Despite growing recognition of nutrition as a cornerstone of healthy aging, malnutrition among older adults remains one of the most preventable yet persistent drivers of poor health outcomes, avoidable hospitalizations, and rising healthcare costs across the country.  

For more than a decade, Defeat Malnutrition Today and the Malnutrition Quality Improvement Initiative (MQii) have studied the impact of malnutrition, advocated for policy change, and supported health systems in improving their approach to nutrition care. In 2017 – and again in 2020 – the organizations collaborated with malnutrition and healthy aging experts from around the country to design a National Blueprint for Achieving Quality Malnutrition Care for Older Adults. This comprehensive framework guided stakeholders in healthcare delivery and policy in the actions needed to advance prevention, identification, treatment, research, and public health action towards malnutrition in older adults. Five years have elapsed since the National Blueprint’s goals and calls for actions were issued, so Avalere Health conducted an assessment in late 2025 to determine where progress has been made and where gaps persist. We are pleased to announce the release of findings in a new white paper, Advancing Malnutrition Care Quality for Older Adults: Progress, Gaps, and Strategic Recommendations Towards Achieving the 2020 National Blueprint.  

The assessment found that considerable progress has occurred in acute settings, anchored to the launch of the Malnutrition Care Score (formerly the Global Malnutrition Care Score) into the CMS Inpatient Quality Reporting program (IQR), transforming malnutrition from an underrecognized condition to the forefront as a measurable component of hospital performance. This progress is also bolstered by CMS’s adoption of Age-Friendly Health Systems, which focuses on the unique needs of older adults and includes malnutrition as a key component of quality hospital care. These milestones have driven clinical awareness, improved patient identification and documentation workflows, and further embedded registered dietitian nutritionists (RDNs) into interdisciplinary teams. 

While hospital stays are critical for identifying malnutrition and putting appropriate nutrition care plans in place, the condition requires sustained attention and support as patients transition into post-acute and community settings. Yet substantial gaps in malnutrition care quality remain outside hospitals. Post-acute facilities continue to face limited RDN availability, gaps in transition-of-care data exchange, and a lack of malnutrition-specific quality measures within regulatory reporting frameworks to act as a forcing function and benchmark performance. Effective communication of care needs and plans at transitions between settings is a major issue in every clinical area of healthcare but is especially problematic in malnutrition as treatment plans do not usually involve pharmacologic therapy – and medication lists are the most likely piece of information to be transferred to the next care provider. Another common thread across settings is the need for more patient-centered approaches to clinical nutrition care.  Research has shown that patients and caregivers feel there is a need to better incorporate their own values, needs, preferences into nutrition care plans in the hospital and post-acute care.  

With focused collaboration and building on progress around recognizing that malnutrition is foundational to preventive care, we identified four priority areas for action: 

• Expand Nutrition-Focused Quality Measures Across Settings 

• Strengthen Workforce Capacity 

• Improve Infrastructure for Seamless Transitions 

• Unite Stakeholders Under Shared Evidence-Based Frameworks 

By leveraging proven tools and supporting them with strong policy levers at CMS and the Innovation Center, we can transform nutrition care delivery from sporadic intervention to sustained practice change that invests in and supports healthier aging for millions of Americans for generations to come.  

The full assessment, Advancing Malnutrition Care Quality for Older Adults: Progress, Gaps, and Strategic Recommendations Towards Achieving the 2020 National Blueprint, can be downloaded here.