Bauer, Judith

Isenring, Elizabeth

Marshall, Skye

Young, Adrienne

Journal of the Academy of Nutrition and Dietetics

English

Marshall, S.

Young, A.

Bauer, J.

Isenring, E.

Bond University Research Portal

Malnutrition in geriatric rehabilitation: Prevalence, patient outcomes and criterion validity of the scored Patient-Generated Subjective Global Assessment (PG-SGA) and the Mini Nutritional Assessment (MNA)

Background: Accurate identification and management of malnutrition is essential so that patient outcomes can be improved and resources used efficaciously. Objectives: In malnourished older adults admitted to rehabilitation: 1) report the prevalence, health and aged care use, and mortality of malnourished older adults; 2) determine and compare the criterion (concurrent and predictive) validity of the Scored Patient-Generated Subjective Global Assessment (PG-SGA) and the Mini Nutritional Assessment (MNA) in diagnosing malnutrition; and 3) identify the Scored PG-SGA score cut-off value associated with malnutrition. Design: Observational, prospective cohort. Participants/setting: Participants were 57 older adults (65 years and older; mean±standard deviation age=79.1±7.3 years) from two rural rehabilitation units in New South Wales, Australia. Measurements/statistical analysis: Scored PG-SGA; MNA; and the International Statistical Classification of Diseases and Health Related Problems, 10th revision, Australian Modification (ICD-10-AM) classification of malnutrition were compared to establish concurrent validity and report malnutrition prevalence. Length of stay, discharge location, rehospitalization, admission to a residential aged care facility, and mortality were measured to report health-related outcomes and to establish predictive validity. Results: Malnutrition prevalence varied according to assessment tool (ICD-10-AM: 46%; Scored PG-SGA: 53%; MNA: 28%). Using the ICD-10-AM as the reference standard, the Scored PG-SGA ratings (sensitivity 100%, specificity 87%) and score (sensitivity 92%, specificity 84%, ROC AUC [receiver operating characteristics area under the curve]=0.910±0.038) showed strong concurrent validity, and the MNA had moderate concurrent validity (sensitivity 58%, specificity 97%, receiver operating characteristics area under the curve=0.854±0.052). The Scored PG-SGA rating, Scored PG-SGA score, and MNA showed good predictive validity. Malnutrition can increase the risk of longer rehospitalization length of stay, admission to a residential aged care facility, and discharge to hospital or residential aged care facility instead of home. Conclusions: Malnutrition prevalence in the geriatric rural rehabilitation population is high, and is associated with increased health and aged care use. The Scored PG-SGA ratings and score are suitable for nutrition assessment in geriatric rehabilitation. The MNA may be suitable for nutrition assessment in geriatric rehabilitation, but care should be taken to ensure all malnourished patients are identified. Additional examination of the criterion validity of the Scored PG-SGA and MNA will lend confidence to these findings.</p

Malnutrition in geriatric rehabilitation: Prevalence, patient outcomes, and criterion validity of the scored Patient-Generated Subjective Global Assessment and the Mini Nutritional Assessment

