Abstract: Elderly gastric cancer patients often have high rates of malnutrition, multiple chronic comorbidities, and elevated risks of surgery‑related complications. Among various nutritional risk screening tools, nutritional risk screening 2002, mini nutritional assessment, mini nutritional assess-ment short‑form, malnutrition universal screening tool (MUST), and geriatric nutritional risk index (GNRI) demonstrate superior screening efficacy and consistency for this population. While each tool has its unique advantages, MUST stands out as particularly effective, while GNRI shows greater utility for patients with cognitive impairments. Combining these nutritional risk screening tools, patient‑generated subjective global assessment and global leadership initiative on malnutrition also exhibit high accuracy and consistency in assessing the severity of malnutrition in elderly gastric cancer patients. Different nutritional risk screening and diagnostic tools each contribute positively in predicting surgery‑related complications, tumor clinical staging, postoperative survival time, hospital stays, and in‑hospital mortality in this population. Therefore, tailoring nutritional interventions based on individual characteristics of elderly gastric cancer patients during the perioperative period can enhance the efficacy of malnutrition risk screening and diagnosis, help predict surgical complication risks, and enable proactive nutritional support to improve surgical safety.