A report by the NSW Nurses and Midwives' Association (NSWNMA) highlights the risk of malnutrition in aged care residents due to nutritional deficiency and understaffing, making dietary intervention critical and challenging for nurses.

NSWNMA General Secretary, Brett Holmes, said the ability of nurses to implement nutritional interventions is dependent on adequate, skills-based staffing.

"Nurses working in aged care need the opportunity to sight a person, observe them during mealtimes and have the time to provide supervision over the assistance given by colleagues, such as care workers and assistants in nursing."

Unfortunately, staffing and skills mix levels don't support the required observation of a registered nurse working in aged care.

"The knowledge and expertise of a registered nurse are often undervalued in aged care," said Mr Holmes.

The National Aged Care Survey revealed that residential aged care facilities that employed one registered nurse to over 150 residents were 12 per cent more likely to lack time to assist people in eating and drinking compared to ratios of one to 50 residents or less.

"Any ratio higher than one to 50 residents yielded more chance of failure to adequately meet residents' nutritional and hydration needs."

Undernutrition in aged care residents

Aged care residents face many challenges that negatively impact their ability to maintain adequate nutritional wellbeing, said Mr Holmes.

"Changes in the physiology and immunity of elderly people can often result in a greater need for vitamin and mineral supplements.

"It's well documented that over 50 per cent of residents in residential aged care facilities have dementia.

"Some of these people experience increased physical activity, which means they require higher nutritional intake to prevent them from losing weight.

"It's alarming to note that the average daily spend on food per resident per day, can be as little as $6.

"It's therefore not surprising that approximately half of the residents in these settings are also malnourished.

"Another important factor is practising good oral hygiene and dental care. Anyone with painful gums or ill-fitting dentures is more likely to experience both poor diet and hydration," said Mr Holmes.

Aged Care Clinical Nurse, Angela Donato Connolly, said many factors cause malnutrition in elderly patients.

"Chronic disease, taste bud deterioration, mechanical or motor issues and the onset of dementia, depression and social isolation are just a few of the myriad of influences that can place an elderly person's nutritional intake at risk.

"Whether combined or in isolation, an elderly person's individual circumstances can place them at an increased risk of malnutrition which can then lead to the development of conditions that greatly compromise their health," said Ms Donato Connolly.

Nutritional interventions in aged care

Awareness of routines, preferences, social and cultural factors and education are essential nutritional interventions that minimise the risk of dietary deficiency, explained Ms Donato Connolly.

"Familiarity with a client's usual routines and preferences is a nurses' best ally in assessing any change in their usual nutritional intake.

"Small and subtle changes can often lead to a snowball effect that can lead to bigger, more difficult problems to manage.

"If we catch them early, interventions can be implemented at the early stages to avoid large gaps in nutritional deficits."

Food also has significant social and cultural connections for many Australians, which don't disappear with age.

"If we can keep older Australians engaged, whether by family, friends or the healthcare worker, in sharing food and the practices surrounding it, there is a good chance they will continue to meet their own nutritional needs without the need for intervention.

"These constructs will also be the ones to identify changes in nutritional intake that may require further intervention, which can then be dealt with respectfully and sensitively and tailored to each client."

Nurses are a trusted source of health advice and education on nutrition, which can minimise the risk of nutritional deficiency.

"In knowing a client's preferences and habits, nurses can provide specific practical advice to increase protein intake for wound healing and hydration and fibre intake to avoid bowel issues.

"Small changes can often be the difference between quick fixes and deterioration in a client's health."

Nutritionist Dr Sandra Iuliano, a senior research fellow at Melbourne University, said available literature suggests the nutritional needs of those in aged care are not being met, citing insufficient protein, calcium, zinc and fibre intake.

Nurses play a critical role in identifying nutritional deficiency in aged care residents through routine screening on admission.

"It's important that routine screening captures residents prior to being malnourished.

"And a thorough investigation into why a resident is losing weight with a food-based approach first.

"This requires co-operation with all the systems in aged care, including food service. Staff need to work as a team.

"Better screening to identify those at risk prior to becoming malnourished is crucial as it's more difficult to regain nutritional status than it is to maintain it.

"If nursing staff are alerted to the concerns about a resident, then appropriate investigations with interventions, such as offering foods residents like, can be monitored.

"Protein supplements are effective over the short term, but less effective long-term.

"The ideal is when the intervention is sustainable," said Dr Iuliano.