Comment on “Survey on the Knowledge and Practices in Anorexia of Aging Diagnosis and Management in Japan” by Takagi et al.—The Authors' Reply

Abstract

We thank Dr Cui for the constructive suggestions regarding our manuscript [1, 2].

The study was a secondary analysis of data collected from healthcare professionals in Japan as part of the global unified survey [3] conducted by the Society on Sarcopenia, Cachexia, and Wasting Disorders (SCWD). We focused on the availability of opportunities for continuing education and the differences in awareness and responses to anorexia of ageing (hereinafter referred to as AoA). To avoid losing the subtle nuances of the responses to the survey questions, we presented the results using descriptive statistics and chi-square tests. However, as Dr Cui suggested, adjusting for potential confounding factors underlying the responses can provide deeper insights into the relationship between the availability of educational opportunities and attitudes towards geriatric care. Accordingly, we have further conducted an analysis based on a multivariable regression model, the results of which are reported below.

We used a logistic regression model to analyse the responses to the following two AoA survey questions that were directly related to treatment: ‘Do you use tools or resources to address decreased appetite in geriatric patients?’ (Q15) and ‘Are you confident in recommending nutritional interventions for geriatric patients with decreased appetite?’ (Q17). To facilitate the analysis, responses to Q15 were categorized as follows: 0 for yes, all of the time and yes, most of the time and 1 for all other responses. For Q17, 0 was assigned to strongly agree and agree, whereas 1 was assigned to all other responses. We conducted binary logistic regression analysis using ‘access to educational opportunities’ as the explanatory variable (0 = yes, 1 = no). Potential confounding factors included the occupation (categorized into six groups: physician, nurse, registered dietitian, pharmacist, rehabilitation therapist and other professions) and workplace (categorized into four groups: hospital, nursing home, home health care or clinic and others). The results showed that regardless of occupation or workplace, the group without educational opportunities had a significantly higher odds ratio (OR) for ‘not using tools or resources to care for geriatric patients with decreased appetite’ (OR: 3.86; 95% CI: 2.72–5.46) (Table 1) and ‘not being confident in recommending nutritional interventions for geriatric patients with decreased appetite’ (OR: 2.38; 95% CI: 1.74–3.26) (Table 2). These results indicate that even when accounting for potential confounding factors such as occupation and workplace, continuing education in nutrition influences the ability to provide AoA-related care.

In global ageing, there is concern that decreased appetite in older adults (i.e., AoA) may simply be considered ‘a consequence of aging’. This could lead to a vicious cycle of exacerbating sarcopenia and frailty, eventually resulting in a need for long-term care [4]. This study highlights the importance of improving and expanding continuous nutrition education programs, irrespective of occupation or workplace, to ensure the early detection of these issues and promote independence among older adults.

M.A. received research funding from Eisai, Kracie Pharma, Mitsubishi-Tanabe Pharma and Tsumura and lecture fees from Bayer HealthCare, Daiichi Sankyo, Toa Eiyo and Towa Pharmaceutical. I.A. has received consultancy fees from Pfizer. A.C. has received honoraria and/or lecture fees from AstraZeneca, Boehringer Ingelheim, Menarini, Novartis, Servier, Vifor, Abbott, Actimed, Arena, Cardiac Dimensions, Corvia, CVRx, Enopace, ESN Cleer, Faraday, Impulse Dynamics, Respicardia and Viatris. S.D.A. has received grants and personal fees from Vifor and Abbott Vascular and personal fees for consultancies, trial committee work and/or lectures from Actimed, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, BioVentrix, Brahms, Cardiac Dimensions, Cardior, Cordio, CVRx, Cytokinetics, Edwards, Farraday Pharmaceuticals, GSK, HeartKinetics, Impulse Dynamics, Novartis, Occlutech, Pfizer, Repairon, Sensible Medical, Servier, Vectorious and V-Wave. He has been named co-inventor of two patent applications regarding MR-proANP (DE 102007010834 and DE 102007022367), but he does not benefit personally from the related issued patents.