Geriatric Malnutrition Risk Assessment
Patient Information
Name
Age
Gender
Anthropometry
Height (cm)
Weight (kg)
BMI
Nutritional Intake
Has food intake declined over the past 3 months?
Medical Factors
Acute disease or psychological stress in past 3 months?
Presence of mobility issues?
Physical Assessment
Signs of muscle wasting or loss of subcutaneous fat
Other Notes