Article

Late‐Life Anemia Is Associated with Increased Risk of Recurrent Falls

Authors:
  • Princess Maxima Center for Pediatric oncology (PMC)
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Abstract

To examine whether anemia is associated with a higher incidence of recurrent falls. Prospective cohort study. Community-dwelling sample in The Netherlands. Three hundred ninety-four participants aged 65 to 88 from the Longitudinal Aging Study Amsterdam. Anemia was defined according to World Health Organization criteria as a hemoglobin concentration less than 12 g/dL in women and less than 13 g/dL in men. Falls were prospectively determined using fall calendars that participants filled out weekly for 3 years. Recurrent fallers were identified as those who fell at least two times within 6 months during the 3-year follow-up. Of the 394 persons, 11.9% (18 women and 29 men) had anemia. The incidence of recurrent falls was 38.3% of anemic persons versus 19.6% of nonanemic persons (P=.004). After adjustment for sex, age, body mass index, and diseases, anemia was significantly associated with a 1.91 times greater risk for recurrent falls (95% confidence interval=1.09-3.36). Poor physical function (indicated by muscle strength, physical performance, and limitations) partly mediated the association between anemia and incidence of recurrent falls. Late-life anemia is common and associated with twice the risk of recurrent falls. Muscle weakness and poor physical performance appear to partly mediate this association.

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... In the third National Health and Nutrition Examination Survey (NHANES III) study, the prevalence of anemia was 11% in elderly aged 65 years and older [10]. Similar prevalence has been found in the Longitudinal Ageing Study Amsterdam [11] and in the InChianti Study [12]. Anemia prevalence increases rapidly after the age of 50, approaching a rate of over 20% in elderly aged 85 years or older [10], and has been found to be up to 65% among nursing home residents [8]. ...
... Late life anemia is associated with subsequent physical decline [3], like impaired physical performance not explained by disease [13], increased disability, and muscle weakness [12]. Anemia has found to be an independent risk factor for falls among hospitalized older adults [14], nursing home residents [8,15], and among communityliving elderly when injurious falls [16] or recurrent falls [11] are the outcome. However, there is a need for further studies of the association between anemia and all falls among community-living elderly people. ...
... An association between anemia and falls was not found in this general population of elderly women and men [17]. These results differ from other studies [11,16]. In 394 participants from the Longitudinal Ageing Study Amsterdam [11] using fall calendars in a follow-up time of 3 years, anemia was a significant predictor of the outcome recurrent falls. ...
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Background: Falls are common among elderly people, and the risk increase with age. Falls are associated with both health and social consequences for the patient, and major societal costs. Identification of risk factors should be investigated to prevent falls. Previous studies have shown anemia to be associated with increased risk of falling, but the results are inconsistent. The aim of this study was to investigate the association between anemia and self-reported falls among community-living elderly people. The study is a replication of the study by Thaler-Kall and colleagues from 2014, who studied the association between anemia and self-reported falls among 967 women and men 65 years and older in the KORA-Age study from 2009. Methods: We included 2441 participants (54% women) 65 years and older from the population-based Tromsø 5 Study 2001-2002. Logistic regression models were used to investigate the association between anemia (hemoglobin <12 g/dL in women and <13 g/dL in men) or hemoglobin level and self-reported falls last year, adjusted for sex, age, medication use and disability. Further, associations between combinations of anemia and frailty or disability, and falls, were investigated. Results: No statistical significant associations were found between anemia and falls (OR 95% CI: 0.83, 0.50-1.37) or hemoglobin level and falls (OR, 95% CI: 0.94, 0.81-1.09), or with combinations of anemia and frailty or disability, and falls (OR, 95%: CI: 0.94, 0.40-2.22 and 0.78, 0.34-1.81, respectively). Conclusions: In this replication analysis, in accordance with the results from the original study, no statistically significant association between anemia or hemoglobin and falls was found among community-living women and men aged 65 years or older.
... The prevalence of anemia in people above 65 years old is estimated to be 10 -15% and as the age increases, the frequency of anemia increases (12,13). The high prevalence of anemia in the elderly is due to concomitant diseases (14). There are several studies about the relationship between anemia and falls in the elderly. ...
... As the hemoglobin levels decrease, the risk of falls increases considerably (6, 15 -18). In a study by Penninx et al., after modification of gender, age, body mass index and diseases, anemia was significantly associated with increased falls (14). ...
... However, despite the small sample size, the frequent falls in the people with anemia was 1.9 times more than other people (CI-95% =3.36-1.09), which is not consistent with the present study (14). In the study of Pandya et al., 564 residents of care centers for the elderly were included in the study, 70% of which were women. ...
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BACKGROUND AND OBJECTIVE: Falls are the major cause of disability, hospitalization and mortality in the elderly. Various risk factors such as anemia cause falls in the elderly. The present study was conducted to investigate the relationship between anemia and falls in the elderly in Amirkola. METHODS: This cross-sectional study was conducted among people aged 60 years and above in Amirkola during a one-year period as a census. Complete blood count was performed based on fasting blood sample. History of falls and associated chronic diseases was confirmed based on the patient's report, doctor's prescription and the patient's medications. The cognitive status was measured using Mini Mental State Examination (MMSE) standard questionnaire, symptoms of depression were measured using Geriatric Depression Scale (GDS) standard questionnaire and the balance status was measured using Berg Balance Test (BBT) standard questionnaire. FINDINGS: 1482 elderly individuals, including 817 men (55.1%) and 665 women (44.9%) were examined, among which 271 (18.3%) individuals experienced falls. 21.2% of people with anemia and 17.6% of people without anemia experienced falls, though the difference was not significant. Mean hemoglobin in all the participants as well as men (13.46 and 13.84 gr/dl, respectively) was less than people who did not experience falls (13.74 gr/dl, p=0.009 and 14.33 gr/dl, p=0.007, respectively). Based on logistic regression model, age of ≥75 (OR = 1.81), depression (OR = 1.84) and underlying diseases (OR = 1.2) played the most significant role in increasing falls. CONCLUSION: Results of the study demonstrated that there is no relationship between anemia and falls. However, after differentiating genders, decline in hemoglobin levels increased falls in the elderly men.
... There is growing recognition that EDs could play an important role in implementing contextually appropriate fall prevention strategies targeting older adults at high risk of falls 3 . A range of conditions has been associated with high fall risk, including history of prior falls 5 , dementia and other cognitive impairment 5,6 , Parkinson's disease 7 , depression 5,8 , polypharmacy, 5,9 certain medications 8,10-12 , osteoarthritis 13,14 , anemia 15 , various heart conditions, and diabetes 16 . Geriatric care experts have recommended that older adults presenting to the ED be screened for fall risk and referred when appropriate 17 . ...
... The NISS has been demonstrated in several studies to provide an accurate estimate of the time it takes for someone to regain his or her health after an injury 27 . Our model also included certain chronic comorbidities that have been associated with risk of falling: depression 5,8 ; anemia 15 ; diabetes 16 ; Alzheimer's disease and related disorders 5,6 ; osteoporosis and osteoarthritis conditions 13,14 ; and heart conditions, including history of acute myocardial infarction 12,28 , atrial fibrillation 28 , heart failure 29,30 , ischemic heart disease 12 , and stroke or transient ischemic attack 31 (the risk from these heart conditions is largely linked to syncope and some medications associated with these conditions 12,28,30,32 ). These conditions were flagged according to the CMS Comorbidity Conditions Warehouse (CCW), which uses standardized algorithms to identify certain conditions in the Medicare data. ...
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Objectives To determine whether providing physical therapy (PT) services in the emergency department (ED) improves outcomes for older adults who fall. Design We used Medicare claims data to examine differences in recurrent fall‐related ED revisit rates of older adults who presented to the ED for a ground‐level fall and whether they received PT services in the ED. Our logistic regression model controlled for age, sex, Medicaid eligibility, acute injury, and certain known chronic comorbidities associated with risk of falling. Setting We analyzed national 2012–13 Medicare claims data for individuals aged 65 and older. Participants This was a claims‐based analysis. We defined an index visit as any ED claim that included an International Classification of Diseases, Ninth Revision, Clinical Modification E‐Code indicating a ground‐level fall. Visits resulting in admission were excluded, as were claims associated with an individual who died during follow‐up; 17,975 of the 560,277 claims for eligible outpatient index visits included revenue center codes for PT services. Measurements We calculated the proportion of index visits associated with a fall‐related ED revisit within 30 and 60 days and assessed differences in these proportions between individuals who did and did not receive PT services in the ED. Results Receiving PT services in the ED during an index visit for a ground‐level fall was associated with a significantly lower likelihood of a fall‐related ED revisit within 30 days (odds ratio (OR)=0.655, p<.001) and 60 days (OR=0.684, p<.001). Conclusion Expanding PT services in the ED may reduce future fall‐related ED use of older adults. Additional analyses could assess characteristics of individuals receiving PT in the ED and follow‐up PT use after discharge.
