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Malnutrition in Care

Homes:

Helping Residents

with or recovering

from COVID 19 If a resident has had an illness that affects their breathing

such as COVID 19, their body will need more protein and

calories than usual. If they have lost weight or muscle,

they will need good quality nutrition to recover more

quickly and to ensure they stay healthy.

If you are struggling to find nourishing snacks and meals

due to your resident having special dietary requirements,

please contact the dietitian.

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Contents

Must Flowchart 3

MUST Management Plan 4

Treating and Preventing Malnutrition with 3-2-1 5

Lose of Taste 6

Nourishing Drinks 7

Nourishing Drinks Recipes 9

Nourishing Snacks 10

Nourishing Meals 11

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Identifying Malnutrition with

Malnutrition Universal Screening Tool

Communicate each resident’s MUST score to all relevant people such as

catering, all care staff and family.

Remember: MUST scores should be updated monthly.

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SCORE 0 Low Risk SCORE 1 Med Risk SCORE 2+ High Risk

Aim to maintain a healthy weight and follow a balanced diet.

Offer two nourishing drinks each day.

Offer two nourishing drinks each day.

If overweight (BMI >30kg/m2), encourage healthier low fat and low sugar alternatives.

Offer two nourishing snacks each day.

Offer two nourishing snacks each day.

Complete MUST monthly to monitor and update plan.

Keep food record charts.

Fortify meals, snacks and drinks.

Complete MUST monthly to monitor and update plan.

Keep food record charts.

Complete MUST monthly to monitor and update plan.

Refer to the Dietitian if the resident continues to lose weight after one month of following the above plan.

MUST - Management Plan

Once you have identified the MUST score of a resident to highlight their risk of

malnutrition, follow the management plan below.

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3 Regular nourishing meals each day. Fortified with

ingredients to increase the protein and calorie content.

2 Nourishing snacks each day, mid-morning and

afternoon. Aim for 300kcals and 4g protein per snack.

1 1 pint of whole or fortified milk per day. Use for cereal,

sauces, desserts and milky drinks.

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Helping residents with or recovering

from COVID-19

Loss of taste or not being able to taste anything

Residents may experience breathlessness if they are unwell with coronavirus

meaning eating and drinking becomes more difficult.

Choosing foods that are full of flavour and aromas may help to enhance the flavour

of food.

Try sharp tasting foods and drinks, such as citrus fruits, juices, sorbet, jelly,

lemon mousse, fruit yoghurt, boiled sweets, mints, lemonade, Marmite, Bovril,

or aniseed.

If you have time, marinate foods in herbs, spices or sauce before cooking.

Provide the resident with any of the following so they can add flavour to their

own taste: salt, pepper, vinegar, salad dressing, mayonnaise, pickles, chutney,

ketchup, or mustard.

Ensure that the resident cleans their mouth and teeth at least twice a day. Swilling

out the mouth with water before food and drink also helps.

Breathlessness

Residents may lose their ability to taste if they are unwell with or recovering from

coronavirus.

Taste is the ability to detect flavour of food and drinks. Our senses of how a food

tastes is also linked to smell.

Adopting a “little and often” approach is much better if breathlessness is an

issue.

Choose soft, easy to chew meals so the resident doesn’t over-exert

themselves.

Avoid eating and drinking at the same time.

Ensure the resident is relaxed for the meal and not rushed.

Nourishing drinks will really help residents who are breathless maintain their

calorie intake.

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Helping residents recovering from

COVID-19

If a resident has had an illness that affects their breathing such as

COVID-19, they may find eating difficult, and drinks much easier to take.

When to offer Nutritious Drinks

If a resident is eating very little food, try to offer nutritious drinks at least 6 times a

day. If the resident is eating, don’t offer nourishing drinks within 1 hour of food as

this may mean they are too full to eat their meal.

Make sure that you are still offering other fluids, such as water, squash and tea,

so that residents are still meeting their daily requirements of at least eight cups

(in total) of fluid each day.

Milk and Milky Drinks

Milk is a particularly nutritious drink. It is not only a source of energy

(calories) and protein, but also provides calcium, which is important for bone

health. When someone has a poor appetite, you should try using full fat

(whole) milk. If they find full fat milk too rich, you can use semi-skimmed

milk. If nourishing drinks contain 200ml milk, they will provide 7g protein.

You can make milk more nutritious by ‘fortifying’ it (see page 9 for recipes).

Other high Energy Drinks

Fruit Juice (pure, not diluted cordial type). Try adding some lemonade to

fruit juice for variety or freeze to make ice lollies.

Fizzy drinks. Avoid sugar free or zero versions when appetite is poor.

Sports drinks. Make sure you look at the label, look for those that contain

sugar near the beginning of the ingredients list.

Alcohol. A small amount of alcohol can not only provide a source of

energy, but can help to improve appetite. Always check with the GP

whether the resident can include alcohol in their diet.

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Helping residents recovering from

COVID-19

The list below details drinks that are high in energy. Milky drinks also

provide a source of protein.

Hot milky drink ideas Cold milky drink ideas

Hot chocolate Milkshakes

Horlicks/ Ovaltine Blended fruit smoothies

Milky coffee Blended yoghurt drinks

Try adding cream for extra calories !

Or perhaps top hot chocolate with

marshmallows, or a chocolate flake.

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Helping residents recovering from

COVID-19

Nourishing drink recipes

Fortified milk recipe

One pint (500ml) of whole

milk mixed with 4 tablespoons

of dried milk powder.

Offer this as a drink, use in

cereal; or use as a base to

make other nourishing drinks

such as a homemade

milkshake.

