The aim of this study was to (1) determine the prevalence of malnutrition and (2) investigate factors affecting nutritional status of older persons living in urban areas of Lake Victoria Basin. The prevalence of underweight was 16.5%, with men (24.1%) being significantly more likely to be underweight (P < 0.05) than women (12.3%). Overall, 61.2% had normal body mass indices, 13.2% were overweight, and 9.1% were obese. Energy intake was low (1596.3-1630.5 Kcal), with only 22% and 38% of men and women, respectively, meeting their daily requirements. Protein intake was adequate in more than half of men and women. Vitamin A, iron, and zinc intakes were moderate, while calcium intake was low (P < 0.05). Inadequate food access, poor health, living arrangements, and poor eating patterns were the main nutritional risk factors. There is a need to plan nutrition programs that can improve living conditions, health, and nutritional status of older adults in these urban areas of the Lake Victoria Basin.