... 4 In OA, ID without anemia has been associated with health consequences negatively affecting survival, particularly among those with a cardiovascular disease. 5,6 On the other hand, anemia in OA has been associated with cognitive impairment, 7 frailty, a decline in physical performance, 8 and an increased susceptibility to falls, 9 among other consequences which affect quality of life 9 and survival. 10 According to the Mexican National Health and Nutritional Survey 2012 (Ensanut 2012), the prevalence of anemia in OA in Mexico was 16.5%, affecting 1 out of every 3 OA of 80 years or more (30%) and 1 out of every 5 OA in the southern region of Mexico. ...
... 4 In OA, ID without anemia has been associated with health consequences negatively affecting survival, particularly among those with a cardiovascular disease. 5,6 On the other hand, anemia in OA has been associated with cognitive impairment, 7 frailty, a decline in physical performance, 8 and an increased susceptibility to falls, 9 among other consequences which affect quality of life 9 and survival. 10 According to the Mexican National Health and Nutritional Survey 2012 (Ensanut 2012), the prevalence of anemia in OA in Mexico was 16.5%, affecting 1 out of every 3 OA of 80 years or more (30%) and 1 out of every 5 OA in the southern region of Mexico. ...
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Objective: To describe the current status of anemia and iron deficiency (ID), as well as associated sociodemographic characteristics, in older adults (OA). Materials and meth-ods. Serum and capillary blood samples from a sample of OA participants (n=2 902) from the Ensanut 2018-19 were analyzed. ID was defined as s-ferritin<15 μg/L, and anemia was defined according to World Health Organization stan-dards. Logistic regression models were used to associate the characteristics of OA with anemia and ID. Results: Of the OA analyzed, anemia was present in 28.4%, ID in 5% and iron deficiency anemia in 2.07%. Diabetes (OR=2.14), renal insuf-ficiency (OR=10.4), higher age, and urban dwelling (OR=1.35) were conditions associated with higher odds for anemia (p<0.05). Belonging to the 70-79 year age group was the only condition associated with higher odds for ID (OR=1.86, p<0.05). Conclusions: Anemia affects a high proportion of OA, and ID is not the main contributor to anemia. Chronic comorbidities help explain the anemia problem in OA.
... The most common cause of anemia in the world is iron deficiency (IDA); in contrast, in elderly patients (>65 years of age), multifactorial anemia (chronic kidney disease, nutritional deficiency, occult hemorrhages, gastrointestinal blood loss, use of antithrombotic drugs, ineffective erythropoiesis,) [4] and anemia related to chronic diseases (CDA) have a higher prevalence [2,3], though in some cases the condition may remain unexplained: on a whole, 40% of hospitalized and 47% of institutionalized patients are anemic [5]. Elderly patients with anemia have a reduced physical performance [6], reduced 2 of 9 muscle strength leading to a higher incidence of falling [7], to more frequent hospitalizations [8], and to an increased risk of death [9][10][11][12]. ...
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Anemia is extremely common in hospitalized patients who are old and often with multiple diseases. We evaluated 435 consecutive patients admitted in the internal medicine department of a hub hospital and 191 (43.9%) of them were anemic. Demographic, historic and clinical data, laboratory tests, duration of hospitalization, re-admission at 30 days and death were recorded. Patients were stratified by age (<65, 65–80, >80 years), anemia severity, and etiology of anemia. The causes of anemia were: iron deficiency in 28 patients, vitamin B12 and folic acid deficiencies in 6, chronic inflammatory diseases in 80, chronic kidney disease in 15, and multifactorial in 62. The severity of the clinical picture at admission was significantly worse (p < 0.001), length of hospitalization was longer (p < 0.001) and inversely correlated to the Hb concentration, re-admissions and deaths were more frequent (p 0.017) in anemic compared to non-anemic patients. A specific treatment for anemia was used in 99 patients (36.6%) (transfusions, erythropoietin, iron, vitamin B12 and/or folic acid). Anemia (and/or its treatment) was red in the discharge letter only 54 patients. Even if anemia is common, in internal medicine departments scarce attention is paid to it, as it is generally considered a “minor” problem, particularly in older patients often affected by multiple pathologies. Our data indicate the need of renewed medical attention to anemia, as it may positively affect the outcome of several concurrent medical conditions and the multidimensional loss of function in older hospitalized patients.
... Bangladesh is developing nation where the number anemic cases increased significantly [1]. Anemia has been associated with significant negative clinical impacts such as decreased physical performance [2], increased number of falls [3], increased frailty, decreased cognition [4], increased [5]. dementia, hospitalization and mortality [6]. ...
Article
Anemia is common nutritional disorder and it affects one third of population around the globe. Assessing nutritional status of human is an inevitable process to lead a healthy life. Females are affected significantly by anemia compare to male. According to WHO report, developing herbs-based formulation to treat anemic patients is safe and less toxic. In this study a double-blind, cross group comparative clinical trial of Nabayas Louha (NBL) a Ayurvedic haematinic preparation with G-Iron Folic Acid (IFA) was undertaken on 66 female anemic volunteers with age between 20-30 years. It was seen that NBL after being administered at a daily dose of 500 mg for 30 days significantly increased the hemoglobin content of the treated volunteers. It produced an increase in serum iron content and decreases total iron binding capacity. The ESR level was also decreased. These effects of NBL were found to be comparable with IFA. There was a marked decrease in WBC count noticed, however statistically significant increase in the lymphocytes count was seen. Furthermore, the level of toxicity related enzymes SGOT and SGPT was not altered significantly in the NBL treated group which vividly confirm that supplementation of NBL is not toxic. In conclusion, these findings recommend use of NBL as supplement in the treatment of iron deficiency anemia and WBC disorders
... In the Established Populations for Epidemiologic Studies of the Elderly (EPESE) project performed in the United States, in fouryear observation anemia was identified as an independent risk factor for higher hospitalization rate and more extended stay, as well as higher mortality (3). Anemia in old age may result in more reduced muscle strength and physical performance, leading to the increased risk of falls and depression, as well as deterioration of cognitive functions (4)(5)(6). The significant functional deterioration and increased mortality rate among older anemic individuals may, at least partly, result from agedependent worsening of compensatory mechanisms such as endothelial angiogenesis induced by hypoxia (7). ...
Article
Anemia is an independent risk factor for functional decline and mortality among older adults. Since mild anemia in older people is often under-diagnosed and ignored, its prevalence needs precise determination and recognition of predisposing factors. None of the previous studies based on the data obtained from the representative elderly population identified the influence of socio-economic factors on the prevalence of anemia. PolSenior was a cross-sectional population-based study performed on the nationally representative sample of Polish seniors. Complete blood count was assessed in 4003 respondents aged 65 years or above (1910 women) divided into six five-year cohorts and a reference group of 622 people aged 55 - 59 years (333 women). Anemia was defined based on the WHO criteria: Hb < 12.0 g/dL in women and Hb < 13.0 g/dL in men. The following socio-economic factors were evaluated through the multiple logistic regression analysis: education level, marital status, place of residence, living arrangements and self-reported poverty. The prevalence of anemia in older persons standardized for the population was 10.8% (17.4% of the study group) and was more frequent in men than in women (20.8% versus 13.6%). The frequency of anemia progressed with age from 5.3% in the youngest to 37.7% in the oldest cohort, and the progression was higher in men. The multiple logistic regression analysis revealed the link between anemia and age in both genders, as well as unmarried status and urban dwelling in men. When age was not taken into account, logistic regression showed the link between anemia and unmarried status, urban place of residence (both genders), and low level of education (women only). Among seniors, those poorly educated, unmarried and city inhabitants require intense screening for anemia.
... The patients' electronic medical charts were reviewed for the following data: age (years); male gender (yes/ no); various chronic co-morbidities (yes/no); living in a nursing home (yes/no); walking device used (either cane/walker/wheelchair); independence in basic activities of daily living (BADL) according to the Katz index [8]; a history of falls during the six months prior to their admission; laboratory findings upon admission whose anomalies might be associated with weakness, falls, and frailty (including hemoglobin blood levels [9], albumin serum levels [10], urea and creatinine serum levels [11], Alanine aminotransferase serum levels [12], and electrolyte serum levels); a list of medications used during hospitalization which might be associated with weakness and falls (anti-Parkinson medications, benzodiazepines, diuretics, anti-epileptics, opiates, statins, oral hypoglycemic agents, insulin, nitrates, neuroleptics, steroids, anti-depressants [13][14][15][16]; and the modified Morse fall scale scores upon admission [5]. Fall events in this cohort, like all other hospitalized patients in our medical center, were reported within 24 hours of event to the unit of patient safety and risks management. ...
