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Screen and Treat for Malnutrition (STreaM) Programme

About 20% of older people living at home are at risk of malnutrition. In particular poor appetite is an important risk factor for malnutrition and for weight loss, which is in turn a risk factor for the development of infections, hospital admissions and even longer term mortality. This may be because they are not getting enough to eat, or because they are not eating enough of the right food.

An intervention (‘Eat well, feel well, stay well’) has been developed, to help doctors and nurses in general practice to check if older adults who live at home are at risk of malnutrition. They can then offer support to those who need it. This includes booklets and other materials for older adults, and a support tool for health professionals. The support tool includes guidance about when to see patients, and for those more severely at risk when to use oral nutritional supplements.

The intervention was developed by experts who looked at previous literature to find what helps or hinders older adults eating well, and what is likely to work best in general practice. The intervention was improved after feedback from people aged over 65 years, patients and healthcare professionals.

This study aims to assess the effectiveness of the intervention. All patients get a brief intervention with patient booklets and follow-up, but individuals who are at much greater risk will have the brief intervention plus oral nutritional supplements (ONS) for short spells when they are unwell. The study will also follow a group of patients who have the usual care that is provided by their doctors’ surgery.


  • To undertake a cluster randomised controlled trial in primary care to determine whether nutritional intervention following screening for nutritional risk in older adults is practical, acceptable and effective.
  • To determine whether nutritional intervention following screening for nutritional risk in older adults is likely to be cost-effective in primary care.

Funded by:

NIHR Programme Grant

Research team members:

Professor Paramjit Gill, Ruman Sandhu, Ria Wilson 


University of Southampton (lead), Oxford University 


2020 -