Booster milkshake

170 ml Whole Milk

30ml Double cream

5 heaped tsp (15g) dried milk powder 3 heaped tsp (15g) milkshake powder 200mls serving = 360kcals

Lemon & Lime Sublime

80ml Lemonade (not sugar free) 80ml Lime cordial (to taste) 2 tbsp. Dairy free lemon curd 2tbsp. Icing sugar 1 tbsp. Golden syrup 200mls serving = 490kcals

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Helping residents recovering from

COVID-19

Aim to offer at least two nourishing snacks every day.

Remember to choose the higher calorie versions. Please avoid low fat products.

Sweet snack ideas Savoury snack ideas

Bakery

A slice of bread or toast with butter or

margarine, jam, marmalade, lemon curd or

honey.

A toasted tea cake or fruit loaf with butter

or margarine and jam.

A slice of cake or a sweet pastry, such as

a chocolate éclair, mini doughnut,

cinnamon whirl or custard slice.

Cookies or biscuits e.g. shortbread,

chocolate coated or cream.

Small sandwich or roll with cheese, egg

mayonnaise, tuna mayonnaise, hummus,

peanut butter or sliced meat with salad

cream, pickle or chutney .

A slice of bread and butter.

Half a bagel with full fat cream cheese.

An English muffin or crumpet with butter

or margarine and melted cheese.

Desserts Deli

A pot of thick and creamy yoghurt or

fromage frais.

A small bowl of custard, ice cream,

rice pudding, semolina or instant whip.

A bowl of tinned fruit with cream,

evaporated milk, condensed milk or ice

cream.

A pot of crème caramel, mousse, jelly,

custard, panna cotta, tiramisu or

cheesecake.

A slice of pizza or quiche (for a softer

option try crustless quiche).

A pork pie, sausage roll or small pasty.

Scotch egg or hard boiled egg.

A samosa, onion bhaji or falafel.

Mini kebab.

Hard boiled egg mashed with mayo.

Mashed corned beef with mayo or pickle.

Nibbles

Chocolate or sweets.

Dried fruit or sweet popcorn.

Yoghurt or chocolate covered dried fruit or

nuts.

Cereal bar or flapjack.

Cheese or pâté on crackers or oat cakes.

Cheese triangles or mini cheeses.

Crisps, nachos or breadsticks with a

creamy dip, hummus, salsa or guacamole.

Olives, nuts or savoury popcorn.

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Helping residents recovering from

COVID-19

For residents who are recovering from COVID-19 and/or have a MUST score of 2, their

diet will need to be fortified to help them gain weight. Food fortification means increasing

the calorie and protein without increasing the portion size.

Aim to offer at least three nourishing meals every day until they are a healthy weight or

returned to their usual weight.

Remember to choose the higher calorie versions. Please avoid low fat products.

Below are some ideas of high calorie ingredients that can be

added to meals and snacks. The portion sizes below provide

approximately 100 calories.

To savoury meals and snacks add:

To sweet meals and snacks add:

A small handful of grated cheese

1 ½ dessert spoons of mayonnaise

1 ½ dessert spoons of peanut butter

1 ½ dessert spoons of oil

2 cubes of butter

3 dessert spoons of pesto

3 dessert spoons of hummus

4 dessert spoons of skimmed milk

powder.

2 dessert spoons of sugar

1 small pot of full fat yoghurt

2 ½ dessert spoons of double cream

3 dessert spoons of chocolate sauce

3 dessert spoons of golden syrup

3 dessert spoons of lemon curd

3 dessert spoons of condensed milk

3 dessert spoons of honey

2 scoops of ice cream

A small handful of dried fruit

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Helping residents recovering from

COVID-19

Breakfast

Creamy scrambled egg with thickly buttered toast.

Egg bread.

Porridge or cereal with added sugar or jam, made with fortified milk.

Scotch pancakes, English muffins, crumpets or waffles with butter, jam, honey or

chocolate spread.

Bacon sandwich with plenty of butter.

Light meals

Sandwiches filled with cold meat, bacon, tinned fish, cheese, hard boiled eggs or peanut

butter. You can add mayonnaise or salad cream, pickles or relish. Thickly spread the

bread with full fat margarine or butter.

Toast with baked beans and cheese, pate, cheese, ravioli, spaghetti and cheese, eggs,

pilchards, sardines and or ham. Add a thick spread of full fat margarine or butter.

Creamy soup with added cream, grated cheese with bread and butter.

Chunky soup with added meat, fish or beans.

Main meals

All meals listed below can be served with buttered vegetables and/or potatoes, chips, rice,

pasta, couscous or bread. Tinned, frozen or fresh varieties are fine.

Stew, casserole or curry made with meat, fish or lentils.

Oven ready fish, fish fingers or fish cakes.

Macaroni, lasagne, cauliflower cheese or chilli – with extra grated cheese on top.

A buttered jacket potato with cheese, beans or tuna mayonnaise.

Sausages or burgers with baked beans and bread or potatoes.

Desserts

Thick and creamy yoghurt.

Tinned fruit with evaporated or condensed milk, cream, custard or ice cream.

Sponge cake or fruit crumble with cream, custard or ice cream.

Mousse, crème caramel, egg custard, panna cotta.

Below are some meal ideas that you could offer residents who are

recovering from COVID-19 and/ or have a MUST score of 2 or above

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Please contact us on 01926 600818, selecting option 3

Dietetic Department Dietetic Department

George Eliot Hospital Warwick Hospital

Nuneaton Warwick