Background: The benefit of providing early nutrition intervention and its continuation post-discharge in older hospitalized patients is unclear. This study examined efficacy of such an intervention in older patients discharged from acute care. Methods: In this randomized controlled trial, 148 malnourished patients were randomized to receive either a nutrition intervention for 3 months or usual care. Intervention included an individualized nutrition care plan plus monthly post-discharge telehealth follow-up whereas control patients received intervention only upon referral by their treating clinicians. Nutrition status was determined by the Patient Generated Subjective Global Assessment (PG-SGA) tool. Clinical outcomes included changes in length of hospital stay, complications during hospitalization, Quality of life (QoL), mortality and readmission rate. Results: Fifty-four males and 94 females (mean age, 81.8 years) were included. Both groups significantly improved PG-SGA scores from baseline. There was no between-group differences in the change in PG-SGA scores and final PG-SGA scores were similar at 3 months 6.9 (95% CI 5.6–8.3) vs. 5.8 (95% CI 4.8–6.9) (P ¼ 0.09), in control and intervention groups, respectively. Median total length of hospital stay was 6 days shorter in the intervention group (11.4 (IQR 16.6) vs. 5.4 (IQR 8.1) (P ¼ 0.01). There was no significant difference in complication rate during hospitalization, QoL and mortality at 3-months or readmission rate at 1, 3 or 6 months following hospital discharge. Conclusion: In older malnourished inpatients, an early and extended nutrition intervention showed a trend towards improved nutrition status and significantly reduced length of hospital stay.