JAGS
MAY 2015–VOL. 63, NO. 5
RESPONSE TO SAFER AND KULCU To the Editor: We thank Safer and Kulcu1 for their valuable comments on our recent article.2 They made important points about measuring lean body mass using bioimpedance analysis (BIA). In the Korean Longitudinal Study on Health and Aging (KLoSHA), body composition of participants was measured on the same day that blood chemistries, including cholesterol and glucose, were measured after at least 10 hours of overnight fasting.3,4 Consequently, we believe that the possible influence on the difference in total body water status from fluid or food intake would have been attenuated. We could not fully investigate the longitudinal change of diuretic use in participants with hypertension, but few participants were taking diuretics for hypertensive monotherapy in the baseline study.3 Furthermore, a literature search showed that taking diuretics was not associated with a significant difference in water balance in individuals with hypertension,5 so it is less likely that the possible effect of change in water balance associated with medication could affect the results of our study. The longitudinal association between baseline frailty and change in lean mass was unchanged (odds ratio (OR) = 2.77, 95% confidence interval (CI) = 1.03—7.44 for frail; OR = 1.37, 95% CI = 0.84—2.22 for prefrail) after adjusting for diuretics in Model 3 (table 3).1 Although BIA was previously cross-validated using magnetic resonance imaging (MRI) in Western populations,6 it has been validated using dual-energy X-ray absorptiometry rather than computed tomography or magnetic resonance imaging in older Koreans, as Safer and Kulcu noted. Thus, random error might be possible in measuring the lean body mass of individual participants, but this possible random error from measurement method would result in false-negative conclusions (bias toward the null) rather than false-positive conclusions. BIA has many advantages over other methods because it is safe, easy to use, readily reproducible, and appropriate for ambulatory and bedridden individuals. Accordingly, a European and Asian working group on sarcopenia suggested the use of BIA for the measurement of skeletal muscle mass in research and clinical practice.7,8 Therefore, ongoing larger community-based studies on frailty and sarcopenia could reinforce the possible longitudinal effect of frailty on lean mass and change in muscle strength. Hee-Won Jung, MD, MSc Kwang-il Kim, MD, PhD Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea College of Medicine, Seoul National University, Seoul, Korea
ACKNOWLEDGMENTS Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper.
LETTERS TO THE EDITOR
1051
Author Contributions: Hee-Won Jung and Kwang-il Kim discussed and prepared the manuscript. Sponsor’s Role: None.
REFERENCES 1. Safer VB, Kulcu DG. Bioimpedance analysis and frailty. J Am Geriatr Soc 2015;63. 2. Jung HW, Kim SW, Lim JY et al. Frailty status can predict further lean body mass decline in older adults. J Am Geriatr Soc 2014;62:2110–2117. 3. Kim KI, Chang HJ, Cho YS et al. Current status and characteristics of hypertension control in community resident elderly Korean people: data from a Korean Longitudinal Study on Health and Aging (KLoSHa study). Hypertens Res 2008;31:97–105. 4. Lim S, Yoon JW, Choi SH et al. Combined impact of adiponectin and retinol-binding protein 4 on metabolic syndrome in elderly people: the Korean Longitudinal Study on Health and Aging. Obesity 2010;18:826–832. 5. Tapolyai M, Faludi M, Dossabhoy NR et al. Diuretics and bioimpedancemeasured fluid spaces in hypertensive patients. J Clin Hypertens 2014;16:895–899. 6. Janssen I, Heymsfield SB, Baumgartner RN et al. Estimation of skeletal muscle mass by bioelectrical impedance analysis. J Appl Physiol 2000;89:465– 471. 7. Cruz-Jentoft AJ, Baeyens JP, Bauer JM et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010;39:412–423. 8. Chen LK, Lui LK, Woo J et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc 2014;15:95– 101.
