Illness, constipation, medicines and other causes of change

People rarely stop eating or drinking without a reason. Reduced intake often follows infection, pain, constipation, nausea, depression, mouth problems, delirium, fatigue, poorly fitting dentures, recent transfers or medicines that change appetite, bowel function, alertness or urine output. Dehydration is more likely with vomiting, diarrhoea, fever or diuretics.

NHS England advises that concerns about hydration and nutrition should be escalated to the appropriate multidisciplinary team members, for example dietitians, GPs, speech and language therapists, pharmacists and community nurses. Frontline staff do not need to diagnose the cause, but they must describe the situation clearly.

Useful causes and clues to think about

• Constipation: discomfort, bloating, straining, reduced appetite or agitation may be signs.
• Pain or illness: people often eat and drink less when they feel unwell or sore.
• Mouth and denture problems: chewing can be painful or tiring.
• Medicine effects: nausea, dry mouth, drowsiness, diarrhoea, constipation or increased urination can reduce intake.
• Acute change: confusion, infection, vomiting or diarrhoea may require escalation within the same shift.

The quality of an escalation often depends on whether staff connect the food and drink problem to the wider health change around it.