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BACKGROUND: Falls during hospitalization harbor both clinical and financial outcomes. The modified Morse fall scale [MMFS] is widely used for an in-hospital risk-of-fall assessment. Nevertheless, the majority of patients at risk of falling, i.e. with high MMFS, do not fall. The aim of this study was to ascertain our study hypothesis that certain patients' characteristics (e.g. serum electrolytes, usage of a walking device etc.) could further stratify the risk of falls among hospitalized patients with MMFS. METHODS: This was a retrospective cohort analysis of adult patients hospitalized in Internal Medicine departments. RESULTS: The final cohort included 428 patients aged 76.8±14.0 years. All patients had high (9 or more) MMFS upon admission, and their mean MMFS was 16.2±6.1. A group of 139 (32.5%) patients who fell during their hospitalization was compared with a control group of 289 (67.5%) patients who did not fall. The fallers had higher MMFS, a higher prevalence of mild dependence, and a greater use of a cane or no walking device. Regression analysis showed the following patients' characteristics to be independently associated with an increased risk of falling: mild dependence (OR=3.99, 95% CI 1.97-8.08; p<0.0001), treatment by anti-epileptics (OR=3.9, 95% CI 1.36-11.18; p=0.011), treatment by hypoglycemic agents (OR=2.64, 95% CI 1.08-6.45; p= 0.033), and hypothyroidism (OR=3.66, 05%CI 1.62-8.30; p=0.002). In contrast to their role in the MMFS, the use of a walker or a wheelchair was found to decrease the risk of falling (OR=0.3, 95% CI 0.13-0.69; p=0.005 and OR=0.25, 95% CI 0.11-0.59; p= 0.002). CONCLUSIONS: Further risk stratification of hospitalized patients, already known to have a high MMFS, which would take into account the characteristics pointed out in this study, should be attained.
... Anemia is an important predictor of adverse outcomes later in life, such as falls, disability, hospitalization, and death (Penninx et al., , 2005(Penninx et al., , 2006Zakai et al., 2005). Penninx et al., 2006 andZakai et al., 2005 in studies with 4 and 11-year of follow-up, respectively, demonstrated that anemic individuals have a mortality risk higher than 50% compared to non-anemic in a population of older American adults. ...
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Background/Objective Anemia and dynapenia can occur simultaneously. Separately, both conditions increase the mortality risk with advancing age. However, there is no epidemiological evidence on the combined effect of these conditions on mortality in older adults. We investigated whether combined anemia and dynapenia increase the mortality risk, and whether there are gender differences. Methods A 10-year follow-up study was conducted involving 5,310 older adults from the English Longitudinal Study of Ageing (ELSA). According to the diagnosis of anemia (hemoglobin concentration < 13.0 g/dL in men and < 12.0 g/dL in women) and dynapenia (grip strength < 26 kg for men and < 16 kg for women), individuals at baseline were categorized as “non-anemic/non-dynapenic”, “dynapenic”, “anemic” and “anemic/dynapenic”. The outcome was all-cause mortality during the follow-up period. Results A total of 984 deaths were computed during the follow-up (63.7% in non-anemic/non-dynapenic, 22.8% in dynapenic, 7.5% in anemic and 6.0% in anemic/dynapenic). Adjusted Cox proportional hazard models stratified by sex showed that anemia and dynapenia combined was associated with an increased mortality risk in men (HR: 1.64; 95% IC 1.08 – 2.50) and women (HR: 2.17; 95% CI 1.44 – 3.26). Anemia in men (HR: 1.68; 95% CI 1.22 – 2.32) and dynapenia in women (HR: 1.37; 95% CI 1.09 – 1.72) were also risk factors for mortality. Conclusions The coexistence of anemia and dynapenia increases the mortality risk, highlighting the need for early identification, prevention, and treatment of these conditions to reduce their complications and the mortality risk.
... Elderly patients with anemia are heterogeneous in terms of clinical history, coexisting medical conditions, and concomitant medication use than young adults. In elderly, anemia is associated with poor performance status, increased frailty, dementia, depression, reduced mobility, increased risk of falls, and poor quality of life [12][13][14][15][16][17][18][19] . Anemia portends worse prognosis in elderly patients with cardiovascular and other chronic illnesses. ...
... Anemia in the elderly has been shown to be associated with functional decline, poor cardiovascular outcomes and overall increased morbidity and mortality [7,12,18,20]. A number of studies have highlighted the association between anemia and impaired performance-based mobility function and even aft er adjustment for confounding factors like sex, age, body mass index, and other diseases, anemia was found to be signifi cantly associated with a 1.91 times greater risk for recurrent falls [17,19]. Mortality risk during hospitalization and aft er discharge was also higher among the anemic elderly [18]. ...
... Even though this is also true for Hb, its levels do not seem to negatively influence functional independence either in the acute rehabilitation period[23], or later on after hospital discharge[24]. We believe that Hb improvement should be pursued because anaemia is associated with several adverse outcomes such as the development of cardiovascular and renal diseases[20], death, functional dependence, dementia, and falls[25][26][27][28]. As a consequence, improving both hypoAlb and anaemia is of great importance for both individual health and the economic sustainability of the health system. ...
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Essential amino acids (EAAs) are nutritional substrates that promote body protein synthesis; thus we hypothesised that their supplementation may improve circulating albumin (Alb) and haemoglobin (Hb) in rehabilitative elderly patients following hip fractures (HF). Out of the 145 HF patients originally enrolled in our study, 112 completed the protocol. These subjects were divided into two randomised groups, each containing 56 patients. For a period of two months, one group (age 81.4 ± 8.1 years; male/female 27/29) received a placebo, and the other (age 83.1 ± 7.5 years; male/female 25/31) received 4 + 4 g/day oral EAAs. At admission, the prevalence of both hypoAlb (<3.5 g/dL) and hypoHb (<13 g/dL male, <12 g/dL female) was similar in the placebo group (64.3% hypoAlb, 66% hypoHb) and the treated group of patients (73.2% hypoAlb, 67.8% hypoHb). At discharge, however, the prevalence of hypoAlb had reduced more in EAAs than in placebo subjects (31.7% in EAAs vs. 77.8% in placebo; p < 0.001). There was a 34.2% reduction of anaemia in hypoHb in EAA subjects and 18.9% in placebo subjects, but the difference was not statistically significant. Oral supplementation of EAAs improves hypoAlb and, to a lesser extent, Hb in elderly rehabilitative subjects with hip fractures. Anaemia was reduced in more than one third of patients, which, despite not being statistically significant, may be clinically relevant.
... The decline in oxygen delivery is attributed to the reduction of hemoglobin levels, whereby hemoglobin functions as an oxygen carrier to skeletal muscles, leading to a reduction in muscle function and declining mobility. This nding was in agreement with the three-year Longitudinal Aging Study Amsterdam demonstrating frequent episodes of falls among older adults with anemia as compared to their non-anemic counterparts [30]. Low hemoglobin levels were also shown to increase the risk of recurrent falls among the U.S. population, aged 45 years and above [31]. ...
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Background: Falls incidence rate and comprehensive data on factors that predict occasional and repeated falls from large population-based studies are scarce. This study aimed to determine the incidence of falls and identify predictors of occasional and recurrent falls within the social, medical, physical, nutritional, biochemical, cognitive dimensions among community-dwelling older Malaysians. Methods: Data from 1,763 Malaysian community-dwelling older adults aged ≥60 years were obtained from the LRGS-TUA longitudinal study. Participants were categorized into three groups according to the presence of a single fall (occasional fallers), ≥two falls (recurrent fallers), or absence of falls (non-fallers) at an 18-month follow-up. Results: Three hundred and nine (17.5%) participants reported fall occurrence at 18-month follow-up, of whom 85 (27.5%) had two or more falls. The incidence rate for occasional falls and recurrent falls was 8.47 and 3.21 per 100 person-years, respectively. Following multifactorial adjustments, being single (OR: 5.310: 95% CI: 1.963-14.361), having higher depression score (OR: 1.123; 95% CI: 1.045-1.207), lower hemoglobin level (OR: 0.873; 95% CI: 0.797-0.956), and taking a longer time to complete the chair stand test (OR: 0.936; 95% CI: 0.881-0.995) remained independent predictors of occasional falls. While, having higher depression score (OR: 1.116; 95% CI: 1.010-1.233), being a stroke survivor (OR: 5.639; 95% CI: 1.502-21.129), having higher percentage of body fat (OR: 1.038; 95% CI: 1.010-1.067), lower hemoglobin level (OR: 0.853; 95% CI: 0.741-0.982), and taking longer time to complete the chair stand test (OR: 0.907; 95% CI: 0.824-0.998) appeared as recurrent falls predictors. Conclusions: Having depression, lower muscle strength and hemoglobin levels predict both occasional and recurrent falls among Malaysian community-dwelling older adults. This finding has implications for future research planning, which should aim to identify effective strategies for preventing falls among older adults by modifying these identified predictors.
