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Malnutrition Learning 

Collaborative - State Resources

The 2020 Older Americans Act (OAA) reauthorization and subsequent guidance 

incorporated reduce malnutrition to the purpose of the Senior Nutrition Services. 

With this addition it allows states to identify how to address malnutrition in the OAAfunded programs. This resource guide is meant to serve as a suggested set of steps 

for incorporating malnutrition into your state plan on aging and beginning to 

address older adult malnutrition across your state.

Step 1: Educate Yourself about Malnutrition

Some basic materials to educate yourself about older adult malnutrition include:

• The Nutrition and Aging Resource Center-this site has a dedicated page for 

malnutrition resources including handouts, toolkits, and innovative examples 

across the network.

• Defeat Malnutrition Today website – this site, run by the Defeat Malnutrition 

Today coalition, has a wide range of resources on older adult malnutrition for 

both providers and consumers.

• National Blueprint: Achieving Quality Malnutrition Care for Older Adults, 2020 

Update – this Defeat Malnutrition Today publication provides an overview of 

the condition of malnutrition and steps that various stakeholders can take to 

address it

• Malnutrition in Older Adults—Recent Advances and Remaining Challenges –

this article details the challenges of understanding, identifying, and treating 

malnutrition in older adults
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• Nutrition-Related Policy Fundamentals for Supporting Older Adults in the

Community during a Pandemic: Lessons from COVID-19 – this article provides 

ideas to improve congregate and home-delivered meal programs postpandemic

Step 2: Incorporate Malnutrition into Your State Plan

Next, your state plan should reference older adult malnutrition. 

Some resources to assist you in doing this during your state plan’s update process, 

include sample plan language:

• ADvancing States has a Map of State Plans on Aging, which includes every 

state’s State Plan on Aging (SPA) including those with references to

malnutrition.

• Advancing states has a “tools for planning” webpage focused on SPA 

development: that includes a link to a checklist for SPA requirements

• Malnutrition-related Conditions and Interventions in US State/Territorial Older

Americans Act Aging Plans – this article looks at malnutrition in current state 

aging plans and gives ideas for additions/improvements

• Review sample malnutrition language from other states: 

o Ohio State Plan on Aging Malnutrition Excerpt

▪ Outcome to Improve Nutrition with the strategy, “Malnutrition 

prevention and treatments.” Across strategies, meals should be 

adjusted for cultural considerations and preferences and 

medically tailored to the maximum extent practicable. Examples 

include community gardens, mobile produce markets, nutrition 

service programs for older adults, expand SNAP-ed, increase 

malnutrition screening and intervention, improve discharge 

planning, and provide Stepping Up Your Nutrition. 

o Maryland State Plan on Aging Malnutrition Excerpt

▪ Focus Area of, “Addressing Food Insecurity & Malnutrition.” 

Increase the availability of promising and evidence-based 

programs and practices that empower individuals to improve 

the quality of their health, independence and well-being. 

Beginning in FY 2016, the Department will engage key 

stakeholders to create nutrition and health-related community 
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interventions to address malnutrition. The vision is to bring 

together businesses, healthcare agencies, professional groups 

and community organizations to develop tools that will positively 

impact malnutrition-related population health outcomes. 

Additionally, address the negative impacts of malnutrition and 

falls through the development of training modules and 

awareness campaigns.

• For further sample language, here are additional State Plans on Aging who 

mention malnutrition (current as of 2023)

o Arizona ; Colorado ; Georgia ; Iowa ; Indiana ; Kansas ; Massachusetts; 

Minnesota ; Missouri ; Montana ; New Mexico ; New York ; Oklahoma ; 

Texas ; Virginia ; Utah ; Wisconsin

Step 3: Set Targets and Other Goals

Your state may consider setting targets and other goals for preventing and 

addressing malnutrition. One case study is provided here:

Goal Setting Examples from Massachusetts (MA)

• Goal: identify and reduce malnutrition prevalence in MA

o Initiate the use of a malnutrition screener statewide to identify 

malnutrition prevalence in the service population of each area agency 

on aging (AAA)

▪ MA used the Malnutrition Screening Tool (MST) (MST is discussed 

in more detail in a future section) to establish a baseline of 

malnutrition prevalence

o Set percentage goals for reducing malnutrition from the baseline, such 

as “XX% people who are identified as at risk for malnutrition are 

receiving counseling or other forms of intervention”

o Conduct training on how to use the selected screening tool with local 

AAAs 

o Conduct training with case managers on a routine basis and/or add 

this information in the new case manager information package

• Goal: reduce food insecurity among MA older adults
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o Increase rates of SNAP (Supplemental Nutrition Assistance Program)

enrollment among eligible older adults, working together with the state 

social services agency administering SNAP benefits

▪ You can find your own state’s SNAP enrollment rate here.

