The Geisinger Rural Aging Study (GRAS) was initiated between 1994-99 as a longitudinal study of health outcomes in relation to nutritional status among 21,645 individuals ≥65-years of age. At the time of initiation, the participants were recruited from within the Geisinger Health System service area located in about 25 counties of north central and eastern Pennsylvania. Active participant data collection is complete but passive data collected through the Electronic Health Record continues for those surviving. Prior patient reported data were collected at baseline and at a rescreening visit occurring 3-4 years after baseline, using questionnaires that encompass multiple domains of nutrition risk. Our investigations have found high prevalence of poor-quality diets, obesity, and ill health. Low diet quality as revealed by the Diet Quality Screening Questionnaire (DQSQ) is associated with outcomes measured within our electronic medical record (low body mass index, increased co-morbidity, and increased mortality risk). The GRAS dataset currently spans more than two decades including patient reported data, clinical data captured within an electronic medical record, and includes novel sub-cohorts such as the oldest old (≥85 years) and centenarians (≥100 years).