How COVID-19 can increase the risk of malnourishment and how to spot it early

7 minutes

The health and wellbeing of the people you care for is your top priority. Good nutrition is the most important, yet simple, way to maintain strong health and prevent disease. 

According to the British Dietetic Association, 3 million people in the UK either have an increased risk or are currently malnourished; and 93% of them are living at home. High-risk groups of people currently staying home to reduce the likelihood of becoming infected with COVID-19 are also at a much greater risk of malnutrition. Proactive steps taken by caregivers to prevent it can reduce the likelihood of infections, falls, and hospitalisation. See report here.

What is malnourishment?

Malnourishment is a health condition caused by a wrong balance and lack of nutrients from your diet. The six essential nutrients we need are vitamins, minerals, protein, fats, water, and carbohydrates.

How can being malnourished affect your health?

Malnourishment leads to much slower recovery times from illness. A crisis like COVID-19 makes it more serious, especially for older adults with weaker immune systems. Other risks include:

  • increased risk of illness and infection
  • slower wound healing 
  • increased risk of falls
  • low mood
  • reduced energy levels
  • reduced muscle strength
  • reduced quality of life
  • reduced independence and ability to carry out daily activities (BDA, 2020)

How can COVID-19 increase the risk of malnourishment?

Isolation and social distancing may reduce an individual’s ability to access a wide range of foods needed to maintain good health. Isolation is linked with feelings of loneliness and lower mood, possibly leading to a decreased appetite and less overall food intake. Lower availability of fruits and vegetables makes it more challenging to plan well-balanced meals and ensure that the person you care for is eating a balanced diet. 

Additionally, many shop staples that have become harder to spot on the supermarket shelves (e.g. bread, cereal, milk, pasta, flour) are not only energy-dense but also fortified with key vitamins and nutrients. This might impact those who already have a limited palette and don’t typically consume a wide variety of fruits and vegetables, as they rely on staples to provide most of their nutrients.

How do I spot malnourishment? 

Malnourishment can often go unnoticed because it generally occurs over a long time. It’s common among elderly people who become frailer with age. However, the biggest red flag is unexpected weight loss. If it’s difficult to weigh your clients then look out for loose-fitting clothes, jewellery or even dentures! A decrease in appetite or a loss of interest in food and drink is important to monitor, especially over long time  periods. Dark circles under their eyes may be caused by iron-deficiency anaemia, so a person may feel weaker and tire more frequently throughout the day. These food-related issues should be watched closely and not swept under the rug due to just old age. It’s a good idea to offer training to staff on how to spot these symptoms. 

What foods should I encourage my clients to eat?

Studies show that eating a well balanced diet is much more effective than taking supplements. Your body is designed to break down whole foods and get the nutrients it needs from them. 

“To date, the European Food Safety Authority have not authorised any claim for a food or food component in the UK to be labelled as protecting against infection. Good nutrition, including eating enough protein, is essential to protect people’s muscles including respiratory muscles to help with breathing.” (BDA, 2020)

Individuals and caregivers should be encouraged to follow the recommended guidelines:

  • Eat 2-3 portions of high protein foods every day such as meat, fish, eggs, nuts, beans, pulses, soya, tofu and other meat-free protein foods.
  • Eat/drink 2-3 portions of dairy foods every day such as cheese, milk and yoghurt or non-dairy alternatives like soya, almond or coconut milk. If they’re malnourished then fortify foods with higher fat versions of these products to increase calories.
  • Eat a serving of starchy food at each meal (e.g. bread, cereals, potatoes, pasta or rice).
  • Eat some fruit and vegetables every day (fresh, frozen, tinned, dried or juiced).
  • If you enjoy fish, go for oily fish such as mackerel, salmon, herring, trout, pilchards or sardines as these are rich in omega-3 fatty acids. Aim for 2 portions a week (can be tinned or frozen for convenience).
  • Have at least 6-8 glasses/mugs of fluid every day, choosing drinks which contain some nutrition where possible such as milky drinks (malted drinks, hot chocolate, milky coffee, smoothies and milkshakes) which can provide energy, protein and vitamins and minerals or sugary drinks such as fruit juice, fizzy drinks or squash can provide extra energy. 
  • Consider taking daily vitamin D supplements containing 10 micrograms if you’re unable to spend some time outdoors in the sun throughout Spring. Vitamin D helps to protect bones, teeth and muscle strength; reducing the likelihood of falls and fractures.

(BDA, 2020)

How can Birdie help? 

Realtime care notes make it easier to observe and accurately record observations about your clients, including their daily food and fluid intake. As a care manager, you can see at a glance what kinds of foods and fluids the older adults in your care are intaking. If you notice patterns, for example less food at lunchtimes or refusing snacks, you can update care plans easily and remind staff to prompt their clients to eat or drink.

You can also encourage your care staff to raise concerns about high-risk individuals, who are displaying concerning behaviours through the Birdie app. This way, you’ll be instantly notified of any changes in your client’s behaviours. Plus, with a digital trail of concerns and evidence of your response (i.e. updating a care plan or task list) you can show how you’ve responded to these issues to the CQC and also GPs or nurses, if required. 

Sharing your care notes and logs with care circle professionals will help them to make informed decisions, utilising up to the minute information and help you to refer clients at the earliest possible opportunity. 

For more information please visit these trusted websites:


Eating a balanced diet:

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This piece was written by qualified Nutritionist and Birdie staff member Natalie Waite, BSc (Hons) Nutrition.

*This article is intended for information purposes only. It should not be substituted for medical diagnosis or dietary advice given by a dietitian/registered nutritionist.


  • Elia M, Russell C. 2009. Combating Malnutrition: Recommendations for Action. Report from advisory group on malnutrition led by BAPEN.
  • Brotherton A, Simmonds N, Stroud M. 2010. Malnutrition Matters: Meeting Quality Standards in Nutritional Care. A report on behalf of the BAPEN Quality Group
  • Thorax; 64. 326-331 Published Online First: 15 December 2008 doi:10.1136/thx.2008.097352
  • Thomas B (2001) Manual of Dietetic Practice. Oxford: Blackwell Scientific Publications.

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