long- term health condition and the older population. • Use of the MUST tool for evaluation and monitoring of a person malnutrition status and risk. • Prescription of fortified drinks/foods, to supplement a person’s diet • Training to care givers and staff, to help early identification of malnutrition. 2.3.3 Tertiary • Malnutrition is recognised, with focus on reducing impact and restore health. • Tailored dietary plans and supplements Treatment of underlying health conditions/co-morbidity. • Rehabilitation support via dietician, physiotherapist and social care. 2.3.4 Preventing dehydration Figure 2: I-Drink infographic23 Preventing dehydration can be achieved with some simple changes. The University of West London have devised a helpful infographic using the acronym of DRINK23 D- Dehydration Matters- it is essential for good health as it can cause, ITI’s, constipation, falls and hospital admittance R- Remove barriers to drinking- easily available drinks that are in reach, easy to use cups, and encouraging those that worry about incontinence to continue drinking. I-Identify signs of dehydration- Dry mouth or tongue, headaches, confusion, drowsiness or unsteadiness. N-Not just water- Water, squash, fizzy drinks, juice, tea, coffee all count. Even fluid rich foods like soup, jelly, ice cream and yogurt. K-Keep the drinks coming- provides lots of opportunities to drink, 1.5 litres or 8 larges cups or mugs every day is the minimum amount. If you are a woman aim to drink at least 1,600ml (3 pints) fluid every day and if you are a man aim to drink at least 2,000ml (3½ pints) fluid every day24. Source: University of West London -The I-Hydrate Project Figure 3: BDA infograpic on preventing dehydration24. Source: British Dietetics Association - Hydration in older adults 2.4 Derbyshire picture and how we compare 2.4.1 Population and Geographic patterns We know that the UK has an ageing population and that England’s 85+ population is projected to double to more than 2.6 million in the next 25 years26. This is something to celebrate but it also must be factored into planning because the health and social care system rely on there being enough people of working age to both fund and provide care for the older population. Another side-effect of increasing life expectancy is the number of people living longer with chronic illnesses, which is predicted to increase by 37% by 2040 26. The health needs of the population are also projected to become more complex as the number of people living with more than one condition increases26. Figure 4: Population by age group in Derbyshire by locality27. Area 0-15 years 16- 64 years 65+ years Total Derby 54,956 174,676 44,517 274,149 Derbyshire 137,322 499,035 186,020 822,377 Amber Valley 21,569 78,858 30,024 130,451 Bolsover 14,300 52,218 17,255 83773 Chesterfield 17,604 64,755 23,686 106,045 Derbyshire Dales 10,111 40,615 21,031 71,757 Erewash 19,174 70,825 24,264 114,253 High Peak 14,973 55,690 21,296 92,959 North East Derbyshire 17,684 62,527 26,435 106,646 South Derbyshire 21,907 73,547 22,039 117,493 Source: Population – Derbyshire Joint Strategic Needs Assessment Derbyshire’s over-65 population is currently 182,459 and projected to grow by 31% by 2043, with the 90+ age group expected to double28. This demographic shift increases the need to focus on healthy life expectancy, where nutrition and hydration play a critical role especially as we age. Figure 5: Population predictions for Derbyshire28 Source: Derbyshire County Council - Joint Derbyshire and Derby Dementia Strategy There has been limited local data available on nutrition and hydration, however Joined Up Care Derbyshire has provided some information based on hospital admission data across the Derbyshire Integrated Care Board area. This graph shows the age group 80-89 years had the highest count of hydration related admissions when compared to other age groups. This also mirrors patients admitted with dehydration as a primary diagnosis. Figure 6: Number of hydration-related admissions by age category. Data source: Derby and Derbyshire ICB29 Source: Private Correspondence In relation to malnutrition: 2) This graph shows there was a higher nutrition related indicated count for the 70–79-year age group when compared to the 80–89-year age group across all financial years24. Figure 7: Number of nutrition related indicated count by age group29 Nutrition-Related Indicated (With Nutritional Deficiency in All Diagnosis) 40 35 30 25 Count 20 15 10 5 0 30-39 40-49 50-59 60-69 70-79 80-89 Age 20/21 21/22 22/23 23/24 24/25 Source: Private Correspondence Although higher hospital