EFFECT OF THE OVERLAP SYNDROME OF DEPRESSIVE SYMPTOMS AND DELIRIUM ON OUTCOMES IN ELDERLY ADULTS WITH HIP FRACTURE: A COMMENT To the Editor: We read with great interest the paper by Radinovic and colleagues on depressive symptoms and delirium in individuals with hip fracture recently published in the Journal of the American Geriatrics Society.1 We would like to contribute to this topic with data regarding individuals admitted to our orthogeriatric unit (OGU)2 from October 2011 to October 2013. All underwent a comprehensive geriatric assessment on admission, including age, sex, education, cognition (Mini-Mental State Examination (MMSE)), depressive symptoms (15item Geriatric Depression Scale (GDS)), health (Charlson Comorbidity Index and number of drugs), and prefracture functional status (Katz activities of daily living). Delirium was assessed on admission and every day until discharge using the Confusion Assessment Method3 and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria.4 Data were also collected on American Society of Anesthesiologist (ASA) score, type of surgery, and type of anesthesia. From a cohort of 319, 96 were excluded because the GDS was not administered (75 for severe dementia, 21 for refusal), two because of advanced cancer, 12 because of delirium detected on admission, and 33 because they were already undergoing antidepressant therapy before fracture. Clinical characteristics of the study sample (N = 177) are reported in Table 1 and appear to be strikingly different from those of participants in the Radinovic study, being older (83.4 6.5 vs 78.0 8.2) and having a shorter time from fracture to surgery (3.2 2.1 vs
Copyright of Journal of the American Geriatrics Society is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
MAY 2015–VOL. 63, NO. 5
RESPONSE TO SAFER AND KULCU To the Editor: We thank Safer and Kulcu1 for their valuable comments on our recent article.2 They made important points about measuring lean body mass using bioimpedance analysis (BIA). In the Korean Longitudinal Study on Health and Aging (KLoSHA), body composition of participants was measured on the same day that blood chemistries, including cholesterol and glucose, were measured after at least 10 hours of overnight fasting.3,4 Consequently, we believe that the possible influence on the difference in total body water status from fluid or food intake would have been attenuated. We could not fully investigate the longitudinal change of diuretic use in participants with hypertension, but few participants were taking diuretics for hypertensive monotherapy in the baseline study.3 Furthermore, a literature search showed that taking diuretics was not associated with a significant difference in water balance in individuals with hypertension,5 so it is less likely that the possible effect of change in water balance associated with medication could affect the results of our study. The longitudinal association between baseline frailty and change in lean mass was unchanged (odds ratio (OR) = 2.77, 95% confidence interval (CI) = 1.03—7.44 for frail; OR = 1.37, 95% CI = 0.84—2.22 for prefrail) after adjusting for diuretics in Model 3 (table 3).1 Although BIA was previously cross-validated using magnetic resonance imaging (MRI) in Western populations,6 it has been validated using dual-energy X-ray absorptiometry rather than computed tomography or magnetic resonance imaging in older Koreans, as Safer and Kulcu noted. Thus, random error might be possible in measuring the lean body mass of individual participants, but this possible random error from measurement method would result in false-negative conclusions (bias toward the null) rather than false-positive conclusions. BIA has many advantages over other methods because it is safe, easy to use, readily reproducible, and appropriate for ambulatory and bedridden individuals. Accordingly, a European and Asian working group on sarcopenia suggested the use of BIA for the measurement of skeletal muscle mass in research and clinical practice.7,8 Therefore, ongoing larger community-based studies on frailty and sarcopenia could reinforce the possible longitudinal effect of frailty on lean mass and change in muscle strength. Hee-Won Jung, MD, MSc Kwang-il Kim, MD, PhD Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea College of Medicine, Seoul National University, Seoul, Korea
ACKNOWLEDGMENTS Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper.
LETTERS TO THE EDITOR
1051
Author Contributions: Hee-Won Jung and Kwang-il Kim discussed and prepared the manuscript. Sponsor’s Role: None.
REFERENCES 1. Safer VB, Kulcu DG. Bioimpedance analysis and frailty. J Am Geriatr Soc 2015;63. 2. Jung HW, Kim SW, Lim JY et al. Frailty status can predict further lean body mass decline in older adults. J Am Geriatr Soc 2014;62:2110–2117. 3. Kim KI, Chang HJ, Cho YS et al. Current status and characteristics of hypertension control in community resident elderly Korean people: data from a Korean Longitudinal Study on Health and Aging (KLoSHa study). Hypertens Res 2008;31:97–105. 4. Lim S, Yoon JW, Choi SH et al. Combined impact of adiponectin and retinol-binding protein 4 on metabolic syndrome in elderly people: the Korean Longitudinal Study on Health and Aging. Obesity 2010;18:826–832. 5. Tapolyai M, Faludi M, Dossabhoy NR et al. Diuretics and bioimpedancemeasured fluid spaces in hypertensive patients. J Clin Hypertens 2014;16:895–899. 6. Janssen I, Heymsfield SB, Baumgartner RN et al. Estimation of skeletal muscle mass by bioelectrical impedance analysis. J Appl Physiol 2000;89:465– 471. 7. Cruz-Jentoft AJ, Baeyens JP, Bauer JM et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010;39:412–423. 8. Chen LK, Lui LK, Woo J et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc 2014;15:95– 101.
EFFECT OF THE OVERLAP SYNDROME OF DEPRESSIVE SYMPTOMS AND DELIRIUM ON OUTCOMES IN ELDERLY ADULTS WITH HIP FRACTURE: A COMMENT To the Editor: We read with great interest the paper by Radinovic and colleagues on depressive symptoms and delirium in individuals with hip fracture recently published in the Journal of the American Geriatrics Society.1 We would like to contribute to this topic with data regarding individuals admitted to our orthogeriatric unit (OGU)2 from October 2011 to October 2013. All underwent a comprehensive geriatric assessment on admission, including age, sex, education, cognition (Mini-Mental State Examination (MMSE)), depressive symptoms (15item Geriatric Depression Scale (GDS)), health (Charlson Comorbidity Index and number of drugs), and prefracture functional status (Katz activities of daily living). Delirium was assessed on admission and every day until discharge using the Confusion Assessment Method3 and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria.4 Data were also collected on American Society of Anesthesiologist (ASA) score, type of surgery, and type of anesthesia. From a cohort of 319, 96 were excluded because the GDS was not administered (75 for severe dementia, 21 for refusal), two because of advanced cancer, 12 because of delirium detected on admission, and 33 because they were already undergoing antidepressant therapy before fracture. Clinical characteristics of the study sample (N = 177) are reported in Table 1 and appear to be strikingly different from those of participants in the Radinovic study, being older (83.4 6.5 vs 78.0 8.2) and having a shorter time from fracture to surgery (3.2 2.1 vs
Copyright of Journal of the American Geriatrics Society is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
