Understanding Malnutrition: What is the must score for the elderly?

Oct 29, 2025 3 min read •

nutrition Senior Health Geriatric Care

Malnutrition affects over three million people in the UK alone and is a significant concern for seniors. The Malnutrition Universal Screening Tool (MUST) provides a critical framework for healthcare professionals to systematically determine what is the must score for the elderly, allowing for early detection and intervention of malnutrition risk.

Quick Summary

The MUST score for the elderly is a nutritional risk indicator derived from a five-step screening tool that evaluates BMI, unintentional weight loss, and acute disease effects to help manage malnutrition risks in older adults.

Key Points

Five-Step Tool: The MUST score is determined through a 5-step process assessing BMI, unintentional weight loss, and the impact of acute illness.
Risk Categories: A MUST score of 0 is low risk, 1 is medium risk, and 2 or more is high risk for malnutrition.
Informs Action Plan: The score dictates the necessary action, from routine monitoring for low risk to immediate dietitian referral for high risk.
Widely Used: MUST is a validated and commonly used screening tool in various settings, including hospitals and care homes.
Not for Frailty: The tool has limitations, including low sensitivity for detecting frailty, a distinct condition common in the elderly.
Consider Context: Scores should be interpreted in the context of the patient's overall health and can be limited by challenges in measuring immobile patients.

What is the Malnutrition Universal Screening Tool (MUST)?

The Malnutrition Universal Screening Tool (MUST), developed by the British Association for Parenteral and Enteral Nutrition (BAPEN), is a validated and widely used five-step screening tool to identify adults, including the elderly, at risk of malnutrition. It helps healthcare professionals assess nutritional status in various settings like hospitals, care homes, and the community. The aim is to proactively address poor nutrition, which can lead to negative health outcomes such as longer hospital stays and increased complications.

The Five Steps to Calculate the MUST Score

The MUST score is calculated by following a five-step process, with each step contributing a numerical value to determine the overall risk of malnutrition.

Step 1: Measure Body Mass Index (BMI)

BMI is calculated to assess weight status, with different scores assigned based on the result. For those over 65, slightly higher BMI cutoffs are used. If direct measurement is not possible for immobile elderly patients, alternative methods like mid-upper arm circumference (MUAC) or ulna length can estimate BMI.

BMI > 20 kg/m² (or > 22 kg/m² for those over 65): Score 0
BMI 18.5–20 kg/m² (or 20–22 kg/m² for those over 65): Score 1
BMI < 18.5 kg/m² (or < 20 kg/m² for those over 65): Score 2

Step 2: Assess Unintentional Weight Loss

This step checks for significant unintentional weight loss over the past 3 to 6 months.

Unintentional weight loss < 5%: Score 0
Unintentional weight loss 5–10%: Score 1
Unintentional weight loss > 10%: Score 2

Step 3: Note Acute Disease Effect

The presence of an acute disease or condition leading to little or no food intake for over 5 days adds to the risk.

No acute disease effect: Score 0
Acute disease effect is present: Score 2

Step 4: Sum the Scores

The scores from the first three steps are added to determine the total MUST score and the malnutrition risk category.

Step 5: Develop an Action Plan

A care plan is developed based on the final risk category.

Interpreting the MUST Score for Elderly Individuals

The total MUST score guides healthcare professionals on necessary actions for patient management.

Low Risk (Score 0): No specific nutritional intervention needed, but rescreening is recommended periodically.
Medium Risk (Score 1): Document a nutrition care plan, monitor intake and weight, and consider dietitian referral if no improvement.
High Risk (Score ≥ 2): Refer to a dietitian or nutrition support team for a comprehensive assessment and individualized care plan.

Comparing Nutritional Screening Tools

While MUST is widely used, other tools exist, each with specific strengths and weaknesses, especially in older populations. A comparison helps understand the context for choosing MUST.


Feature	Malnutrition Universal Screening Tool (MUST)	Mini Nutritional Assessment Short Form (MNA-SF)	Nutritional Risk Screening (NRS-2002)
Focus	Malnutrition risk, including obesity	Institutionalized older adults	Hospitalized patients, generally
Steps	5 steps: BMI, weight loss, acute disease	6 questions related to food intake, weight, mobility, psychological stress	Combines initial screening with nutritional assessment
Ease of Use	Simple and quick for various staff with minimal training	Can be simple, but potentially poor validity in elderly	Slightly more complex, but higher specificity in hospitalized elderly
Setting	Hospital, community, care homes	Hospital and care homes	Hospital settings primarily
Specificity	Lower specificity than NRS-2002, especially in elderly hospitalized patients	Can have poor sensitivity and agreement in hospitalized elderly	Higher specificity for hospitalized elderly patients

The Role of MUST in Elderly Care and Its Limitations

Early identification of malnutrition risk is crucial in the elderly. MUST's strength is its simplicity and broad application. However, it has limitations in older adults, such as low sensitivity for detecting frailty and potential issues with standard BMI interpretation and weight measurement in immobile patients. The acute disease component might also sometimes be misleading.

For more information on nutritional health management, resources from the British Association for Parenteral and Enteral Nutrition (BAPEN), the developer of MUST, are available on their website: https://www.bapen.org.uk/.

Conclusion

The MUST score is a vital tool for preventing and managing malnutrition in the elderly by systematically identifying individuals at risk. Understanding what is the must score for the elderly and its interpretation is key for timely nutritional intervention. While it has limitations, the MUST score is a trigger for further comprehensive nutritional assessment and tailored care plans to improve outcomes for older adults.

Frequently Asked Questions

A high MUST score (≥ 2) indicates the elderly person is at a high risk of malnutrition. This requires immediate referral to a dietitian for a comprehensive nutritional assessment and the creation of an individualized care plan to address their specific needs.

For elderly individuals who cannot be weighed or measured for height accurately, healthcare professionals can use alternative methods. This includes measuring mid-upper arm circumference (MUAC) or ulna length to estimate their BMI and complete the screening process.

While the MUST tool is relatively simple, it is primarily designed for trained healthcare professionals to ensure accuracy and appropriate follow-up. Caregivers can use it as an indicator to raise concerns, but a professional assessment is crucial for accurate diagnosis and care planning.

The MUST tool has some limitations when used with older adults. It has been shown to have low sensitivity for detecting frailty, and the standard BMI cutoffs may not be sensitive enough for some geriatric populations. Accurate measurements can also be difficult for immobile patients.

Nutrition screening, like the MUST, is a quick process to identify risk factors for malnutrition. A full nutritional assessment is a more in-depth, specific evaluation by a dietitian to determine the cause and severity of any nutritional problems and define a treatment plan.

A very low BMI (<18.5) does contribute a score of 2, which places a person in the high-risk category. However, a person with a higher BMI could still have a moderate or high risk due to significant unintentional weight loss or an acute disease effect.

Once an elderly person is identified as high-risk, a dietitian can implement a personalized care plan. This may involve oral nutritional supplements, dietary modifications to increase energy and protein, and treating any underlying conditions contributing to malnutrition.

References

Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice. Always consult a qualified healthcare provider regarding personal health decisions.