admission rates among people aged 80–90 are expected due to other underlying health conditions, both graphs show that admissions begin rising from ages 40–49 and continue to increase markedly up to age 80. Overall, the data provided shows higher admission rates for females than males for both dehydration and malnutrition. We can also consider data relating to the well-established risk factor of isolation and loneliness. Derbyshire is a large county, with extensive rural areas and a higher proportion of older residents 30. Evidence shows that adults aged 50 and over are 3.7 times more likely to experience loneliness if they are in poor health, highlighting the combined impact of rurality, ageing and health status on vulnerability 30. Figure 8: Map showing frequency of GP prescriptions for loneliness30. Source: Loneliness – Derbyshire Joint Strategic Needs Assessment Over 65’s that live alone have a significantly lower body mass index compared to those that live with family31. 2.4.2 What are we doing and the assets and services in place? Nationally, the UK government guidance on nutrition and hydration can be found in “Healthy eating: applying All Our Health - GOV.UK”32 and is published as a guide aimed at the general population. It supports frontline staff promote the benefits of a healthy, balanced diet including fluid intake. Alternatively, information can also be found on the NHS – eat well guide21. The Association of UK Dieticians has a healthy eating resource has been developed to highlight new evidence and a more age-appropriate message around food and nutrition for older adults33. The resource, which is supported by the Friends of the Elderly and British Geriatrics Society has been created by the British Dietetic Association’s (BDA) Older People Specialist Group for the BDA33. The group recognised that a resource like this was much needed and enlisted the support of the University of Plymouth to review the latest dietetic evidence to support its creation33. 2.5 Recognised tools for assessing malnutrition and dehydration are: MUST – (Malnutrition Universal Screen Tool) is a five-step screening tool to identify adults, who are malnourished, at risk of malnutrition (undernutrition), or obese34. It also includes management guidelines which can be used to develop a care plan34. It is for use in hospitals, community and other care settings and can be used by all care workers. GULP – (Guage, Urine, Look, Plan) is a screening tool to assess older adults’ dehydration risk35. Locally, Derby and Derbyshire Integrated Care Board (ICB) has also developed the ‘Big Nutrition and Small Appetites’36,that is directed towards patients who are not eating very much, and losing weight, providing information, advice and guidance on the recommended ways to fortify their diet. Adult Care Nutrition & Hydration Policy37 and Care Home pack38, but these are primarily aimed at DCC staff. 2.6 Additional assets across the health system to support are: 2.6.1 Hospital (acute) Malnutrition and dehydration are often under recognised at the point of hospital admission despite NICE guidance for early screening39. Tools such as MUST and GULP, support individual assessment of a person hydration and nutrition status39. Dehydration is common and associated with admissions with falls, delirium, urinary tract infections and acute kidney injury9. NHS initiatives increasingly promote early screening, food-based interventions and monitoring of intake. Dietetic referrals and support offered. 2.6.2 Care home Malnutrition affects around one third (36%) of older care home residents 40. Hydration continues to be a major concern, with barriers such as cognitive impairment, poor mobility, and lack of staff time or structured hydration support41. Care homes are required to screen residents on admission and maintain robust monitoring and care plan mechanisms (NICE CG323; CQC Reg 1442). In Derbyshire there has been a resource pack designed to promote excellence in nutrition and hydration in the care home setting38. The I-Hydrate project has also developed resources to support care residents with their hydration needs 23, as have the Association of UK Dietitians43. 2.6.3 Community More than 3 million people are estimated to be malnourished, and over 90% of them live in the community25. Early identification is key, and utilising key tools such as MUST and GULP are strongly advocated, as well as utilising community and volunteer led services such as G.P practice screenings, community dietetic services and Age UK. Across all settings ‘food first’ strategies are being widely encouraged to tackle unintentional weight loss and frailty, advocating that food (over supplements) be used in the first instance to nourish an individual 37. This approach is referenced in Derbyshire’s Nutrition and Hydration policy37. 