Unintentional weight loss in Care Home Residents can indicate malnutrition or an underlying illness. It may also be related to frailty and careful assessment is needed whether it is appropriate to manage more aggressively or whether this would be inappropriate.
This pathway supports care home staff in recognising risks early and knowing what to do next.
Screening – Use the MUST Tool
Use the Malnutrition Universal Screening Tool (MUST) whenever a resident loses weight or their appetite drops.
Step 1: Measure BMI
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More than 20 (or over 30 if obese) – score 0
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Between 18.5 and 20 – score 1
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Less than 18.5 – score 2
Step 2: Check for unplanned weight loss in the last 3–6 months
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Less than 5% – score 0
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Between 5% and 10% – score 1
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More than 10% – score 2
Step 3: Assess for acute illness
If the resident is acutely unwell and has eaten little or nothing for five days or more, score 2.
Step 4: Add up the scores to get the total MUST score.Interpreting the MUST Score
Score 0 – Low risk. Continue normal care and recheck monthly.
Score 1 – Medium risk. Give Food First advice, monitor food and weight monthly, and review if no progress.
Score 2 or more – High risk. Follow Food First advice, start supplements, and refer to a dietitian.
If the resident’s intake is very poor or there are clear signs of malnutrition, treat as high risk even if the score is lower.
Escalation and GP Review
If the MUST score is 2 or above, or there are ongoing concerns:
Complete a Weight Loss Form and add the resident to the next ward round list.
The GP will assess for reversible causes such as medication side effects, depression, or physical illness.
Consider whether investigation for cancer or other serious disease is appropriate, based on the resident’s Ceiling of Care Form.
Nutrition Management
Start with Food First approaches:
Encourage high-calorie, high-protein meals and snacks.
Add milk powder, butter, or cream to foods.
Offer small, frequent meals and favourite items.
Provide nourishing drinks such as milkshakes or full-fat milk.
Record food and fluid intake.
If the resident’s intake and weight do not improve after 4–6 weeks, start 1st line oral nutritional supplements and review.
If still no improvement, start 2nd line supplements and refer to a dietitian.
Monitoring Progress
Weigh residents at least once a month, or every two months in the community.
If continued weighing is no longer appropriate, the Weighing Amendment Form is completed
Monitor treatment goals such as maintaining or gaining weight, improving nutrition, or aiding wound healing.
If goals are met and the resident is eating well, discuss stopping supplements with the GP or dietitian.
When to Seek Further Help
Contact the GP or dietitian if the resident:
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Loses weight rapidly or unexpectedly despite interventions
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Has swallowing difficulties or choking episodes
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Shows ongoing poor appetite, nausea, or vomiting
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Develops new pressure wounds or recurrent infections
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Has symptoms that could indicate a serious illness