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Use of the Patient-Generated Subjective Global Assessment to Identify Pre-Frailty and Frailty in Hospitalized Older Adults

  • Original Research
  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

The Scored Patient-Generated Subjective Global Assessment (PG-SGA) and Edmonton Frail Scale (EFS) are widely used in acute care settings to assess nutritional and frailty status, respectively. We aimed to determine whether the scored PG-SGA can identify pre-frailty and frailty status, to simultaneously evaluate malnutrition and frailty in clinical practice.

Design

Cross-sectional study.

Settings and Participants

A convenience sample of 329 consecutive patients admitted to an acute medical unit in South Australia.

Measurements

Nutritional and frailty status were ascertained with scored PG-SGA and EFS, respectively. Optimal cut-off scores to identify pre-frailty and frailty were determined by calculating the Scored PG-SGA’s sensitivity, specificity, positive and negative predictive values, Youden Index (YI), Liu index, Receiver Operator Curves (ROC) and Area Under Curve (AUC). Nutritional status and patient characteristics were analysed according to frailty categories.

Results

The optimal cut-off PG-SGA score as determined by the highest YI, to identify both pre-frailty and frailty was >3, with a sensitivity of 0.711 and specificity of 0.746. The AUC was 0.782 (95% CI 0.731–0.833). In this cohort, 64% of the patients were well-nourished, 26% were moderately malnourished and 10% were severely malnourished. Forty-three percent, 24% and 33% of the patients were classified as robust, pre-frail and frail, respectively. Bivariate analysis showed that those robust were significantly younger than those who were pre-frail (−2.8, 95% CI −5.5 to −0.1, p=0.036) or frail (−3.4, 95% CI −5.9 to −1.0, p=0.002). Robust patients had significantly lower Scored PG-SGA than those who were pre-frail (−2.5, 95%CI −3.8 to −1.1, p<0.001) or frail (−4.9, 95% CI −6.1 to −3.7, p<0.001).

Conclusion

The Scored PG-SGA is moderately sensitive in identifying pre-frailty/frailty in older hospitalized adults and can be useful in identifying both conditions concurrently.

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Acknowledgements

The authors would like to thank Dr Pawel Skuza in helping with statistical analyses. All authors would also like to thank respective Heads of Departments and nurse managers at the Flinders Medical Centre for facilitating the study.

Funding

Funding: This study is partially supported by Flinders University’s College of Nursing and Health Sciences Research Student Maintenance and the Australian Government Research Training Program Scholarship. In addition, in-kind support for the staff working on this project has been provided by the Flinders Medical Centre, Southern Adelaide Local Health Network. These supporting bodies have no influence over the study protocol.

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Authors and Affiliations

  1. Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, SA, 5042, Australia

    Chad Yixian Han, A. Yaxley, C. Baldwin & M. Miller

  2. College of Medicine and Public Health, Flinders University, Bedford Park, Australia

    Y. Sharma

  3. Department of General Medicine, Flinders Medical Centre, Bedford Park, Australia

    Y. Sharma

Authors
  1. Chad Yixian Han
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  2. Y. Sharma
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  3. A. Yaxley
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  4. C. Baldwin
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  5. M. Miller
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Contributions

Authors’ Contributions: CH, MM, YS, AY and CB contributed significantly to the study design. CH collected the data and drafted the manuscript. MM, YS, AY and CB made substantial contribution, analysed the data and edited the manuscript. All authors gave final approval of the published version.

Corresponding author

Correspondence to Chad Yixian Han.

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Competing interests: All authors declare that they have no competing interest.

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Han, C.Y., Sharma, Y., Yaxley, A. et al. Use of the Patient-Generated Subjective Global Assessment to Identify Pre-Frailty and Frailty in Hospitalized Older Adults. J Nutr Health Aging 25, 1229–1234 (2021). https://doi.org/10.1007/s12603-021-1704-5

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