A variety of nutrition support strategies are currently used to optimise nutrition in care homes. This audit aimed to establish the use of oral nutritional supplements (ONS) according to malnutrition risk, BMI and unintentional weight loss in residents of care homes.

In this audit of 43 care homes in Hampshire (17 nursing, 18 residential, 8 dual registered, 1176 residents (mean age 86.5 (sd 8.7) years, mean BMI 22.80 (sd 4.99) kg/m²) information was collected on the use of all types of prescribable and non-prescribable ONS (powders, liquids, single and multi-nutrient supplements) over the previous 4 weeks. ONS use was related to the residents' malnutrition risk category (low, medium and high) using the ‘Malnutrition Universal Screening Tool’ ‘MUST’ (www.bapen.org.uk)⁽Reference Elia¹⁾, BMI and percentage unintentional weight loss.

Although 39% of residents were at risk of malnutrition (14% medium and 19% high risk), only 8.2% of all residents received ONS in the 4 weeks prior to the audit. ONS usage increased according to ‘MUST’ category; 2.5% of residents at low risk, 7.4% at medium risk and 19.1% at high risk of malnutrition.

ONS use in the 4 weeks prior to the audit varied with BMI: 28% in those with a BMI<18.5 kg/m²; 40% in those with a BMI<16.0 kg/m²; and 50% in those with a BMI<14.0 kg/m². Weight loss in the previous 3–6 months occurred in all these low BMI categories and increased as BMI decreased (3.6 (sd 5.1)% in those with a BMI<18.5 kg/m², 6.0 (sd 6.7)% in those with a BMI<16.0 kg/m² and 6.7 (sd 6.6)% in those with BMI<14.0 kg/m²). Among those who lost more than 10% body weight in the previous 3–6 months, 15% received ONS in previous 4 weeks. None of the residents were under the care of a dietitian.

The audit indicates that most residents with malnutrition do not receive ONS, and therefore there is a need to assess the extent to which other forms of nutritional support, if any, are given to malnourished residents in care homes.