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

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 wellnourished, 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.

Validity of the Malnutrition Universal Screening Tool for Evaluation of Frailty Status in Older Hospitalised Patients

“…The MUST, specifically, does not include components which can measure muscle dysfunction. This is in contrast to some other nutritional tools such as the PG-SGA ( Jager-Wittenaar & Ottery, 2017 ) which includes measures of functional capacity and has been found to have a comparatively higher sensitivity (71.1%) and specificity (74.6%) for the detection of frailty in older hospitalised patients ( Han et al, 2021 ).…”

“…Therefore, it is possible that MUST can also be a useful measure of an acutely unwell hospital in-patient’s frailty status, but, such a role needs verification against an established frailty screening tool. Although previous studies have used the Mini-Nutritional Assessment (MNA) ( Dent et al, 2012 ) and the Patient Generated-Subjective Global Assessment (PG-SGA) ( Han et al, 2021 ) to assess frailty, we specifically used the MUST because compared to the other tools, this tool is less lengthy and is thus easy to administer in acute care settings.…”

The association between pre-operative malnutrition and post-amputation clinical outcomes: A systematic review

“…It can also detect pre-frailty/frailty, which is related to malnutrition, saving time for time-pressured clinicians. 45 In contrast, the PG-SGA SF omits physical examination and nutritional metabolic demands. Nevertheless, the study by Banning et al 27 provides the best evidence thus far on the prevalence of malnutrition risk in patients with had amputation.…”

Pre-Frailty and Frailty in Hospitalized Older Adults: A Comparison Study in People with and without a History of Cancer in an Acute Medical Unit

“…At present, there is no consensus on the optimum frailty screening or assessment tool for the geriatric oncology population [ 12 ]. In fact, frailty and pre-frailty can also be detected using non-frailty-specific assessment tools used in oncology populations (e.g., the scored patient-generated subjective global assessment (PG-SGA)), which is primarily a nutritional assessment tool [ 13 ]. While there is significant variability in how studies categorize frailty and pre-frailty within the older adult oncology population, addressing these conditions remains a priority in geriatric oncology research [ 12 , 14 ].…”