The British Dietetic Association (BDA) welcomes Public Health England’s newly updated Healthier and More Sustainable Catering: A toolkit for serving food to older people in residential care, which now features greater recognition of the often underappreciated issue of malnutrition in care home settings.

The BDA, founded in 1936, is the professional association and trade unio for dietitians in Great Britain and Northern Ireland. It is the nation’s largest organisation of food and nutrition professionals with over 8,500 members.

The BDA met with Public Health England (PHE) in late 2016 to argue that the guidance needed greater recognition of malnutrition – an issue that requires more specialist support than the usual healthy eating guidance. The updated guidance highlights evidence from BAPEN, which shows that 35% of care home residents are malnourished, or at risk of malnourishment.

Although the mention of malnutrition is a significant improvement on the previous guidance, we remain concerned that the primary focus of the document remains on ‘standard’ healthy eating. The needs of the 35% of residents at risk of malnutrition may not be fully understood or treated by care home staff reading this guidance. There is also no mention of the 40% of care home residents who have difficulties swallowing (dysphagia) who therefore require a specially modified diet2. We therefore hope that in promoting these new standards, PHE will further emphasise the need for an individualised approach to take account of malnutrition and other health conditions.

The toolkit provides advice to care homes and catering organisations on choosing, preparing and serving food for older people as well as providing advice around the Government Buying Standards for Food and Catering Services. The new guidance is complemented by another PHE report, issued earlier this month, entitled Helping older people maintain a healthy diet: a review of what works3. This includes a positive focus on prevention, identification and treatment of malnutrition, and provides useful advice and case studies.

The BDA will continue to work with PHE to promote the new guidance and ensure that care homes provide appropriate care to malnourished patients, including expert input from dietitians.