Clinical guide
Malnutrition in Rehabilitation Patients
People arrive in rehabilitation after illness, surgery, or a long period of eating poorly. Low intake can show up as weakness and slow healing. Naming malnutrition is a nutrition assessment, not a therapy label.
Why it shows up in therapy
The Academy of Nutrition and Dietetics and ASPEN describe adult malnutrition using a set of characteristics that a trained nutrition professional applies after an assessment. Those characteristics include insufficient energy intake, weight loss, loss of muscle or fat, fluid accumulation, and reduced grip strength. A therapist may notice the functional pieces, especially weakness and poor session tolerance. Noticing them is a reason to refer, not a reason to enter a malnutrition diagnosis.
Risk indicators worth reporting
- The patient reports eating much less for more than a few days.
- Clothes or a wristband are looser, or the patient reports unplanned weight loss.
- A pressure injury or surgical wound is not progressing and intake is poor.
- The patient cannot finish meals because of pain, nausea, cognition, or a swallowing problem.
Interprofessional response
Tell the referring physician or the facility dietitian what you observed and what the patient said. If swallowing is the barrier, a speech-language pathologist is the right referral. Occupational therapy may address feeding setup, utensils, and mealtime routines. None of those referrals requires the therapist to prescribe a therapeutic diet.
Related resources
Screening
The step before a nutrition referral.
Protein
Why protein comes up, and why the dose is not universal.
State CEU directory
37 standard, 4 extra-documentation, 3 partner, and 6 not-approved classifications.
Learn screening before you teach it
The assessment course is for clinicians who have finished Introduction to Nutrition.