... Bangladesh is developing nation where the number anemic cases increased significantly [1]. Anemia has been associated with significant negative clinical impacts such as decreased physical performance [2], increased number of falls [3], increased frailty, decreased cognition [4], increased [5]. dementia, hospitalization and mortality [6]. ...
Article
Full-text available
Anemia is common nutritional disorder and it affects one third of population around the globe. Assessing nutritional status of human is an inevitable process to lead a healthy life. Females are affected significantly by anemia compare to male. According to WHO report, developing herbs-based formulation to treat anemic patients is safe and less toxic. In this study a double-blind, cross group comparative clinical trial of Nabayas Louha (NBL) a Ayurvedic haematinic preparation with G-Iron Folic Acid (IFA) was undertaken on 66 female anemic volunteers with age between 20-30 years. It was seen that NBL after being administered at a daily dose of 500 mg for 30 days significantly increased the hemoglobin content of the treated volunteers. It produced an increase in serum iron content and decreases total iron binding capacity. The ESR level was also decreased. These effects of NBL were found to be comparable with IFA. There was a marked decrease in WBC count noticed, however statistically significant increase in the lymphocytes count was seen. Furthermore, the level of toxicity related enzymes SGOT and SGPT was not altered significantly in the NBL treated group which vividly confirm that supplementation of NBL is not toxic. In conclusion, these findings recommend use of NBL as supplement in the treatment of iron deficiency anemia and WBC disorders
... Wykazano jej wpływ na wzrost śmiertelności, niesprawność, upadki i zaburzenia intelektualne u osób starszych oraz ostre niedokrwienie mózgu u dzieci. [17,18,19,20,21,22]. Stwierdzono, że u pacjentów z udarem krwotocznym niskie stężenie hemoglobiny w ostrym okresie choroby jest niezależnym czynnikiem predykcyjnym deficytu neurologicznego [23]. ...
Article
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Wstęp Anemia jest czynnikiem ryzyka chorób sercowo-naczyniowych. Celem badania była ocena potencjalnego wpływu niedokrwistości na stan neurologiczny pacjentów w pierwszej dobie oraz funkcjonalny w 14 dobie od wystąpienia niedokrwiennego udaru mózgu. Materiał i metody Do prospektywnego badania włączono 109 pacjentów (w tym 53 kobiety) w wieku 72,8 ± 11,12 w pierwszej dobie pierwszego w życiu udaru mózgu. Porównano częstość wybranych chorób i parametrów biochemicznych, stan neurologiczny (wg NIHSS) w pierwszej oraz stan funkcjonowania (wg mRankin) w 14 dobie od wystąpienia udaru mózgu u pacjentów z anemią oraz prawidłowym stężeniem hemoglobiny. Wyniki Anemię stwierdzono u 34 pacjentów (15 kobiet oraz 19 mężczyzn) oraz 8 pacjentów w wieku ≤ 65 r.ż. Częstość lekkiego i umiarkowanego/ciężkiego deficytu neurologicznego w pierwszej dobie nie różniła się znamiennie między pacjentami z anemią i bez anemii. Częstość stanu funkcjonalnego na poziomie 3–5 Rankin w 14 dobie oraz zgonu (do 14 dni od zachorowania) nie różniła się znamiennie między tymi pacjentami. Stan neurologiczny pacjentów z anemią w pierwszej dobie udaru mózgu okazał się niezależnym czynnikiem gorszego rokowania odnośnie do stanu funkcjonalnego w 14 dobie udaru mózgu oraz zgonu do 14 doby od zachorowania. Wnioski Niedokrwistość występuje u ok. 1/3 pacjentów z ostrym niedokrwiennym udarem mózgu. Lekka oraz umiarkowana niedokrwistość nie wykazuje istotnego negatywnego wpływu na stan neurologiczny oraz funkcjonalny pacjentów w ostrym okresie udaru. Stan neurologiczny w pierwszej dobie udaru niedokrwiennego jest niezależnym czynnikiem złego rokowania w obserwacji krótkoterminowej u pacjentów z anemią.
... The decline in oxygen delivery is attributed to the reduction of hemoglobin levels, whereby hemoglobin functions as an oxygen carrier to skeletal muscles, leading to a reduction in muscle function and declining mobility. This finding was in agreement with the three-year Longitudinal Aging Study Amsterdam demonstrating frequent episodes of falls among older persons with anemia as compared to their non-anemic counterparts [31]. The presence of lower hemoglobin may also reflect underlying nutritional deficiencies or chronic conditions affecting hemoglobin production. ...
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Background Falls incidence rate and comprehensive data on factors that predict occasional and repeated falls from large population-based studies are scarce. In this study, we aimed to determine the incidence of falls and identify predictors of occasional and recurrent falls. This was done in the social, medical, physical, nutritional, biochemical, cognitive dimensions among community-dwelling older Malaysians. Methods Data from 1,763 Malaysian community-dwelling older persons aged ≥ 60 years were obtained from the LRGS-TUA longitudinal study. Participants were categorized into three groups according to the presence of a single fall (occasional fallers), ≥two falls (recurrent fallers), or absence of falls (non-fallers) at an 18-month follow-up. Results Three hundred and nine (17.53 %) participants reported fall occurrences at an 18-month follow-up, of whom 85 (27.51 %) had two or more falls. The incidence rate for occasional and recurrent falls was 8.47 and 3.21 per 100 person-years, respectively. Following multifactorial adjustments, being female (OR: 1.57; 95 % CI: 1.04–2.36), being single (OR: 5.31; 95 % CI: 3.36–37.48), having history of fall (OR: 1.86; 95 % CI: 1.19–2.92) higher depression scale score (OR: 1.10; 95 % CI: 1.02–1.20), lower hemoglobin levels (OR: 0.90; 95 % CI: 0.81-1.00) and lower chair stand test score (OR: 0.93; 95 % CI: 0.87-1.00) remained independent predictors of occasional falls. While, having history of falls (OR: 2.74; 95 % CI: 1.45–5.19), being a stroke survivor (OR: 8.57; 95 % CI: 2.12–34.65), higher percentage of body fat (OR: 1.04; 95 % CI: 1.01–1.08) and lower chair stand test score (OR: 0.87; 95 % CI: 0.77–0.97) appeared as recurrent falls predictors. Conclusions Having history of falls and lower muscle strength were predictors for both occasional and recurrent falls among Malaysian community-dwelling older persons. Modifying these predictors may be beneficial in falls prevention and management strategies among older persons.
... Iron deficiency continues to be a major health issue worldwide -and iron deficiency anaemia is associated with welldocumented adverse health outcomes. 1 Many studies have shown that iron deficiency is associated with a longer length of stay in hospital, 2 cognitive dysfunction, 3 increased risk of falls, 4 and reduced life expectancy. 5 Paradoxically, iron is one of the most abundant minerals on earth and is plentiful in all but the most restricted diets. ...
Article
Iron deficiency continues to be a major health issue worldwide — and iron deficiency anaemia is associated with well-documented adverse health outcomes.1 Many studies have shown that iron deficiency is associated with a longer length of stay in hospital,2 cognitive dysfunction,3 increased risk of falls,4 and reduced life expectancy.5 Paradoxically, iron is one of the most abundant minerals on earth and is plentiful in all but the most restricted diets. The discovery of a new peptide hormone, hepcidin, in 2001, which is made in the liver, is one key advance in this area. The discovery provides a critical insight into how iron deficiency arises in patients with inflammatory disease, despite an adequate intake of iron and no overt loss from bleeding. And, although previously parenteral iron therapy was hazardous and inefficient, modern formulations of intravenous iron overcome the perils of anaphylactic and anaphylactoid reactions6 caused by the dextran component used previously. Now, complete body iron replenishment can be administered feasibly in an ambulant day-case unit. With the advent of such powerful pharmaceutical tools, we have also begun to understand the more subtle aspects of iron deficiency, such as the remarkable effects of even sub-clinical iron deficiency, prior to the onset of anaemia, on cardiac and respiratory function.7–8 It has long been recognised that anaemia arises in many chronic diseases, including chronic renal failure and inflammatory diseases such as rheumatoid arthritis, …
... Deficiency anemias are common in hip fracture patients [39]. Anemia in general is most prevalent among institutionalized elderly people and in the oldest old, and has been associated with reduced physical performance and falls [40,41]. Among the current hip fracture cohort, we were able to ascertain that 469 out of 477 hip fractures (98 %) were preceded by a fall. ...
