The nutrition screen is based on these warning signs of poor nutrition:

Disease

Eating poorly

Tooth loss, mouth pain

Economic hardship

Reduced social contact

Multiple medicines

Involuntary weight loss or gain

Need for assistance in self-care

Elderly (age > 80)

The mnemonic DETERMINE represents the warning signs and the questions in the screen.

Read the statements below. Circle the number in the “YES” column for those that apply to you or someone under your care. For each “YES” answer, score the number listed. Total your nutrition score.

YES

1. I have an illness or condition that made me change the kind and/or amount of food I eat.

2

2. I eat fewer than 2 meals per day.

3

3. I eat few fruits or vegetables, or milk products.

2

4. I have 3 or more drinks of beer, liquor, or wine almost every day.

2

5. I have tooth or mouth problems that make it hard for me to eat.

2

6. I don’t always have enough money to buy the food I need.

4

7. I eat alone most of the time.

1

8. I take 3 or more different prescribed or over-the-counter drugs a day.

1

9. Without wanting to, I have lost or gained 10 pounds in the last 6 months.

2

10. I am not always physically able to shop, cook, and/or feed myself.

2

TOTAL

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