2.7 Local views and service users A scoping exercise completed by Derbyshire Public Health team in 2025 included discussions and feedback from services, agencies and voluntary sectors including • Adult social care (short term and long-term teams) • Housing scheme manager • Rural Action Derbyshire • Chesterfield and North Derbyshire Royal Hospital (CNDRH) Dietetics • Home from Hospital service The themes and information from these discussions found that • Overall people wanted trusted available resources and communication, whether this was for employed staff, family/friends care givers or the individuals at risk themselves. • Training- Services and partners are open to further or continued training, to ensure they are aware and communicating the right advice to those using their services. • BME communities appear more likely to access fresh food at food banks/community pantries. (cultural differences in food preparation and cooking knowledge and skills). 3 CONCLUSION Opportunities for improvement and future development Getting it right: building on good practice and existing guidelines The deep dive into Nutrition and hydration has identified that there are some resources already in place or planned to support and address malnutrition and dehydration in Derbyshire. These include: • Relevant policies in place that are actively reviewed to ensure they are relevant and change with need. • Staff training- adult social care has access to online training that is available for front line staff and managers. This is also looking to be reviewed to ensure it bests meets the needs of the staff. • Tools and resources, such as MUST and GULP, to support assessment of an individual’s needs in their own home and upon admittance to hospital. 3.1 Recommendations Opportunities/Recommendations Key opportunities include: • Older people need to have improved awareness of the risks of malnutrition and dehydration and how it can be prevented. Raising awareness amongst health and social care professionals, utilising MECC to support information sharing and timely advice. • Continue to work closely with our system partners including the voluntary sector, who are in regular contact with those that require additional advice and support on nutrition, including food banks and food pantries. • Integrate Nutrition and Hydration within wider risk factors of health work, including falls and frailty. • Include nutrition and hydration within the Derbyshire food plan and other associated work, distinguishing between generalised healthy eating, with focus to the risks of an ageing population. • Greater collaboration with adult care across public health, joining up for targeted events and promotional work. • Work on the digital divide. Advancing technologies are being developed that can support older people living alone in their homes. These can include devices that prompt people to eat and drink and engage them in conversations throughout the day to reduce loneliness. • Align this document with the Derbyshire State of Ageing report a to ensure Nutrition and Hydration remains a focus. 3.2 Useful links https://www.bapen.org.uk/ https://www.bda.uk.com/ https://www.bda.uk.com/practice-and-education/resources-for-practice/care-home-digest.html 3.3 Tags • Falls • Falls deep dive • Healthy people • Older people • Frailty • Long term conditions • Dementia • Loneliness • Alcohol misuse • Food and Nutrition • Oral health • Excess seasonal mortality 4 REFERENCES 1. British Dietetic Association (BDA). Spotting and treating malnutrition. BDA: Birmingham. 2026 September [Accessed 11 September 2026]. Available from: https://www.bda.uk.com/resource/malnutrition.html 2. National Institute for Health and Care Excellence (NICE). Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition: Introduction. NICE: Manchester. 2025 July [Accessed 31 July 2025]. Available from: https://www.nice.org.uk/guidance/cg32/chapter/Introduction 3. National Institute for Health and Care Excellence (NICE). Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition: Key priorities for implementation. NICE: Manchester. 2025 July [Accessed 31 July 2025]. Available from: https://www.nice.org.uk/guidance/cg32/chapter/Key-priorities-for-implementation 4. World Health Organization (WHO). Malnutrition. WHO: Geneva. 2026 September [Accessed 11 September 2026]. Available from: https://www.who.int/health-topics/malnutrition#tab=tab_1 5. National Health Service (NHS). Dehydration. NHS: London. 