Article
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We report the risks of a comprehensive range of disease and drug categories on hip fracture occurrence using a strict population-based cohort design. Participants included the source population of a Swedish county, aged ≥50 years (n = 117,494) including all incident hip fractures during 1 year (n = 477). The outcome was hospitalization for hip fracture (ICD-10 codes S72.0–S72.2) during 1 year (2009–2010). Exposures included: prevalence of (1) inpatient diseases [International Classification of Diseases (ICD) codes A00–T98 in the National Patient Register 1987–2010] and (2) prescribed drugs dispensed in 2010 or the year prior to fracture. We present age- and sex-standardized risk ratios (RRs), risk differences (RDs) and population attributable risks (PARs) of disease and drug categories in relation to hip fracture risk. All disease categories were associated with increased risk of hip fracture. Largest risk ratios and differences were for mental and behavioral disorders, diseases of the blood and previous fracture (RRs between 2.44 and 3.00; RDs (per 1000 person-years) between 5.0 and 6.9). For specific drugs, strongest associations were seen for antiparkinson (RR 2.32 [95 % CI 1.48–1.65]; RD 5.2 [1.1–9.4]) and antidepressive drugs (RR 1.90 [1.55–2.32]; RD 3.1 [2.0–4.3]). Being prescribed ≥10 drugs during 1 year incurred an increased risk of hip fracture, whereas prescription of cardiovascular drugs or ≤5 drugs did not appear to increase risk. Diseases inferring the greatest PARs included: cardiovascular diseases PAR 22 % (95 % CI 14–29) and previous injuries (PAR 21 % [95 % CI 16–25]; for specific drugs, antidepressants posed the greatest risk (PAR 16 % [95 % CI 12.0–19.3]). Electronic supplementary material The online version of this article (doi:10.1007/s00223-016-0194-7) contains supplementary material, which is available to authorized users.
... About one-third of the cases of anemias in the elderly population are due to reversible causes, such as NDA, which includes iron deficiency anemia (IDA), cobalamin deficiency anemia (CDA) and folate deficiency anemia (FDA) [1]. More notably, anemias in the elderly have been shown to be associated with a number of adverse health outcomes (AHO), such as falls [3], dementia [4], cardiovascular diseases [5,6], increased hospitalizations [7], functional decline [8], and increased mortality [2,7,[9][10][11]. It has been speculated that anemia in the elderly population leads to major physical decline due to suboptimal oxygen delivery to the brain, heart, muscles, and tissue [12]. ...
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Background: The incidence and prevalence of anemia increase with age, particularly in adults older than 65 years, and it is associated with a number of adverse health outcomes (AHO), particularly hospitalizations, falls and mortalities. Given that approximately one-third of these anemias are due to reversible causes, we studied whether the treatment of nutritional deficiency anemia (NDA), namely iron deficiency anemia (IDA), cobalamin deficiency anemia (CDA), and folate deficiency anemia (FDA), improves AHO; and explored whether each NDA had different AHO. Methods: We reviewed electronic medical records of our internal medicine office patients aged 65 years or older, who had a diagnosis of anemia in a non-acute setting. Results: Total 600 patients were included. Mean age was 75.2 years. Thirty-one point three percent had NDA (CDA 15.3%, IDA 12.3%, FDA 3.7%); and 68.7% had other anemias whom we categorized as non-nutritional deficiency anemias (NNDA), which included anemia of chronic disease (11.2%), myelodysplastic syndrome (6.2%), renal insufficiency anemia (5.7%) and unexplained anemia (45.6%). Even after adequate treatment, IDA group had significantly more hospitalizations (median, 25th - 75th: 2 (0 - 4) vs. 0 (0 - 1), P < 0.001), falls (median, 25th - 75th: 1 (0 - 3) vs. 0 (0 - 1), P < 0.001) and mortalities (10.8% vs. 3.4%, P = 0.011); CDA group had significantly more hospitalizations (median, 25th - 75th: 1 (0 - 2) vs. 0 (0 - 1), P = 0.007), but no difference in falls (median, 25th - 75th: 0 (0 - 1) vs. 0 (0 - 1), P = 0.171) and mortalities (7.6% vs. 3.4%, P = 0.083); and FDA group had significantly more hospitalizations (median, 25th - 75th: 1 (0 - 2) vs. 0 (0 - 1), P = 0.001), but no difference in falls (median, 25th - 75th: 0 (0 - 1) vs. 0 (0 - 1), P = 0.615) and mortalities (4.5% vs. 3.4%, P = 0.550), compared to the NNDA group. Age, Black race, higher number of comorbidities, presence of malignancy and use of direct oral anticoagulants were associated with increased odds of AHO in patients with NDA. Conclusions: Compared to the patients with NNDA, patients with IDA had more hospitalizations, falls and mortalities even after adequate treatment; while patients with CDA and FDA had only more hospitalizations. Adequate treatment mitigated falls and mortalities in elderly patients with CDA and FDA.
... This effect can be seen by in impaired cognitive and behavioural development in anaemic children (Jáuregui-Lobera 2014) (Larson, Phiri, and Pasricha 2017) and is also clear in other groups. Anaemia is associated with accelerated cognitive decline in the middle-aged and elderly (Qin et al. 2019) (Schneider et al. 2016) and an increase risk of falls (Penninx et al. 2005). In the context of traumatic brain injury, anaemia is well known to be associated with worse neurological outcomes in head injury. ...
Thesis
Anaemia and iron-deficiency are common in cardiac surgical patients and are associated with poor surgical and patient-centred outcomes. Pre-operative anaemia is increasingly being treated with intravenous iron despite a lack of high-quality evidence of its effectiveness. This thesis explores these topics with a literature review exploring anaemia, iron-deficiency, and transfusion in cardiac surgery, and further review on transfusion risk-prediction models, and treatment of pre-operative anaemia with intravenous iron. The first methodological chapter describes the development of a new risk-scoring system to predict those who are likely to require peri-operative red blood cell transfusion in cardiac surgical patients in the UK. This risk scoring system was then modified and recalibrated using an Australian database to create an alternative score applicable to that population, described in the subsequent chapter. The use of intravenous iron has increased significantly since the introduction of new iron-preparations and is now recommended in many treatment pathways and guidelines. This has occurred in advance of high-quality evidence that it can effectively treat anaemia in the pre-operative period and have any meaningful effect on patient outcomes. Chapter 5 describes a UK-wide multicentre trial that demonstrated that IV iron can significantly increase haemoglobin concentration in cardiac surgical patients in the pre-operative period. Challenges in the recruitment for larger studies of anaemic cardiac surgical patients led to an exploration of the recent trends in anaemia-rates over the last 5-7 years, which is described in Chapter 6. This demonstrates that anaemia rates in certain areas have decreased significantly over that period and there has been concomitant exponential increase in the use of intravenous iron preparations in various medical settings. The final methodological chapter describes a novel method for measuring total haemoglobin mass, which may be a more appropriate method of assessing anaemia in various disease states. Previous methods have been difficult to establish and complicated to undertake. This chapter describes a new method using a modification of an existing respiratory function test which is demonstrated to be a simple method of estimating total haemoglobin mass and plasma volume.
... Anemia drives up healthcare costs in the older people by increasing the risk of falls. Individuals with anemia over the age of 65 years are twice as likely to experience recurrent falling 46 and are 3-fold more likely to have a history of falls when controlling for age, gender, arthritis, and residence type. 40 Anemia is associated with a 66% increase in the incidence of injurious falls among people 65 years and older 47 (10% of all injurious falls in this age group). ...
Article
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Background: Up to 15% of people aged 60 and over are anemic, and the prevalence of anemia increases with age. In older men and women, anemia is associated with increases in the risk of death and all-cause hospitalization, poor functional capacity, quality of life, and depression. Methods and results: We reviewed the literature describing anemia in aging populations, focusing on the specific diagnostic criteria of anemia and potential causes in older men and women. Even after extensive etiologic workup that involves careful medical history, physical examination, laboratory measurements, and additional studies such as bone marrow biopsy, anemia of aging is unexplained in up to 40% of older patients with anemia. As a result, treatment options remain limited. Conclusions: The prevalence of unexplained anemia of aging (UAA; also called unexplained anemia of the elderly, UAE), its deleterious impacts on health, physical function, and quality of life, and the lack of effective treatment or therapy guidelines represent a compelling unmet clinical need. In this review and consensus document, we discuss the scope of the problem, possible causes of UAA, diagnostic criteria, and potential treatment options. Because even mild anemia is strongly linked to poor clinical outcomes, it should receive clinical attention rather than simply being considered a normal part of aging.
