Because of the insidious nature of malnutrition in the elderly and its mimicking the usual aging process, it is important to recognize early warning signs of risks for malnutrition. Because the majority of individuals are encountered at times of a specific event (i.e., illness, injury, surgery, or annual examination) the physician needs to be cognizant of the triggers or alerts of poor nutritional health during history/physical and laboratory examinations for the particular event. Only then will early detection and applicable interventions provide a salutary paradigm shift towards prevention, whether primary, secondary, or tertiary. A high degree of suspicion, a thorough history, and physical examination coupled with pertinent laboratory data can identify the elderly at risk. Those in need of more comprehensive nutrition screen and assessment are examined with the tools developed by the NSI, which encompass not only the routine medical and dietary history and physical exam but also an expansive look at the older individual's psychosocial, functional, socioeconomic, and drug use aspects that are more indirect and significant determinants of risk. Based on parameters from a Level II Screen, measurable indicators are available that provide the nutrition assessment necessary for an overall healthcare plan of selected interventions. Future research should provide more practical, age, sex, and culturally specific nutrition parameters. The main factor in the implementation of a practical, comprehensive geriatric nutrition screening and assessment program is the clinician's imagination and motivation.