The aim of this article is to outline the issues of malnutrition in older people and national initiatives to effectively identify and treat undernutrition, concluding with a local example of how County Durham and Darlington is tackling undernutrition from a regional perspective through a service called Focus on Undernutrition.

Let them eat cake": a retrospective service evaluation of Focus on Undernutrition in care homes. Introduction: Undernutrition is a major cause and consequence of poor health in older people, affecting 35% of residents in care homes. Focus on Undernutrition (FoU), a dietetic service delivered by dietetic assistants uses a multifaceted approach to undernutrition management. This study aims to evaluate FoU's impact on undernutrition outcome measures in care homes; including FoU's influence on weight change in residents "at risk" of undernutrition, and prevalence of undernutrition and pressure ulcers (PU). Methods: A retrospective pragmatic service evaluation was undertaken using pseudonymised data collected over 13 years on weight, undernutrition risk and PU from long-stay residents' notes before and six months after training (FoU). Results: Analysis completed on 104 homes, 4,315 residents (71.3% female; mean stay 10.8 (1-278) months) in County Durham. Following FoU a significant difference was identified for: improved rate of weight change for "at risk" residents (p < 0.001). Undernutrition risk significantly influenced weight change (low: B 1.04 kg, E 0.01 kg; moderate: B-1.79 kg, E-0.38 kg; high: B-0.83kg, E 1.00 kg, B p < 0.001, E p = 0.001). Reduced undernutrition prevalence (p < 0.001) from 32.7% to 29.1% residents "at risk" of undernutrition (moderate: B 13.1%, E 8.9%; high: B 19.6%, E 15.9%). Nutrition screening significantly improved (B 76.3%, E 98.7%, p < 0.001), reduced prevalence PU (51%, p < 0.001). PU prevalence significantly increased with undernutrition severity at baseline (p < 0.001), but not following FoU (p = 0.233) (low: B 5%, E 2.3%; moderate: B 6.9%, E 1.6%; high: B 10.5%, E 3.9%). Odds of developing PU reduced 53% (OR: 0.47). B :baseline; E :evaluation; OR: odds ratio. Conclusion: These results demonstrate dietetic assistants delivering FoU significantly improves weight, undernutrition and PU prevalence in care homes. Indicating FoU is an effective model for improving undernutrition outcomes, with the potential of reducing possible harm, such as PU in care homes.

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