The warning signs of poor nutritional 

health are often overlooked. Use this 

checklist to find out if you or someone you 

know is at nutritional risk. 

Read the statements below. Circle the number in the 

yes column for those that apply to you or someone 

you know. For each yes answer, score the number 

in the box. Total your nutritional score. 

Determine 

Your 

Nutritional 

Health 

YES 

I have an illness or condition that made me change the kind and /or amount of food I eat. 2 

I eat fewer than two meals per day. 3 

I eat few fruits or vegetables, or milk products. 2 

I have three or more drinks of beer, liquor or wine almost every day. 2 

I have tooth or mouth problems that make it hard for me to eat. 2 

I don't always have enough money to buy the food I need. 4 

I eat alone most of the time. 1 

I take three or more different prescribed or over-the-counter drugs a day. 1 

Without wanting to, I have lost or gained 10 pounds in the last six months. 2 

I am not always physically able to shop, cook and/or feed myself. 2 

TOTAL 

Total your nutritional score. If it's --

0-2 Good! Recheck your nutritional score in 6 months.

3-5 You are at moderate nutritional risk.

See what can be done to improve your eating habits 

and lifestyle. Your office on aging, senior nutrition 

program, senior citizens center or health department 

can help. Recheck your nutritional score in 3 months. 

6 or 

mor 

e 

You are at high nutritional risk. Bring this checklist the next time you see your doctor, dietitian or other 

qualified health or social service professional. Talk 

with them about any problems you may have. Ask for 

help to improve your nutritional health. 

Remember that warning signs 

suggest risk, but do not represent diagnosis of any condition. 

Turn the page to learn more 

about the Warning Signs of 

poor nutritional health. 

Questions
 

 

 

 

The Nutrition Checklist is based on the warning signs described below. 

Use the word DETERMINE to remind you of the warning signs. 

Disease

Any disease, illness or chronic condition that causes you to change the way you eat, or makes it 

hard for you to eat, puts your nutritional health at risk. Four out of five adults have chronic diseases 

that are affected by diet. Confusion or memory loss that keeps getting worse is estimated to affect 

one out of five or more of older adults. This can make it hard to remember what, when or if you've 

eaten. Feeling sad or depressed, which happens to about one in eight older adults, can cause big 

changes in appetite, digestion, energy level, weight and well-being. 

Eating Poorly 

Eating too little and eating too much both lead to poor health. Eating the same foods day after day or 

not eating fruit, vegetables and milk products daily will also cause poor nutritional health. One in five 

adults skips meals daily. Only 13 percent of adults eat the minimum amount of fruits and vegetables 

needed. One in four older adults drinks too much alcohol. Many health problems become worse if 

you drink more than one or two alcoholic beverages per day. 

Tooth Loss/Mouth Pain

A healthy mouth, teeth and gums are needed to eat. Missing, loose or rotten teeth or dentures which 

don't fit well or cause mouth sores make it hard to eat. 

Economic Hardship

As many as 40 percent of older Americans have incomes of less than $6,000 per year. Having less--

or choosing to spend less--than $25 to $30 per week for food makes it very hard to get the foods you 

need to stay healthy. 

Reduced Social Contact

One-third of all older people live alone. Being with people daily has a positive effect on morale, 

well-being and eating. 

Multiple Medicines

Many older Americans must take medicines for health problems. Almost one half of older Americans 

take multiple medicines daily. Growing old may change the way we respond to drugs. The more 

medicines you take, the greater the chance for side effects such as increased or decreased appetite, 

change in taste, constipation, weakness, drowsiness, diarrhea, nausea and others. Vitamins or 

minerals when taken in large doses act like drugs and can cause harm. Alert your doctor to 

everything you take. 

Involuntary Weight Loss/Gain

Losing or gaining a lot of weight when you are not trying to do so is an important warning sign that 

must not be ignored. Being overweight or underweight also increases your chance of poor health. 

Needs Assistance in Self Care

Although most older people are able to eat, one of every five has trouble walking, shopping, buying 

and cooking food, especially as they get older. 

Elder Years Above Age 80

Most older people lead full and productive lives. But as age increases, risk of frailty and health 

problems increase. Checking you nutritional health regularly makes good sense. 

The Nutrition Screening Initiative • 1010 Wisconsin Avenue, NW • Suite 800 • Washington, DC 20007

The Nutrition Screening Initiative is funded in part by a grant from Ross Products Division of Abbott Laboratories, Inc.