... In the literature, falls have been shown to be associated with hypoalbuminemia (9), anemia (10,11), and electrolyte imbalances such as hyponatremia and hypokalemia (12). In the present study, we aimed to investigate prognostic factors in geriatric patients with falls and identify variables associated with repeated falls and mortality in the first 2 months post fall. ...
... In the population of older Americans anemia was identified as an independent risk factor for higher hospitalization rate and more extended stay, as well as higher mortality [3]. Anemia in old age is associated with reduced muscle strength and physical performance, leading to the increased risk of falls and depression, as well as deterioration of cognitive functions [4][5][6]. Anemia is one of the leading causes of type 2 myocardial infarction in the geriatric population [7]. ...
Article
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Vitamin B12, folate, iron deficiency (IDA), chronic kidney disease (CKD), and anemia of inflammation (AI) are among the main causes of anemia in the elderly. WHO criteria of nutritional deficiencies neglect aging-related changes in absorption, metabolism, and utilization of nutrients. Age-specific criteria for the diagnosis of functional nutritional deficiency related to anemia are necessary. We examined the nationally representative sample of Polish seniors. Complete blood count, serum iron, ferritin, vitamin B12, folate, and renal parameters were assessed in 3452 (1632 women, 1820 men) participants aged above 64. Cut-off points for nutritional deficiencies were determined based on the WHO criteria (method-A), lower 2.5 percentile of the studied population (method-B), and receiver operating characteristic (ROC) analysis (method-C). Method-A leads to an overestimation of the prevalence of vitamin B12 and folate deficiency, while method-B to their underestimation with over 50% of unexplained anemia. Based on method-C, anemia was classified as nutritional in 55.9%. In 22.3% of cases, reasons for anemia remained unexplained, the other 21.8% were related to CKD or AI. Mild cases were less common in IDA, and more common in non-deficiency anemia. Serum folate had an insignificant impact on anemia. It is necessary to adopt the age-specific criteria for nutrient deficiency in an old population.
... Older persons with anaemia often report poor quality of life and complaints of fatigue and weakness. Anaemia in old age has been associated with a higher risk of falls, frailty, disability, depression, longer postoperative recovery, as well as lower physical and cognitive capacity, a higher rate of comorbidity, and an increased mortality risk [2][3][4][5][6][7][8]. ...
Article
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Background and objectives Nutritional deficiencies, renal impairment and chronic inflammation are commonly mentioned determinants of anaemia. The aim of this study was to investigate the effects of these determinants, singly and in combination, on anaemia in the very old. Method The TULIPS Consortium consists of four population-based studies in oldest-old individuals: Leiden 85-plus Study, LiLACS NZ, Newcastle 85+ study, and TOOTH. Five selected determinants (iron, vitamin B12, and folate deficiency; low estimated glomerular filtration rate (eGFR); and high C-reactive protein (CRP)) were summed. This sum score was used to investigate the association with the presence and onset of anaemia (WHO definition). The individual study results were pooled using random-effects models. Results In the 2216 participants (59% female, 30% anaemia) at baseline, iron deficiency, low eGFR and high CRP were individually associated with the presence of anaemia. Low eGFR and high CRP were individually associated with the onset of anaemia. In the cross-sectional analyses, an increase per additional determinant (adjusted OR 2.10 (95% CI 1.85–2.38)) and a combination of ≥2 determinants (OR 3.44 (95% CI 2.70–4.38)) were associated with the presence of anaemia. In the prospective analyses, an increase per additional determinant (adjusted HR 1.46 (95% CI 1.24–1.71)) and the presence of ≥2 determinants (HR 1.95 (95% CI 1.40–2.71)) were associated with the onset of anaemia. Conclusion Very old adults with a combination of determinants of anaemia have a higher risk of having, and of developing, anaemia. Further research is recommended to explore causality and clinical relevance.
... 16 Anaemia is common in the frail elderly, 7 and is positively associated with the incidence of falls. 32 Histories of using psychiatric medications 14 and living alone 3 14 are positively associated with the incidence of falls in the elderly. A history of falls is known to be an independent risk factor for future falls. ...
Article
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Objectives We investigated whether calcaneal quantitative ultrasound (QUS-C) is a feasible tool for predicting the incidence of falls. Design Prospective epidemiological cohort study. Setting Community-dwelling people sampled in central western Taiwan. Participants A cohort of community-dwelling people who were ≥40 years old (men: 524; women: 676) in 2009–2010. Follow-up questionnaires were completed by 186 men and 257 women in 2012. Methods Structured questionnaires and broadband ultrasound attenuation (BUA) data were obtained in 2009–2010 using QUS-C, and follow-up surveys were done in a telephone interview in 2012. Using a binary logistic regression model, the risk factors associated with a new fall during follow-up were analysed with all significant variables from the bivariate comparisons and theoretically important variables. Primary outcome measures The incidence of falls was determined when the first new fall occurred during the follow-up period. The mean follow-up time was 2.83 years. Results The total incidence of falls was 28.0 per 1000 person-years for the ≥40 year old group (all participants), 23.3 per 1000 person-years for the 40–70 year old group, and 45.6 per 1000 person-years for the ≥70 year old group. Using multiple logistic regression models, the independent factors were current smoking, living alone, psychiatric drug usage and lower BUA (OR 0.93; 95% CI 0.88 to 0.99, p<0.05) in the ≥70 year old group. Conclusions The incidence of falls was highest in the ≥70 year old group. Using QUS-C-derived BUA is feasible for predicting the incidence of falls in community-dwelling elderly people aged ≥70 years.
... Anemia is common among older adults, with prevalence estimates ranging from 20% to 30% and increasing with age (18,19). It is a risk factor for falls, frailty, and early mortality, and there is an increased prevalence of anemia among frail individuals (20)(21)(22). Additionally, low hemoglobin, even within the normal range, have been associated with frailty. ...
Article
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Background Frailty is associated with reduced quality of life, poor health outcomes, and death. Past studies have investigated how specific biomarkers are associated with frailty but understanding biomarkers in concert with each other and the associated risk of frailty is critical for clinical application. Methods Using a sample aged ≥59 years at baseline from the Swedish AMORIS cohort (n=19341), with biomarkers measured at baseline (1985-1996), we conducted latent class analysis with 18 biomarkers and used Cox models to determine the association between class and frailty and all-cause mortality. Results Four classes were identified. Compared to the largest class, the Reference class (81.7%), all other classes were associated with increased risk of both frailty and mortality. The Anemia class (5.8%), characterized by comparatively lower iron markers and higher inflammatory markers, had HR=1.54, 95% CI 1.38, 1.73 for frailty and HR=1.76, 95% CI 1.65, 1.87 for mortality. The Diabetes class (6.5%) was characterized by higher glucose and fructosamine, and had HR=1.59, 95% CI 1.43, 1.77 for frailty and HR=1.74, 95% CI 1.64, 1.85 for mortality. Finally, the Liver class (6.0%), characterized by higher liver enzyme levels, had HR=1.15, 95% CI 1.01, 1.30 for frailty and HR=1.40, 95% CI 1.31, 1.50 for mortality. Sex-stratified analyses did not show any substantial differences between men and women. Conclusions Distinct sets of commonly available biomarkers were associated with development of frailty and monitoring these biomarkers in patients may allow for earlier detection and possible prevention of frailty, with the potential for improved quality of life.
... Importantly, all of the above discussed factors for frailty also apply to the anemia-fall relationship. However, in the LASA (and present) study, a positive correlation was found between fall rates and anemia, while in the TROMSO and KORA-Age studies, no significant relationship was found between falling and hemoglobin concentration [33][34][35]. When the KORA-age study was examined, it was found that the anemia-falling relationship was not observed in the whole population (967 communitydwelling older women and men), but anemic women fell almost 2 times more than anemic men [35]. ...
