Nurse-Led Nutritional Screening and Early Identification of Malnutrition Among Hospitalized Older Adults: A Scoping Review

Background/Objectives: Malnutrition is common in hospitalized older adults and is linked to functional decline, longer stay, readmission, and mortality. Nurses usually screen at admission, but evidence on nurse-led screening is scattered. This review mapped instruments, measurement properties, recognition and referral outcomes, and implementation barriers. Methods: A rapid scoping review followed the Joanna Briggs Institute methodology, PRISMA-ScR reporting, and the Population–Concept–Context framework. PubMed, Scopus, and Web of Science Core Collection were searched in June 2026 for studies published from 1 January 1999 to 31 July 2026; in July 2026, the evidence set underwent bibliographic and indexing verification only, with no search update. Two coauthors searched, screened, and charted the data; two others verified all decisions against full texts. Implementation findings were coded inductively without critical appraisal. Results: Of 1743 records, 1169 were screened and 18 included. Tools: MNA, MNA-SF, MST, MUST, NRS-2002, SNAQ. Standardized screening improved recognition; undernutrition identification rose from 38.6% to 73.1%. Nurse-administered MST reached 94% sensitivity and 89% specificity in a high-readmission-risk cohort, whereas nurse MNA-SF scoring showed ICC = 0.74 with only fair agreement (kappa = 0.37). Barriers included inconsistent scoring, limited nutrition knowledge, workload, and documentation gaps. Conclusions: Nurse-led screening is feasible and improves case finding, recognition, screening completion, and dietitian referral, although scoring errors and inter-rater disagreement persisted. No study measured complications, length of stay, readmission, functional decline, or mortality, so the evidence supports better identification, not better outcomes. Reported accuracy came from selected populations and single assessors. Future work should link screening fidelity to patient outcomes.