Young, Adrienne M

Bauer, Judith Dorothea

Isenring, Elisabeth

Bond UniversityResearch RepositoryMalnutrition in geriatric rehabilitation: prevalence, patient outcomes and criterion validity of theScored Patient-Generated Subjective Global Assessment (PG-SGA) and the Mini NutritionalAssessment (MNA)Marshall, Skye; Young, Adrienne M; Bauer, Judith Dorothea; Isenring, ElisabethPublished: 01/11/2015Document Version:Peer reviewed versionLink to publication in Bond University research repository.Recommended citation(APA):Marshall, S., Young, A. M., Bauer, J. D., & Isenring, E. (2015). Malnutrition in geriatric rehabilitation: prevalence,patient outcomes and criterion validity of the Scored Patient-Generated Subjective Global Assessment (PG-SGA) and the Mini Nutritional Assessment (MNA). Bond University Faculty of Health Sciences and MedicineHigher Degree Researcher Conference, Gold Coast, Australia.General rightsCopyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright ownersand it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.For more information, or if you believe that this document breaches copyright, please contact the Bond University research repositorycoordinator.Download date: 10 May 2019Skye MarshallDr. Adrienne Young, A/Prof. Judith Bauer, Prof. Elizabeth IsenringMalnutrition in geriatric rehabilitationPrevalence, patient outcomes and criterion validity of the Scored Patient-Generated Subjective Global Assessment (PG-SGA) and the Mini Nutritional Assessment (MNA) “Food and nutrient intake is unable to meet protein, energy and nutrient requirements over time leading to a disruption of homeostasis in lean tissues, body weight and physical function.”Skipper A. Agreement on defining malnutrition. Journal of Parenteral and Enteral Nutrition. 2012;36(3):26Kunert MP. Stress and Adaptation. In: Porth CM, editor. Pathophysiology, concepts of altered health states. 7th e.d. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 187 - 276.33-53%14-24%30-65%????????????(Observational cohort: Aug 2013-Feb 2014)In malnourished older adults admitted to rehabilitation: 1) Determine the criterion (concurrent and predictive) validity of nutrition assessment tools:• Scored Patient-Generated Subjective Global Assessment (PG-SGA) • Mini Nutritional Assessment (MNA) in diagnosing malnutrition;1) Report the prevalence, health and aged care use, and mortality of rural malnourished older adults.Methods of diagnosis at admission1. ICD-10-AM Classification of malnutrition (yardstick)2. Scored Patient-Generated Subjective Global Assessment (PG-SGA)3. Mini Nutritional Assessment (MNA)Longitudinal outcomes at discharge1. Discharge location (home/hospital/other)2. Length of rehabilitation stayLongitudinal outcomes at 12 weeks post-discharge1. Admission to residential aged care at 12 weeks post-discharge2. Mortality at 12 weeks post-discharge3. Rehospitalisation length of stay at 12 weeks post-dischargeParticipants:• Rehabilitation inpatients in rural NSW• n=57, 79 years, 49% female• Live at home usually• Usual care (0.15FTE dietitian)That’s a lot of acronyms Skye... Methods of diagnosis at admission1. ICD-10-AM Classification of malnutrition (yardstick)2. Scored Patient-Generated Subjective Global Assessment (PG-SGA)3. Mini Nutritional Assessment (MNA)Criterion validity:1) Concurrent validity: compared to accepted standard- ICD-10-AM (hospital coding for malnutrition)- Sensitivity and specificity (%)2) Predictive validity- Health and aged care outcomes- Significant difference (t-test or chi-squared)Classification DefinitionE43: Unspecified severe protein-energy malnutritionIn adults, BMIa <18.5 kgb/mc2 or unintentional loss of weight (≥10%) with evidence of suboptimal intake resulting in severe loss of subcutaneous fat and/or severe muscle wastingE44.0: Moderate protein-energy malnutritionIn adults, BMI <18.5 kg/m2 or unintentional loss of weight (5-9%) with evidence of suboptimal intake resulting in moderate loss of subcutaneous fat and/or moderate muscle wastingE44.1: Mild protein-energy malnutritionIn adults, BMI <18.5 kg/m2 or unintentional loss of weight (5-9%) with evidence of suboptimal intake resulting in mild loss of subcutaneous fat and/or mild muscle wastingThe International Statistical Classification of Diseases and Health Related Problems 10th Revision Australian Modification (sixth edition, ICD-10-AM) classifications for protein-energy malnutrition in adults • Global rating:• A = Well-nourished• B = Moderately malnourished• C = Severely malnourished• Score: ≥9 in adult oncology patientsGlobal rating (A, B, C) criterion validity in geriatric rehabilitation patients?• Sensitivity 100%• Specificity 87%• Can predict • rehospitalisation LOS (P=0.005)• admission to RACF (P=0.008)• discharge location (P=0.046)= STRONG CRITERION VALIDITYScore (≥7) criterion validity in geriatric rehabilitation patients?• Sensitivity 92%• Specificity 84%• ROC AUC 0.910±0.038• Can predict • rehospitalisation LOS (P=0.03)• discharge location (P=0.033)= STRONG CRITERION VALIDITYWe recommend for use in geriatric rehabilitation • Scored 0 – 30 points. Categories:• <17 = malnourished• 17 – 23.5 = risk of malnutrition• 24 – 30 = well-nourishedCategories’ criterion validity in geriatric rehabilitation patients?• Sensitivity 58%• Specificity 97%• Can predict • rehospitalisation (P=0.023)• admission to RACF (P=0.034)• discharge location (P=0.019)= MODERATE CRITERION VALIDITYWe recommend to use with caution in geriatric rehabilitation Malnutrition prevalence was 46% (ICD-10-AM)Variable Well-nourished (n=31) Malnourished (n=26) P-valueRehabilitation LOSa (days), median (IQRb) 23.0 (16.0-37.5) 22.0 (13.75-32.75) NSRehospitalization LOS (days), median (IQR)c 4.0 (1.0-14.75) 10.0 (7.0-36.0) 0.032Rehospitalization incidence- Median (IQR)c- Counts (%)2.0 (1.0-2.0)n=12 (38.7%)1.0 (1.0-2.0)n=11 (38.5%)NSDischarge location, counts (%)- Home- Otheren=27 (87.1%)n=4 (12.9%)n=17 (65.4%)n=9 (34.6%)0.052Admitted to RACFg, counts (%) n=4 (12.9%) n=7 (26.9%) NSMortality, counts (%) n=0 n=3 (11.5%) 0.052• Generalisability• Limitation in yardstick• Smallish sample size• Researcher bias

Malnutrition in geriatric rehabilitation: prevalence, patient outcomes and criterion validity of the Scored Patient-Generated Subjective Global Assessment (PG-SGA) and the Mini Nutritional Assessment (MNA)

Skye Marshall

Adrienne Young

Judith Bauer

Elizabeth Isenring

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Malnutrition in Geriatric Rehabilitation: Prevalence, Patient Outcomes, and Criterion Validity of the Scored Patient-Generated Subjective Global Assessment and the Mini Nutritional Assessment

https://pure.bond.edu.au/ws/files/30056805/HSM_HDR_S_MARSHALL.pdf

Malnutrition in geriatric rehabilitation: Prevalence, patient outcomes, and criterion validity of the scored Patient-Generated Subjective Global Assessment and the Mini Nutritional Assessment

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