Article
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Objectives: The objective of this study was to investigate associations between anemia with geriatric syndromes and comprehensive geriatric assessment (CGA) parameters in older women. Methods: 886 older outpatient women were included . Anemia was defined as a hemoglobin concentration below 12 g/dL. patients were divided into two groups as anemic and non-anemic. The relationships between anemia and CGA parameters/geriatric syndromes were determined. Results: The mean age of the participants was 76.00 ± 8.91. The prevalence of patients with anemia was 15.35%. There was a significant difference between anemic and non-anemic groups in terms of age, Charlson Comorbidity Index, body mass index, the number of drugs used, and the presence of chronic renal failure (p < 0.05). After adjustment for these covariates, anemia was associated with Timed Up and Go test (OR: 1.10, 95% CI: 1.02–1.18), muscle strength (OR: 0.99, 95% CI: 0.83–0.99), dynapenia (OR: 1.92, 95% CI: 1.06–3.47), Mini Nutritional Assessment scores (OR: 0.88, 95% CI: 0.83–0.94), poor nutritional status (OR: 1.97, 95% CI: 1.10–3.48), Fried scores (OR: 1.42, 95% CI: 1.24–1.68), frailty (OR: 2.58, 95% CI: 1.42–4.69), falls (OR: 1.78, 95% CI: 1.10–2.92) and polypharmacy (OR: 2.31, 95% CI: 1.38–3.86). Conclusion: In the present study anemia was associated with frailty, polypharmacy, poor nutritional status, falls, and decreased muscle strength. Therefore, anemia may be a sign of poor health status in older women. When anemia is detected in an older woman, CGA should be strongly considered if not routinely performed.
... In elderly, anemia is associated with poor performance status, increased frailty, dementia, depression, reduced mobility, increased risk of falls, and poor quality of life. [5][6][7][8][9][10][11][12] Anemia portends worse prognosis in elderly patients with cardiovascular and other chronic illnesses. Studies have reported a survival benefit with the treatment of geriatric anemia. ...
Article
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Background Geriatric anemia is a global health problem because of its high prevalence and associated significant morbidity and mortality. Aim The objectives of this study were to estimate the pattern of anemia in the elderly patients and the underlying etiology of anemia. Research Design and Methods This was a hospital-based prospective observational study, conducted in patients aged 60 years and above at PGIMER, Chandigarh, a tertiary care center of North India. Anemia is defined as hemoglobin level less than 13 g/dl in men and 12 g/dl in women. Results Among the 105 older patients with anemia, the mean value of hemoglobin was 8.8 ± 2.3 g/dl. The etiological distribution of anemia was iron deficiency in 26 patients (24.8%), chronic disease in 24 patients (22.9%), hematological disorders in 21 (20%), chronic kidney disease in 13 (12.4%), multifactorial in 8 (7.6%), vitamin B12 deficiency in 2 (1.9%), folate deficiency in 1 (0.9%), and hypothyroidism in 1 patient (0.9%). No etiology could be found in 9 patients (8.6%). 57.6% of the iron-deficient patients had upper gastrointestinal lesions and 30.7% had a nutritional cause. Common chronic diseases causing anemia were malignancy (36.6%) and liver disease (29.1%). The myelodysplastic syndrome was the commonest hematological disorder. 53.35% of the patients had normocytic anemia, 40% had microcytic anemia, and 6.6% had macrocytic anemia. Conclusions In most of the cases, anemia in the elderly had a treatable cause. Thus, a thorough investigation including gastrointestinal endoscopy is warranted. Unexplained progressive or unresponsive anemia requires bone marrow examination.
Article
The conjunction of the demographic aging and the increase in the frequency of anemia with the advancing age, mean that the number of globular concentrates delivered each year increases with a consequent heavy pressure on blood collection. The etiologies of anemia in the elderly are often multifactorial and their investigation is an indispensable step and prior to any treatment. Transfusion thresholds, particularly in the elderly, are gradually evolving and a so-called restrictive strategy is now favored. Immediate and delayed complications of transfusion are more frequent in the elderly due to vulnerability factors associated with frailty and the risk of multiple transfusions. The screening of complications related to transfusion of RBCs is essential and makes it possible to avoid their recurrence. The impact of transfusion on the quality of life of elderly patients is not obvious and is a controversial issue. In addition, transfusion of red blood cells (RBCs) is accompanied by an increase in health expenditure and an increase in morbidity and mortality, whose risks can be reduced through alternatives to transfusion. Longitudinal studies, including elderly subjects, would allow a better understanding of the issues involved in the transfusion of RBCs in this population. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
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Anemia is highly prevalent, especially in older individuals. In selected populations, anemia has been reported to be associated with impaired survival and health-related quality of life. However, data on this impact in the general population are rare. Furthermore, discussions on the optimal definition of anemia have not been conclusive. We investigated these issues using survival data, scores from a health-related quality of life questionnaire (RAND-36), and hemoglobin concentration from 138670 subjects, aged 18-93 years, participating in the Lifelines cohort. Anemia was defined according to World Health Organization criteria and was further subclassified in participants over 60 years old. Anemia was present in 5510 (4.0%) of all 138670 subjects and 516 (2.8%) in the 18667 individuals older than 60 years. Anemia had no impact on overall survival and limited impact on health-related quality of life in individuals less than 60 years old. In contrast, in individuals over 60 years old anemia significantly impaired overall survival and health-related quality of life. The lower health-related quality of life was mainly observed in subscales representing physical functioning. Although consensus on the subclassification of anemia is lacking, our data suggest that particularly anemia of chronic inflammation was associated with worse overall survival and decreased health-related quality of life. Multivariate models confirmed that anemia was an independent risk factor for decreased health-related quality of life in older individuals. Finally, women with a hemoglobin concentration between 12.0-13.0 g/dL (considered anemia in men, but not in women) experienced a significantly lower health-related quality of life. This large, prospective, population-based study indicates that anemia is associated with worse overall survival and health-related quality of life in older individuals, but not in younger individuals. The findings of this study challenge the definition of anemia in women over 60 years old, and suggest that the optimal definition of anemia, in the perspective of health-related quality of life, in women over 60 years old should be altered to a hemoglobin concentration below 13.0 g/dL (8.0 mmol/L), which is comparable to that in men.
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Anemia affects a substantial fraction of the elderly population, representing a public health problem that is predicted to further increase in coming years because of the demographic drive. Being typically mild, it is falsely perceived as a minor problem, particularly in the elderly with multimorbidity, so that it often remains unrecognized and untreated. Indeed, mounting evidence indicates that anemia in the elderly (AE) is independently associated with disability and other major negative outcomes, including mortality. AE is generally multifactorial, but initial studies suggested that etiology remains unexplained in near one-third of cases. This proportion is consistently declining due to recent advances highlighting the role of several conditions including clonal hematopoiesis, "inflammaging," correctable androgen deficiency in men, and under-recognized iron deficiency. Starting from a real-world case vignette illustrating a paradigmatic example of anemia in an elderly patient with multimorbidity, we review the main clinical and pathophysiological aspect of AE, giving some practical insights into how to manage similar cases.
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Introduction People who sustain a hip fracture are typically elderly, frail and require urgent surgery. Hip fracture and the urgent surgery is associated with acute blood loss, compounding patients’ pre-existing comorbidities including anaemia. Approximately 30% of patients require a donor blood transfusion in the perioperative period. Donor blood transfusions are associated with increased rates of infections, allergic reactions and longer lengths of stay. Furthermore, there is a substantial cost associated with the use of donor blood. Cell salvage and autotransfusion is a technique that recovers, washes and transfuses blood lost during surgery back to the patient. The objective of this study is to determine the clinical and cost effectiveness of intraoperative cell salvage, compared with standard care, in improving health related quality-of-life of patients undergoing hip fracture surgery. Methods and analysis Multicentre, parallel group, two-arm, randomised controlled trial. Patients aged 60 years and older with a hip fracture treated with surgery are eligible. Participants will be randomly allocated on a 1:1 basis to either undergo cell salvage and autotransfusion or they will follow the standard care pathway. Otherwise, all care will be in accordance with the National Institute for Health and Care Excellence guidance. A minimum of 1128 patients will be recruited to obtain 90% power to detect a 0.075-point difference in the primary endpoint: EuroQol-5D-5L HRQoL at 4 months post injury. Secondary outcomes will include complications, postoperative delirium, residential status, mobility, allogenic blood use, mortality and resource use. Ethics and dissemination NHS ethical approval was provided on 14 August 2019 (19/WA/0197) and the trial registered ( ISRCTN15945622 ). After the conclusion of this trial, a manuscript will be prepared for peer-review publication. Results will be disseminated in lay form to participants and the public. Trial registration number ISRCTN15945622 .