▪ In MA, the agencies partnered to address instances of missed 

interview appointments among eligible older adults

▪ A pilot program called the Bay State CAP for SSI recipients to 

quickly enroll in SNAP is administered through local Social 

Security offices

▪ MA focused on AAAs and counties with populations of lower 

socioeconomic status and costs of living higher than average, 

collaborating with these local communities to do more SNAP 

outreach and education

• Goal: increase food access for MA older adults, especially among harder-toreach clients

o MA provides frozen home-delivered meals via 7-Day Total Meal

SystemsTM

o Local markets and/or food banks host a mobile market at senior 

centers and other meal sites at least once a month and provide premade grocery bags

o Older adults can receive Commodity Supplemental Food Program

(CSFP) benefits and SNAP benefits at the same time

• Goal: raise awareness of malnutrition and food insecurity among MA older 

adults, caregivers, care managers, and the general public

o Hosted a “Be a Nutrition Neighbor” social media campaign during 

Malnutrition Awareness Week in October 2021 (some images are also 

included as an appendix to this resource guide)

o Created a malnutrition awareness and prevention toolkit and used the 

Stepping Up Your Nutrition training program (which originated in 

Maryland)

o Used menu backs and other public announcements

Step 4: Collect Data and Promote Screening

Next, consider collecting your state’s baseline data on malnutrition prevalence. One 

example of malnutrition data collected from Massachusetts, a five-year report

submitted to the State Legislature, is linked.
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In order to do this, consider promoting malnutrition screening in your state among 

AAAs, local providers, and the general public.

Getting AAA/Local Stakeholder Buy-in

The first step to getting buy-in is by starting the conversation. During your 

conversation, discuss the following:

• Give a basic overview of the topic of malnutrition and risk factors if necessary 

and explain the new OAA requirements

• Identify a screening tool that meets the needs of the agency.

• Show stakeholders that screening won’t add more time to their day

▪ This webinar provides ideas on the benefits of screening tools

▪ This malnutrition toolkit for AAA is also helpful

• Provide resources for stakeholders to use for follow-up for those who screen at 

risk for malnutrition

• Encourage using a consistent, simple process – the main barrier many 

stakeholders cite is TIME

• Explain what stakeholders can gain financially by addressing malnutrition: 

additional external resources and interest, pathways to reimbursement for 

medical nutrition, and potential new revenue sources

• Group discussion resources:

o Promotional flyer

o Conversation sign-in and notes

o Malnutrition Conversation Template/Next Steps Form 

General Social Media and Awareness Notes and Resources

• Massachusetts “Be a Nutrition Neighbor” 2021 social media campaign (some 

images are also included as an appendix to this resource guide)

• Massachusetts malnutrition awareness and prevention toolkit

• You need to know your audience and have separate posts for separate 

audiences (community, providers, etc.)

• Partner with senior centers, chambers of commerce, counties, caregivers and 

their support organizations; refer to entry point such as AAA or aging and 

disability resource center (ADRC)

• Another idea to consider is partnering with local news outlets to provide social 

media PSAs
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Step 5: Training Providers and Identifying High-Risk Older 

Adults

Next, train local providers to begin identifying high-risk older adults. 

Training Resources

• Stepping Up Your Nutrition training program (2.5 hours long) – a great 

resource for case managers or AAA staff

• National Council on Aging website

• Defeat Malnutrition Today Consumer Resource Hub

Screening Tools and Identifying High-Risk Older Adults

• Ohio has created a combination malnutrition and food Insecurity risk 

screening tool (supporting research paper)

• A food security screener tool for prioritizing home-delivered meals

• This presentation by Pam VanKampen (Wisconsin) on the topic of the addition

of the Malnutrition Screening Tool and Food Security Screening Tool to the

registration and assessment forms for nutrition services (PowerPoint

Presentation; on the ENP Vimeo Training Page)

• Enhanced DETERMINE process by Pam

VanKampen, is a checklist developed in

Wisconsin to additionally screen for nutrition risk

• SCREEN Tools

• There are multiple validated malnutrition 

screening tools (See this review for more 

details)

o Malnutrition Screening Tool, or MST, is a 

two question screener endorsed by many nutrition 

organizations. See the screener on the right.

Step 6: Collaboration with Other Partners

Your state should bring all possible partners into this effort. Some resources to assist:

Working with Healthcare Entities

• International Council on Active Aging/Defeat Malnutrition Today webinar with 

examples of hospital-community partnerships for malnutrition and food 
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insecurity, “Strengthening the hospital-community connection: working 

together to address malnutrition” recording.

• An academic article on Opportunities to Improve Quality Outcomes:

Integrating Nutrition Care Into Medicare Advantage to Address Malnutrition

and Support Social Determinants of Health

Collaborating with the Community

• The Opportunity for Quality Malnutrition Care to Improve Rural Health 

Outcomes and Health Equity for Older Americans – this article has ideas for

community resources (national and local), especially in rural areas 

Further Reading

Peer-reviewed Publications

• Are You Prepared for the Decade of Healthy Aging 2020-2030?

• Opportunities for Adding Undernutrition and Frailty Screening Measures in US

National Surveys

• Screening Community-Living Older Adults for Protein Energy Malnutrition and

Frailty: Update and Next Steps

• Prevalence and Economic Burden of Malnutrition Diagnosis Among Patients

Presenting to United States Emergency Departments

• Measuring Malnutrition and Food Insecurity to Facilitate Quality Care and

Health Equity (2022 Supplement to the Journal of the Academy of Nutrition 

and Dietetics)

• Malnutrition Quality Improvement Initiative Yields Value for Interdisciplinary

Patient Care and Clinical Nutrition Practice (2019 Supplement to the Journal of 

the Academy of Nutrition and Dietetics)

Other Publications/Resources

• Malnutrition Quality Improvement Initiative (MQii) Roundtable

Proceedings/Malnutrition and Health Equity

• Malnutrition Quality Improvement Initiative (MQii) website
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Appendix: Sample Social Media Images from MA 

Campaign
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