Assess older people’s nutrition, hydration and dining needs and preferences as part of your assessment and planning processes.

Assess each older person’s individual nutrition, hydration and dining needs and preferences. Do this regularly and in partnership with the older person (Outcome 2.1) and include anyone else the older person wants to involve (Outcome 3.1). For example, their supporters, family, carers, registered health practitioners and allied health professionals.

When you assess the older person’s individual nutrition, hydration and dining needs and preferences, consider:

• including a clinical assessment of specific food and nutritional needs (Outcome 5.4). This assessment must be performed by an appropriate allied health professional such as an Accredited Practising Dietitian. Assessment of nutritional needs should consider each older person’s requirements, particularly for protein, energy and calcium. They should base this on contemporary, evidence-based practice recommendations and guidelines (Outcome 6.1).
• the older person’s therapeutic, cultural and religious dietary needs and preferences. This may also require considerations relating to how you prepare food (Outcome 6.1). There are resources available to help you assess older people’s food and dining needs and preferences. For example, we have a food and dining preference sheet you can use.
• clinical, physical and cognitive issues that may affect the older person’s ability to eat, drink and swallow. For example, poor oral health or the effects of medication on appetite.
• adopting trauma aware and healing informed practices relating to nutrition, food and dining. The guidance for Outcome 3.2 has more information on delivering trauma aware and healing informed care.

Older people who require enteral nutrition (nutrition and hydration that is delivered via a tube) will need careful and specific planning in line with contemporary, evidence-based practices and guidelines, and in consultation with relevant registered health practitioners and allied health professionals. This includes consideration of:

• the timing, temperature, and volume of enteral formula and water flushes, with consideration of any food or drink they may consume orally
• safe administration, including the skills of the person administering enteral nutrition, positioning, and cleaning of equipment
• the environment, such as temperature of the room and location in which it is provided
• regular ongoing monitoring and reassessment of nutritional requirements and tolerance.

Make sure you record the outcomes of the assessment in the older person’s care and services plan. Review and update these plans regularly. This is to make sure their plan stays effective and meets their needs and preferences (Outcome 3.1). Communicate these outcomes to the older person, their supporters, workers and others involved in their care. Include what and when the older person likes to eat and drink. Do this to support workers to understand what:

• is a positive dining experience for each older person (Outcomes 1.1 and 6.4)
• is culturally and spiritually safe for each older person (Outcome 1.1)
• optimises older people’s independence, reablement and quality of life (Outcomes 3.1). This means helping older people regain and keep their physical, mental and cognitive functions (Outcomes 1.1 and 6.4). You can do this by promoting use their skills and strengths.

Make sure you have processes to support older people to eat and drink independently, when it’s safe to. For example, an allied health professional such as a speech pathologist may recommend individualised safe swallowing strategies. This is to reduce risk and encourage older people to eat safely and independently (Outcomes 3.1 and 5.5).

Put in place strategies to manage deterioration or changes in the older person that relate to them eating and drinking (Outcome 5.4). For example, when deterioration and changes affect the older person’s ability to:

• eat, drink and swallow
• meet their specific nutritional needs
• meet their hydration needs
• access food and drink when they want it (Outcome 3.2).

Make sure you refer and facilitate access to Accredited Practising Dietitians, Certified Practising Speech Pathologists and other allied health professionals to help mitigate instances of deterioration. Severe and immediate deterioration of older people in your care should be seen by a medical professional. This is in line with comprehensive multidisciplinary care (Outcome 5.4).

The guidance for Outcomes 5.4 and 5.5 has more information on managing deterioration and clinical safety relating to choking, swallowing, nutrition and hydration.

Make sure workers who are part of the assessment and planning process have the time, support, resources, and skills to assess nutritional needs and preferences.

Provide workers with guidance and training on how to assess older people’s individual nutritional needs and preferences. This needs to follow:

• the organisation’s policies and procedures. These should reflect contemporary, evidence-based practice.
• workers’ roles and responsibilities.

Relevant to their role, make sure workers understand how to:

• assess each older person’s nutrition, hydration and dining needs and preferences as a part of their care and services plan (Outcome 3.1)
• use this information to plan and provide satisfactory food, drink and dining experiences each older person enjoys
• refer to appropriate registered health practitioners and allied health professionals for specialist advice and reviews. For example, a speech pathologist for an eating, drinking and swallowing assessment (Outcome 5.4).
• undertake relevant screening using validated assessment tools (Outcome 5.5).

Workers who assess nutritional needs may need specific training. Use the system for managing human resources to identify specific training needs (Outcome 2.9). For example, a Registered Nurse may need more training on how to complete a malnutrition screening using a validated tool. You may not expect a care worker to learn how to use this tool, but they may need more training on how to identify and escalate malnutrition concerns to clinical workers.

The guidance for Outcomes 2.8 and 2.9 has more information on workforce planning and worker training.

Monitor how well you’re assessing and planning for older people’s nutritional needs and preferences.

To check if you’re assessing older people’s nutritional needs and preferences effectively, you can review:

• the older person’s aged care service documents (Outcome 3.1). For example, making sure care provided in the progress notes meets the older person’s needs outlined in their care and services plan.
• complaints and feedback (Outcome 2.6a and 2.6b)
• incident information (Outcome 2.5).

Look for situations where:

• there have been incidents involving the older person during eating and drinking (Outcome 5.5). For example, coughing, aspiration, choking or an allergic reaction.
• the older person’s nutritional needs and preferences haven’t been considered or properly assessed.

Assess if workers are following your evidence-based policies and frameworks which outline your assessment and planning process (Outcome 2.9). You can do this through quality assurance reviews.

If you find any issues or ways you can improve through your reviews and assessments, you need to address them. If things go wrong, you need to:

• practise open disclosure (Outcome 2.3). This means being open about what has gone wrong. Share what went wrong with older people, their supporters and others they may want to involve, such as family and carers.
• have strategies to mitigate the risk of things going wrong again.

The guidance for Outcome 2.3 has more information on monitoring the quality system.