Dietary patterns reflect habitual exposure of foods and nutrients and are a preferred means to assess diet and disease relations. Our objective was to design a screening tool to assess diet quality and dietary patterns among older adults and to relate the patterns to markers of general health and nutrition status. We used a population-specific data-based approach to design a diet screening instrument that was tested among subjects sampled from the Geisinger Rural Aging Study cohort (n = 205). All participants attended a local clinic and had biochemical, anthropometric, and other health data collected. Dietary information was obtained via 24-h recall. We used principle components analysis to derive dietary patterns, which were then compared with nutritional outcomes using Pearson partial correlations, controlling for energy, age, BMI, and supplement use. Two dietary patterns were derived; 1 represented by more healthful foods and 1 by less optimal food choices. The healthy pattern was associated with more favorable biomarkers, more nutrient-dense diets, and lower waist circumference, whereas the converse was true for the second pattern. A screening tool can be used by older adults to identify dietary patterns that may relate to nutritional risk. J. Nutr. 137: 421-426, 2007.