2026 September [Accessed 11 September 2026]. Available from: https://www.nhs.uk/conditions/dehydration/ 6. NHS England. Guidance – Commissioning Excellent Nutrition and Hydration 2015-2018. Leeds: NHS England. 2015. Available from: https://www.england.nhs.uk/wp-content/uploads/2015/10/nut-hyd- guid.pdf 7. Age UK. Common conditions and frailty. London: Age UK. [Accessed 14 September 2026]. Available from: https://www.ageuk.org.uk/our-impact/policy-research/frailty-in-older-people/common- conditions-frailty/ 8. BAPEN. What is the scale of malnutrition in the UK? Letchworth Garden City: BAPEN. [Accessed 11 September 2026]. Available from: https://www.bapen.org.uk/malnutrition/introduction-to- malnutrition/what-is-the-scale-of-malnutrition-in-the-uk/ 9. National Institute for Health Research: Applied Research Collaboration: East of England. The risk of dehydration to older people: Raising public awareness in Norfolk. Cambridge: NIHR:ARC: East of England. [Accessed 14 September 2026]. Available from: https://arc-eoe.nihr.ac.uk/research- implementation/research-themes/inclusive-involvement-research/risk-dehydration-older 10. NHS Guy’s and St Thomas’. Eating and drinking well (nutrition). London: Guy’s and St Thomas’. [Accessed 11 September 2026]. Available from: https://www.guysandstthomas.nhs.uk/health- information/falls/eating-and-drinking-well- nutrition#:~:text=Malnutrition%20is%20a%20serious%20condition,increase%20your%20chance%20 of%20falling. 11. Office for Health Improvement and Disparities. Guidance: Falls: Applying All Our Health. 2022. [Accessed 14 September 2026]. Available at: https://www.gov.uk/government/publications/falls- applying-all-our-health/falls-applying-all-our-health 12. Thorpe J. The importance of water: in modern wound care. Wounds-UK. 2010; 5: 115-118. [Accessed 11 September 2026]. Available from: https://wounds-uk.com/wp- content/uploads/2023/02/content_9502.pdf 13. British Journal of Nursing. The impact of nutrition on pressure ulcer healing. London: BJN. [Accessed 11 September 2026]. Available from: https://www.britishjournalofnursing.com/content/nutrition/the-impact-of-nutrition-on-pressure- ulcer-healing 14. NHS England. New awareness campaign to help reduce hospital admissions for urinary tract infections. Leeds: NHS England. [Accessed 11 September 2026]. Available from: https://www.england.nhs.uk/2023/10/new-awareness-campaign-to-help-reduce-hospital- admissions-for-urinary-tract-infections/ 15. UK Health Security Agency. UTIs cost NHS hospitals over £600m last year. London: UK Health Security Agency. [Accessed 11 September 2026]. Available from: https://www.gov.uk/government/news/utis-cost-nhs-hospitals-over-600m-last-year 16. Age UK. Malnutrition signs, causes & prevention. London: Age UK. [Accessed 11 September 2026]. Available from: https://www.ageuk.org.uk/information-advice/health-wellbeing/conditions- illnesses/malnutrition/ 17. BAPEN. Who is at risk of malnutrition? Letchworth Garden City: BAPEN. [Accessed 11 September 2026]. Available from: https://www.bapen.org.uk/malnutrition/introduction-to-malnutrition/who- is-at-risk-of-malnutrition/ 18. Malnutrition Task Force. State of the Nation 2025: Older people and malnutrition in the UK today. London: Malnutrition Task Force. [Accessed 11 September 2026]. Available from: https://www.malnutritiontaskforce.org.uk/sites/default/files/2025- 08/State%20of%20the%20Nation%202025%20revised.pdf 19. NHS Inform. Dehydration. Scotland: NHS Inform. [Accessed 14 September 2026]. Available from: https://www.nhsinform.scot/illnesses-and-conditions/nutritional/dehydration/ 20. British Geriatrics Society. Malnutrition: a significant threat to our health as we age. London: British Geriatrics Society. [Accessed 14 September 2026]. Available from: https://www.bgs.org.uk/blog/malnutrition-a-significant-threat-to-our-health-as-we-age 21. National Health Service (NHS). The Eatwell Guide. London: NHS. [Accessed 11 September 2026]. Available from: https://www.nhs.uk/live-well/eat-well/food-guidelines-and-food-labels/the-eatwell- guide/ 22. National Health Service (NHS). Healthy ways to gain weight. [Accessed 11 September 2026]. Available from: https://www.nhs.uk/live-well/healthy-weight/managing-your-weight/healthy-ways- to-gain-weight/ 23. University of West London. I-Hydrate infographic. [Accessed 11 September 2026]. Available from: https://www.uwl.ac.uk/research/research-centres-and-groups/richard-wells-centre/i- hydrate#infographic 24. British Dietetic Association. Hydration in older adults. Birmingham: BDA. [Accessed 11 September 2026]. Available from: https://www.bda.uk.com/resource/hydration-in-older-adults.html 25. British Dietetics Association. The management of malnourished adults in all community and all health and care settings. Birmingham: BDA. [Accessed 11 September 2026]. Available from: https://www.bda.uk.com/resource-report/the-management-of-malnourished-adults-in-all- community-and-all-health-and-care-settings.html 26. The Health Foundation. Our ageing population: how ageing affects health and care need in England. 