Reflections on the 5 M Framework in Frailty Care: Why We Need a 6th M—Malnutrition
- Kirsten Protherough
- Mar 18
- 4 min read
During my frailty training sessions, I have frequently encountered discussions around the “5 M Framework.” This practical framework guides healthcare professionals and carers in focusing interventions within personalized care plans for older adults. However, through observation and reflection, I believe there is a crucial need to add a sixth “M” – Malnutrition. Let’s explore why.
The 5 M Framework
The 5 M Framework helps geriatricians, healthcare workers, and carers tailor comprehensive care by addressing five key domains. These Ms are:
1. What Matters Most!
Definition: At the heart of person-centered care is understanding a patient’s individual goals, values, and preferences.
How Can Carers Help?
Ask & Listen: Encourage older adults to share their priorities—whether it’s maintaining independence, staying connected with loved ones, or managing pain.
Respect Preferences: Align interventions and care plans with these goals.
Document & Communicate: Ensure that everyone on the care team knows what truly matters to the older adult.
2. Medication (Side Effects & Management)
Definition: Medications can be life-changing but may also cause side effects or worsen frailty.
How Can Carers Help?
Monitor & Report: Stay alert for side effects such as dizziness, confusion, or changes in appetite.
Support Adherence: Help with medication schedules, safe storage, and reminders.
Collaborate: Work with prescribers and pharmacists to review medications regularly.
3. Mobility
Definition: Mobility is central to independence and overall health, yet older adults can face challenges due to frailty.
How Can Carers Help?
Encourage Safe Movement: Promote gentle exercises and regular activity to maintain strength and balance.
Environmental Adjustments: Ensure safe, clutter-free spaces with appropriate assistive devices.
Rehabilitation Focus: Work with physiotherapists, occupational therapists, or exercise programs when needed.
4. Mind
Definition: Cognitive health can be affected by conditions like dementia, delirium, and depression.
How Can Carers Help?
Early Detection: Watch for sudden changes in mental status or behavior.
Stimulation & Engagement: Offer meaningful activities, social interaction, and memory aids (like calendars or reminders).
Collaboration: Communicate changes or concerns to the broader healthcare team quickly.
5. Multicomplexity
Definition: Frailty often involves multiple chronic conditions and social factors that interact in complex ways.
How Can Carers Help?
Holistic View: Recognize that frailty is rarely just one issue—coordinate with various professionals (GPs, nurses, social services).
Care Coordination: Keep track of multiple appointments, treatments, and instructions.
Advocacy: Act as a liaison to ensure each condition is addressed, and none are overlooked.
Why Add a 6th M for Malnutrition?
Frailty and malnutrition often go hand in hand. Malnutrition can accelerate muscle loss, exacerbate weakness, and make recovery from illness far more challenging. Yet, it can be overlooked in busy care environments. I have been suprised that many older adults I see have not recently been weighed and hence weight loss has gone unnoticed.
It’s estimated that around one in ten people over the age of 65 are malnourished or are at risk of malnutrition – that’s over one million older people in the UK today.
Potential Causes of Malnutrition
Cognitive Impairment
How can Carers Help?
Provide adequate assistance at mealtimes: prompt, offer assistance.
Trial color-contrasting plates to draw attention to meals.
Offer family-style meals.
Allow at least 10 seconds for decision-making.
Chewing Problems
How can Carers Help?
Check oral health and consider requesting dental treatment.- Consider texture modification of foods (e.g., softer or pureed foods).- Ensure good mouth care is provided regularly.
Swallowing Problems
How can Carers Help?
Refer to a speech and language therapist for assessment and advice on safe textures.
Implement texture modification (e.g., thickened liquids, pureed foods) based on professional recommendations.
Depressive Mood / Depression
How can Carers Help?
Request a GP review for possible psychiatric intervention.- Encourage social eating
Have meals in a communal setting or with peers.- Promote group activities to help alleviate isolation and improve mood.
Poor Dexterity
How can Carers Help?
Provide specialist tableware: rimmed plates, lightweight glasses, weighted cutlery, non-slip mats.
Consider a referral to an occupational therapist for additional strategies to improve independence at mealtimes.
Bowel Habits (Constipation/Diarrhoea)
How can Carers Help?
Discuss with the GP to review potential causes and consider appropriate treatments (e.g., laxatives, dietary adjustments).
Eating Environment
How can Carers Help?
Observe and optimize the dining environment (calm setting, pleasant smells, suitable music).
Sit those who struggle next to good eaters and pair with supportive staff.- Minimize distractions to encourage focus on eating.
Restrictive Diets
How can Carers Help?
If the resident is on a restrictive diet (e.g., diabetic, low-fat, etc.), request a GP review to consider liberalising these restrictions.- Balance clinical requirements with the resident’s nutritional needs and quality of life.
How Else Can Carers Help with Malnutrition?
Nutritional Screening: Regular weight checks, using tools like the Malnutrition Universal Screening Tool (MUST).
Encourage Balanced Meals: Offer nutrient-dense foods, snacks, and fluids.
Support Mealtime Routines: Provide assistance, adapted utensils, or a calm setting to make meals more enjoyable.
Involve Specialists: Collaborate with dietitians or nutritionists when needed, especially if there are swallowing difficulties or complex dietary needs.
Addressing malnutrition as an integral part of frailty care not only supports strength and mobility but can also significantly improve overall health outcomes. By recognising this “6th M,” carers and healthcare professionals can deliver more holistic, person-centered care.
Ready to Enhance Your Frailty Care Skills?
If you’re looking to boost your teaching and training expertise in frailty assessment and management—including the new focus on Malnutrition.
Join my upcoming 2-Day Train the Trainer Frailty Course.
Developed and delivered by Upskill For Frailty, this interactive program includes all aspects of the 5 Ms, plus the 6th M we’ve just discussed.
Why Attend?
Learn to train your carers core frailty concepts
In-Depth Learning: Comprehensive modules covering frailty fundamentals, including malnutrition screening.
Hands-On Experience in teaching: Case studies, role-plays, and group discussions to bring theory to life.
Practical Tools: Ready-to-use resources to share with your team.
Expert Guidance: Led by a Geri GP with both clinical and teaching expertise.
Contact Details
Register below now - The course is limited to 10 Participants.
Group bookings are available
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