Malnutrition in geriatric rehabilitation: prevalence, patient outcomes, and criterion validity of the dcored patient-generated subjective global assessment and the mini nutritional assessment

Marshall, Skye, Young, Adrienne, Bauer, Judith and Isenring, Elizabeth (2015) Malnutrition in geriatric rehabilitation: prevalence, patient outcomes, and criterion validity of the dcored patient-generated subjective global assessment and the mini nutritional assessment. Journal of the Academy of Nutrition and Dietetics, 116 5: 785-794. doi:10.1016/j.jand.2015.06.013


Author Marshall, Skye
Young, Adrienne
Bauer, Judith
Isenring, Elizabeth
Title Malnutrition in geriatric rehabilitation: prevalence, patient outcomes, and criterion validity of the dcored patient-generated subjective global assessment and the mini nutritional assessment
Journal name Journal of the Academy of Nutrition and Dietetics
ISSN 2212-2672
2212-2680
Publication date 2015-01-01
Sub-type Article (original research)
DOI 10.1016/j.jand.2015.06.013
Open Access Status Not yet assessed
Volume 116
Issue 5
Start page 785
End page 794
Total pages 10
Place of publication New York, NY United States
Publisher Elsevier
Language eng
Subject 1106 Food Science
2916 Nutrition and Dietetics
Abstract 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.
Formatted abstract
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.
Keyword Nutrition assessment
Malnutrition
Rehabilitation
Rural
Aged
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Human Movement and Nutrition Sciences Publications
 
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