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: 1.28). 02/2010; 19(2):113-30. DOI: 10.1177/1054773810362089
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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ABSTRACT: To determine whether anemia is a risk factor for functional decline in nursing home (NH) residents with chronic kidney disease. Prospective 26-week observational study. Eighty-two geographically representative NHs in the United States. Three hundred eleven NH residents with chronic kidney disease (CKD; estimated glomerular filtration rate <60 mL/min per 1.73 m(2) ) who had anemia (hemoglobin <12 g/dL for women, <13 g/dL for men, n = 177) or not (n = 134). The primary outcome was the distance walked or wheeled for 10 minutes. Secondary outcomes were single chair stand time, grip strength, leg extension strength, Dartmouth Primary Care Cooperative Information scores, Modified Barthel Index, falls, hospitalization, and mortality. Mixed-effects model analysis of distance walked or wheeled showed that changes between weeks 2 and 14 but not between weeks 2 and 26 were significantly different between participants with CKD with anemia and those without anemia. There were no significant differences for the other physical performance or self-report measures. After adjustment for an anemia propensity score, participants with CKD with anemia did not have higher rates of hospitalization or death at 26 weeks than those without anemia. Nursing home residents with CKD and anemia experienced greater decline than those with CKD without anemia only for a mobility distance task over a 3-month but not a 6-month period and not for other performance or self-report measures. Anemia may not increase the risk of functional decline in NH residents with CKD, but further research is necessary to confirm these findings and evaluate whether a lower hemoglobin cutpoint confers greater risk for functional decline in this population.
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ABSTRACT: Despite its high prevalence, anemia often does not receive proper clinical attention and its detection, evaluation, and management of iron deficiency anemia and iron-restricted erythropoiesis can possibly be an unmet medical need. A multidisciplinary panel of clinicians with expertise in anemia management convened and reviewed recent published data on prevalence, etiology, and health implications of anemia as well as current therapeutic options and available guidelines on management of anemia across various patient populations, and made recommendations on the detection, diagnostic approach and management of anemia. The available evidence confirms that the prevalence of anemia is high across all populations, especially in hospitalized patients. Anemia is associated with worse clinical outcomes including longer length of hospital stay, diminished quality of life and increased risk of morbidity and mortality, and it is a modifiable risk factor of allogeneic blood transfusion with its own inherent risks. Iron deficiency is usually present in anemic patients. An algorithm for detection and management of anemia was discussed which incorporated iron study (with primary emphasis on transferrin saturation), serum creatinine and GFR and vitamin B12 and folic acid measurements. Management strategies included iron therapy (oral or intravenous), erythropoiesis stimulating agents and referral as needed.
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