2021. [Accessed 14 September 2026]. Available from: https://www.health.org.uk/reports-and- analysis/reports/our-ageing-population 27. Derbyshire County Council. Derbyshire Joint Strategic Needs Assessment – Demographics: Population. JSNA Derbyshire: Derbyshire; 2025 [Accessed on 11 September 2026]. Available from: https://jsnaderbyshire.org.uk/Demographics/Population.html 28. Derbyshire County Council. Joint Derbyshire and Derby Dementia Strategy. 2025. [Accessed 14 September 2026]. Available at: https://democracy.derbyshire.gov.uk/documents/s29685/Joint%20Derbyshire%20and%20Derby%2 0Dementia%20Strategy%20Report.pdf 29. Derby and Derbyshire ICB. Private correspondence with authors of report. 2026. 30. Derbyshire County Council. Derbyshire Joint Strategic Needs Assessment – Loneliness. JSNA Derbyshire: Derbyshire; 2026 [Accessed on 11 September 2026]. Available from: https://jsnaderbyshire.org.uk/Healthy_People/Personal_wellbeing/Loneliness.html 31. British Dietetic Association. Loneliness and malnutrition. [Accessed 11 September 2026]. Available from: https://www.bda.uk.com/resource/loneliness-and-malnutrition.html 32. Office for Health Improvement and Disparities. Guidance: Healthy eating: Applying All Our Health. 2023. [Accessed 11 September 2026]. Available at: https://www.gov.uk/government/publications/healthy-eating-applying-all-our-health/healthy- eating-applying-all-our-health 33. British Dietetic Association. Eating, drinking and ageing well. Birmingham: BDA. [Accessed 11 September 2026]. Available from: https://www.bda.uk.com/resource/eating-drinking-ageing- well.html 34. BAPEN. “Malnutrition Universal Screening Tool”. [Accessed 14 September 2026]. Available at: https://www.bapen.org.uk/pdfs/must/must_full.pdf 35. NHS Essex Partnership University NHS Foundation Trust. GULP Dehydration Risk Screening Tool. [Accessed 14 September 2026]. Available at: https://www.essexproviderhub.org/media/uoqly5go/food-first-gulp-dehydration-risk-screening- tool.pdf 36. Derbyshire Medicines Management. Big Nutrition for Small Appetites. [Accessed 14 September 2026]. Available from: https://www.derbyshiremedicinesmanagement.nhs.uk/assets/Clinical_Guidelines/Formulary_by_B NF_chapter_prescribing_guidelines/BNF_chapter_9/Big_nutrition_for_small_appetites.pdf 37. Derbyshire County Council. Adult Social Care & Health: Nutrition and Hydration Policy. Version 3. Derbyshire: Derbyshire County Council. 2023. [Accessed 11 September 2026]. Available at: https://staff.derbyshire.gov.uk/site-elements/documents/working-here/adult-care/nutrition-and- hydration-policy.pdf 38. Derbyshire Medicines Management. Nutrition_and_Hydration_CARE_HOME_PACK. [Accessed 14 September 2026]. Available from: https://www.derbyshiremedicinesmanagement.nhs.uk/assets/Clinical_Guidelines/Formulary_by_B NF_chapter_prescribing_guidelines/BNF_chapter_9/Nutrition_and_Hydration_CARE_HOME_PACK.p df 39. BAPEN. The “MUST” report: Nutritional screening of adults: a multidisciplinary responsibility. 2003. [Accessed 14 September 2026]. Available at: https://www.bapen.org.uk/pdfs/must/must-report.pdf 40. Norris E, Shelton F, Hetherington M. Nutrition screening of older adults living in care homes. e- SPEN,the European e-Journal of Clinical Nutrition and Metabolism. 2011. doi: https://doi.org/10.1016/j.eclnm.2011.04.002 41. Royal College of Nursing. Dehydration in older people. London: RCN. [Accessed 14 September 2026]. Available at: https://www.rcn.org.uk/news-and-events/Blogs/dehydration-in-older-people 42. Care Quality Commission. Regulations for service providers and managers. 2025. [Accessed 14 September 2026]. Available at: https://www.cqc.org.uk/guidance-regulation/providers/regulations- service-providers-and-managers/health-social-care-act/regulation-14 43. British Dietetics Association. Care Home Digest. Birmingham: BDA. [Accessed 11 September 2026]. Available from: https://www.bda.uk.com/practice-and-education/resources-for-practice/care- home-digest.html

Contributors

Caroline Waller, Advanced Public Health Practitioner

Stacey Speed, Advanced Public Health Practitioner

Public Health Knowledge and Intelligence Team