Which of the following is an approach for nutrition screening of the elderly?

Oct 7, 2025 3 min read •

nutrition Geriatrics Health Screening

According to the World Health Organization, malnutrition includes deficiencies or imbalances in a person's nutrient intake, a condition that is prevalent among older adults. A validated approach for nutrition screening of the elderly is the use of specialized tools, such as the Mini-Nutritional Assessment (MNA) or Subjective Global Assessment (SGA), to identify malnutrition or risk of malnutrition and facilitate timely intervention.

Quick Summary

Several methods are available for screening nutritional status in older adults, including the validated Mini-Nutritional Assessment (MNA) Short-Form and the Subjective Global Assessment (SGA). These approaches systematically evaluate factors like weight change, food intake, and functional capacity to identify individuals at risk for malnutrition.

Key Points

MNA-SF is a widely used questionnaire: The Mini-Nutritional Assessment Short-Form (MNA-SF) is a quick, non-invasive tool used to screen for malnutrition risk in older adults based on diet, weight loss, and other factors.
SGA is a comprehensive clinical assessment: The Subjective Global Assessment (SGA) relies on a healthcare professional's medical history review and physical examination to classify a patient's nutritional status.
GNRI uses objective lab data: The Geriatric Nutritional Risk Index (GNRI) calculates a patient's nutritional risk using serum albumin levels and a weight ratio, making it an objective measure for hospitalized patients.
Screening facilitates early intervention: Using a validated tool to screen for malnutrition risk allows healthcare providers to identify vulnerable individuals early and implement interventions to prevent poor outcomes.
Choice of tool depends on the setting: The most appropriate screening tool depends on the clinical environment (community vs. hospital) and patient population, with consistency being the most important factor.
Screening is not a diagnosis: Nutritional screening identifies risk, but a comprehensive nutritional assessment by a registered dietitian is necessary for a formal diagnosis of malnutrition.

The Mini-Nutritional Assessment (MNA) Short-Form

The Mini-Nutritional Assessment (MNA) Short-Form (MNA-SF) is a widely used and validated tool specifically designed for nutrition screening of the elderly, typically those aged 65 and over. It is known for being quick, simple, and non-invasive. The MNA-SF is designed to be completed in under five minutes, making it practical for use in various settings.

The MNA-SF consists of six questions assessing food intake decline, unintentional weight loss, mobility, psychological stress, neuropsychological problems, and Body Mass Index (BMI). Calf circumference can be used if height and weight are not obtainable. Scores categorize individuals as having normal nutritional status, being at risk of malnutrition, or being malnourished. This screening can lead to a more comprehensive nutritional assessment if needed.

The Subjective Global Assessment (SGA)

The Subjective Global Assessment (SGA) is another valuable approach that uses a comprehensive assessment of medical history and physical examination to classify nutritional status. Used in various patient populations, including the elderly, it classifies individuals as well-nourished, moderately malnourished, or severely malnourished.

The SGA evaluates medical history components such as weight changes, dietary intake changes, gastrointestinal symptoms, and functional capacity. It also includes a physical examination to identify signs of malnutrition like loss of subcutaneous fat, muscle wasting, edema, and ascites. While it includes clinical judgment, making it subjective, the SGA is a practical and well-documented method when administered by trained professionals.

Geriatric Nutritional Risk Index (GNRI)

The Geriatric Nutritional Risk Index (GNRI) is specifically for identifying elderly patients at risk of nutrition-related complications. This objective screening method uses easily obtainable clinical data.

The GNRI is calculated using serum albumin levels and the ratio of actual body weight to ideal body weight. The resulting score indicates the level of nutritional risk:

High Risk: GNRI score below 92
Low Risk: GNRI score between 92 and 98
No Risk: GNRI score above 98

The GNRI is effective in identifying nutritional risk in hospitalized geriatric patients and can predict adverse outcomes. It helps identify vulnerable individuals who may benefit from early nutritional interventions.

Comparison of Common Nutritional Screening Approaches


Feature	Mini-Nutritional Assessment Short-Form (MNA-SF)	Subjective Global Assessment (SGA)	Geriatric Nutritional Risk Index (GNRI)
Target Population	Geriatric patients (65+ years)	Various patient populations, including geriatric	Geriatric medical patients
Methodology	Questionnaire-based; 6 questions and anthropometrics	Interview, history, and physical examination	Calculation-based; uses serum albumin and weight
Time to Complete	Less than 5 minutes	Can take longer due to interview and exam	Quickly calculated with lab results
Invasiveness	Non-invasive	Non-invasive	Minimally invasive (requires blood draw for albumin)
Main Components	Food intake, weight loss, mobility, stress, cognitive issues, BMI	Weight change, dietary intake, GI symptoms, fat/muscle wasting, edema	Serum albumin level, ratio of actual to ideal body weight
Scoring	Numeric score (0-14); Categorical output	Clinical classification (A, B, C)	Numeric score; Categorical output
Primary Strength	Quick, simple, and validated for the elderly	Comprehensive, includes physical exam findings	Objective, relies on specific lab values

Conclusion

Identifying and managing malnutrition in the elderly is vital. The MNA-SF is a practical, widely accepted tool for identifying risk in individuals aged 65 and over. The SGA offers a comprehensive, albeit subjective, approach using patient history and physical examination. The GNRI provides an objective, calculation-based method suitable for hospitalized patients with available lab data. These tools help identify at-risk individuals, enabling early intervention to improve outcomes and reduce costs associated with malnutrition. The best approach depends on the setting and patient condition, with consistent use of a validated tool being crucial.

Frequently Asked Questions

The Mini-Nutritional Assessment Short-Form (MNA-SF) is one of the most widely used and validated tools for identifying malnutrition or the risk of malnutrition in older adults aged 65 and above, especially in clinical and long-term care settings.

The Subjective Global Assessment (SGA) is unique because it combines elements of a medical history (e.g., weight change, dietary intake) with a physical examination (e.g., muscle wasting, edema), resulting in a subjective but comprehensive clinical classification of nutritional status.

The Geriatric Nutritional Risk Index (GNRI) is used to predict nutrition-related complications in hospitalized elderly patients. It provides an objective risk score based on serum albumin levels and the ratio of actual-to-ideal body weight.

Yes, many nutritional screening tools, including the MNA-SF, are designed to be administered by any trained healthcare professional, a caregiver, or even the patient themselves. A dietitian's intervention is typically required only after a risk is identified.

After an initial screening identifies a nutritional risk, a more in-depth nutritional assessment is conducted. This is often followed by a personalized intervention plan, which can include dietary counseling, nutritional supplements, or addressing underlying issues to improve the patient's nutritional status.

Nutritional screening is important because malnutrition is highly prevalent and often underdiagnosed in the elderly. It is associated with negative health outcomes, including increased morbidity, mortality, and healthcare costs.

Some screening tools, like the MNA-SF, include components that account for neuropsychological problems, such as dementia. In cases of severe cognitive impairment, information can be gathered from caregivers, but some subjective questions may be difficult for the patient to answer.

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.