Spotting poor intake, weight loss and dehydration risk

NICE recommends screening people in care settings for malnutrition risk using a validated tool. Clinical concerns include unintentional weight loss, poor appetite, difficulty swallowing, altered bowel habit, loose-fitting clothes, poor wound healing and prolonged illness. Frontline staff often notice these signs before a formal review.

The NHS lists common signs of dehydration in adults: thirst, dark yellow or strong-smelling urine, reduced urine frequency, dizziness, tiredness and a dry mouth, lips or tongue. In older adults dehydration may also present as weakness, reduced engagement, confusion, headache, constipation or a general feeling of being unwell.

Common warning signs to notice early

• Poor food intake: leaving meals, eating less than usual, taking much longer, or losing interest in favourite foods.
• Poor fluid intake: drinks left untouched, repeated refusal, or requiring more prompting than usual.
• Weight-related clues: loose clothes, jewellery becoming looser, reduced muscle bulk or visible frailty.
• Dehydration clues: dark urine, reduced urine output, dry mouth, dizziness, tiredness or headache.
• Associated clues: constipation, confusion, falls, low mood, apathy, swallowing difficulty or recent illness.

People will not usually say "I am dehydrated" or "I am losing weight." Compare current intake and appearance with the person's usual pattern and note any change.

Poor intake is easier to manage when caught early, before weakness, dehydration or acute illness develop.