The Impact of Anemia on Nursing Home Residents

University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, USA.
Clinical Nursing Research (Impact Factor: 0.87). 02/2010; 19(2):113-30. DOI: 10.1177/1054773810362089
Source: PubMed

ABSTRACT The purpose of this secondary data analysis was to describe the prevalence and treatment of anemia and test the impact of anemia on physical and psychosocial outcomes at baseline and following restorative care interventions. A total of 451 residents from 12 nursing homes participated in this study. The average age of the participants was 83.74 (SD = 8.24), the majority were female (79%), White (66%), and unmarried (90%). A total of 245 (54%) residents were anemic, and 66% were treated with at least one medication. Physical performance was worse in those with anemia, and those with anemia associated with chronic kidney disease had lower self-efficacy and outcome expectations for functional activities than those without anemia. There was no time by treatment interaction between those with and without anemia. The findings provide some additional support for the prevalence of anemia and suggest that those with anemia associated with chronic kidney disease are less motivated to engage in functional activities.

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    • "Increased risk of fractures [95], cardiovascular events [100] [102], and mortality [100] [102] 5.5% of adults ≥20 years old in NHANES (USA) [96] 6%-19% with inflammatory bowel disease (Sweden) [97] (Scandinavia) [98] 7.1% of men and 8.8% of women in KNHANES (Korea) [99] 9% in routine exercise treadmill testing (USA) [100] 15% (new-onset) in those attending diabetes clinics (UK) [101] 18.4% in type II diabetics (Italy) [102] Significant variation by race with lower Hb levels among elderly African Americans and a 3-fold higher prevalence of anemia compared with whites (USA) [103] [104] [105] Elderly 8.8% of community-dwelling women aged 70-80 years old (USA) [106] Poor physical performance [109]; poor performance and faster decline on cognitive tests [106]; increased risk of fracture [110], falls [111] [112], hospitalization, nursing home placement [113] [114], and mortality [113] [114] [115] [116]; decline in quality of life [117], cognitive function [118], activities of daily living [115], mobility [119] [120], and strength [120] [121] 10.3% of adults aged N60 years old from ENSANUT (Mexico) [107] 11% of community-dwelling participants in NHANES (US) [104] 29% of adults aged N60 years old in long-term care facilities (Brazil) [108] 54% of residents from 12 nursing homes (USA) [109] 27.6% in admissions with normal kidney function [122] Hospitalized 27.6% undergoing general surgery (Hb b12 g/dL) [123] Longer hospital stay; more resource utilization; increased risk of readmission, acute kidney injury, and death [4] [122] [124] [126] One-third of nonsurgical cases [124] 40.1% of nonsurgical hospitalized patients N60 years old [125] Hospital acquired anemia diagnosed in 74% of admissions [4] Ob/Gyn 5.5% of postmenopausal women (USA) [110] [127] Anemia during pregnancy was associated with lower birth weight in 2 studies [128] [134], but not in another study [132] 6.2% in first and 24.3% in third trimester (Belgium) [128] 14.2%-16.7% during pregnancy (Hungary) [129] 24.4% in 11 maternity units (UK) [130] 39.6% from 14 cities (China) [131] 43.7% and 89.8% in registries from the 1970s and 2000s, respectively (Kola, Russia) [132] Hb b10 and b8 g/dL seen in 22% and 3% of deliveries between 1993 and 2008 in an obstetrics department (Germany) [133] Increasing prevalence from first to third trimesters [131] CKD 32.3% in stage 3-5 CKD (anemia defined as Hb b11 g/dL or documented treatment of ESAs) [135] Increased risk of kidney disease progression, hospitalization, and death [135] [136] [137] 41.3% in stage 3-5 CKD (defined as Hb 11-13.5 g/dL in men and Hb 11-12 g/dL in women) [136] 45% in predialysis cases (defined as Hb ≤11 g/dL) [137] 56.9% of nursing home residents with CKD [138] Respiratory disease Increased risk of hospitalization, readmission, and death [85] [87] [140] [142] [143] 7.5%-34% in COPD [139] 9.8%-33% in cases of acute exacerbation of COPD [85] [87] [140] 11.5% in restrictive disease [141] 13.3% in chronic respiratory failure [141] 14.7% in obstructive disease [141] 18% in first-time admissions to ICU requiring mechanical ventilation [140] 33.9% at admission and 62.1% during stay for community-acquired pneumonia [142] Cerebrovascular disease 6.4%-19% [144] [145] [146] Increased risk of short-and long-term mortality and poor functional outcomes [145] [146] [148] IDA in 6.4%, iron deficiency without anemia in 2.1%, and anemia of other etiologies in 6.4% in patients aged N65 years old admitted with TIA or first ischemic stroke [147] Ischemic heart disease 9.1%-38% overall [149] [150] [151] [152] [153] [154] [155] [156] [157] Increased risk of cardiac events (including heart failure and recurrent ischemia); complications; poor health status; and in-hospital, short-and longterm death [149-157,159-164] 18.2% of patients aged N80 y admitted for acute MI [158] 20%-27.4% at admission [159-161] 34.7% at discharge and 19.5% persistent during follow-up [162] 40% at seventh week after admission [159] 46.8% new-onset during admission [161] Hospital-acquired anemia seen at discharge in 45.4% of patients who were admitted with MI and normal Hb [163] Heart failure (hospitalized) 10% in chronic heart failure at age ≥70 y [165] Poor outcome, hospitalization, readmission, and mortality (cardiovascular as well as all cause) [165-177] 29%-57% [166-170] Cardiac surgery 28%-54.4% [178-180] Increased risk of receiving blood transfusions [179,180], major morbidity, acute kidney injury, mortality, prolonged hospital stay [178] [179] [180] [181] [183], and cardiovascular events [182] 41.9% of 80-to 90-year-old patients undergoing CPB [181] 44% had sustained postoperative anemia for N50 d [182] Organ transplant 42% [5] and 53.7% [184] during posttransplant follow-up. "
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