Chapter
Cambridge Core - Geriatrics - Principles of Geriatric Critical Care - edited by Shamsuddin Akhtar
Article
Objectives This study reports the prevalence of anemia and investigates its associated correlates and outcomes among elderly hospitalized patients in a single hospital in Bahrain. Methods A retrospective study was conducted on 227 consecutive elderly patients admitted under general internal medicine in the biggest tertiary hospital in Bahrain. Medical records were reviewed for all patients, including clinical characteristics, laboratory results, and outcomes. Results Anemia was highly prevalent among hospitalized elderly patients (71.6%). Males were significantly more affected than females (p = 0.031). In terms of severity, the most common type was moderate anemia (56.1%); with regards to etiology, the most common type was anemia associated with chronic disease (48.1%). Anemia was as common as other comorbidities, including hypertension (71.4%) and diabetes mellitus (53.7%). When comparing anemic to non-anemic patients, the length of hospital stay was significantly longer (p < 0.001) and inversely correlated to the level of hemoglobin; furthermore, 1-year mortality was significantly higher (p < 0.001). When compared to those with mild anemia, patients with moderate/severe anemia were more likely to die (odds ratio [OR] = 2.2, 95% confidence interval [CI]: 1.27–4.92). Conclusion The prevalence of anemia in our study was higher than previously reported. Even so, anemia receives minimal attention and is usually seen as a minor problem. Our results reiterate the need to recognize the high importance of anemia especially when diagnosing and treating older patients. This, in turn, could positively affect a number of outcomes such as mortality, length of stay, and the functional decline of admitted individuals.
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Falling is a representative incident in hospitalization and can cause serious complications. In this study, we constructed an algorithm that nurses can use to easily recognize essential fall risk factors and appropriately perform an assessment. A total of 56,911 inpatients (non-fall, 56,673; fall; 238) hospitalized between October 2017 and September 2018 were used for the training dataset. Correlation coefficients, multivariable logistic regression analysis, and decision tree analysis were performed using 36 fall risk factors identified from inpatients. An algorithm was generated combining nine essential fall risk factors (delirium, fall history, use of a walking aid, stagger, impaired judgment/comprehension, muscle weakness of the lower limbs, night urination, use of sleeping drug, and presence of infusion route/tube). Moreover, fall risk level was conveniently classified into four groups (extra-high, high, moderate, and low) according to the priority of fall risk. Finally, we confirmed the reliability of the algorithm using a validation dataset that comprised 57,929 inpatients (non-fall, 57,695; fall, 234) hospitalized between October 2018 and September 2019. Using the newly created algorithm, clinical staff including nurses may be able to appropriately evaluate fall risk level and provide preventive interventions for individual inpatients.
Article
Anemia, a frequently occurring condition in older patients, has no standard definition; however, in most studies, it is defined as hemoglobin level <12 and <13 g/dL in women and men, respectively. Approximately 10% of older adults living in the community have anemia. The prevalence of anemia is significantly correlated with advanced age and male sex. Anemia is associated with falls, frailty and other negative outcomes, including early mortality. However, there remains little consensus regarding whether anemia treatment favorably affects these adverse outcomes. Therefore, this article reviews the prevalence of anemia, and provides updates on its common causes and treatments in older adults. While excluding well‐established hematopoietic diseases, the etiology of anemia in older adults has been grouped into four categories: (i) nutritional deficiency; (ii) inflammation; (iii) clonal hematopoiesis; and (iv) “unexplained anemia,” when there is no clear mechanism to account for the anemia. Recently, clonal leukocytes were detected in a considerable number of older individuals. The number of somatic mutations in blood leukocytes increases with age; however, single mutations of DNMT3A, TET2 and ASXL1 are not correlated with the presence of unexplained anemia in older adults. With an increased understanding of anemia etiology and the availability of innovative anti‐anemic drugs, future studies that evaluate the causes and benefits of treatment are required. Geriatr Gerontol Int 2021; ••: ••–••.
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Importance: Anemia is common and has been associated with poor outcomes in the critically ill population, yet the timing and extent of hemoglobin recovery remains incompletely described, which may have important implications for clinical outcomes following discharge from intensive care. Objectives: To describe longitudinal changes in anemia status during and after critical illness and assess the associations between hemoglobin concentrations and postdischarge mortality. Design, setting, and participants: A population-based cohort study was conducted from January 1, 2010, to December 31, 2016, in Olmsted County, Minnesota; data analysis was performed from June 1 to December 30, 2019. Participants included 6901 adults (age ≥18 years) admitted to intensive care. Main outcomes and measures: Hemoglobin concentrations in the 12 months before hospitalization, during hospitalization, and in the 12 months after discharge, categorized by anemia severity (mild, hemoglobin ≥10.0 to <12.0 g/dL in women or ≥10.0 to <13.5 g/dL in men; moderate, hemoglobin ≥8.0 to <10.0 g/dL; and severe, hemoglobin <8.0 g/dL). Complete recovery from anemia, defined as attainment of nonanemic status by 12 months post hospitalization, and 12-month mortality were also evaluated. Results: Of the 6901 patients included in the study, 3792 were men (55%); median (interquartile range [IQR]) age was 67 (IQR, 52-79) years. Prehospitalization hemoglobin concentrations were available in 83% of the population (n = 5694), with median hemoglobin concentrations of 13.1 (IQR, 11.6-14.4) g/dL. Forty-one percent of the patients (n = 2320) had anemia preceding hospitalization. Hemoglobin values at hospital discharge were 10.8 g/dL (IQR, 9.5-12.4 g/dL), with 80% (n = 5182 of 6460) having anemia: 58% mild, 39% moderate, and 3% severe. The prevalence of anemia post hospitalization was 56% (95% CI, 55%-58%) at 3 months, 52% (95% CI, 50%-54%) at 6 months, and 45% (95% CI, 43%-47%) at 12 months among those alive with available hemoglobin measurements. Rates of complete recovery from anemia at 12 months were 58% (95% CI, 56%-61%) for mild anemia, 39% (95% CI, 36%-42%) for moderate anemia, and 24% (95% CI, 15%-34%) for severe anemia. Of those without baseline anemia surviving hospitalization, 74% of the patients were anemic at hospital discharge, with rates of complete 12-month recovery of 73% (95% CI, 69%-76%) for mild anemia, 62% (95% CI, 57%-68%) for moderate anemia, and 59% (95% CI, 35%-82%) for severe anemia. Higher hospital discharge hemoglobin concentrations were associated with decreased mortality after multivariable adjustment (hazard ratio, 0.95 per 1-g/dL increase; 95% CI, 0.90-0.99, P = .02). Conclusions and relevance: The findings of this study suggest that anemia is common and often persistent in the first year after critical illness. Further studies are warranted to identify distinct anemia recovery profiles and assess associations with clinical outcomes.
Article
Anemia is a common health problem in older adults and is associated with risk factors for fracture such as low physical function and low bone mass. The aim of this study was to examine the relationship between anemia and fracture risk in older adults. We conducted a retrospective cohort study from 2003 to 2013. The participants were community‐dwelling Korean adults aged 65 years and older who participated in the National Health Screening Program (n = 72,131) between 2003 and 2008. Anemia (<12 g/dL for women and <13 g/dL for men) and severity of anemia (mild: 11g/dL ≤ Hb < 12 g/dL, moderate to severe: Hb < 11g/dL) were defined by World Health Organization (WHO) criteria. The incidence of any fractures, vertebral fractures, and femur fractures was identified using ICD‐10 codes. Cox proportional hazard regression models were used to assess risk of fracture according to anemia. Anemia was associated with increased risk of fracture in men (Any: adjusted hazard ratio [aHR] 1.29; 95% confidence interval [CI], 1.18‐1.41; vertebral: aHR 1.20, 95% CI 1.03‐1.40; femur: aHR 1.71, 95% CI 1.44‐2.04), and less strongly, but still significantly in women (Any: aHR 1.10, 95% CI 1.11‐1.41; vertebral: aHR 1.11, 95% CI 1.03‐1.20; femur: aHR 1.37, 95% CI 1.25‐1.52). Higher risk was observed in subjects with moderate‐to‐severe anemia in both sexes. Considering the high prevalence of anemia in older adults, it is important that health professionals recognize increased fracture risk in older adults with anemia. This article is protected by copyright. All rights reserved
Article
Objective Anemia is common during critical illness and often persists after hospital discharge; however, its potential association with physical outcomes after critical illness is unclear. Our objective was to assess the associations between hemoglobin at intensive care unit (ICU) and hospital discharge with physical status at 3-month follow-up in acute respiratory distress syndrome (ARDS) survivors. Methods This is a secondary analysis of a multisite prospective cohort study of 195 mechanically ventilated ARDS survivors from 13 ICUs at 4 teaching hospitals in Baltimore, Maryland. Multivariable regression was utilized to assess the relationships between ICU and hospital discharge hemoglobin concentrations with measures of physical status at 3 months, including muscle strength (Medical Research Council sumscore), exercise capacity (6-minute walk distance [6MWD]), and self-reported physical functioning (36-Item Short-Form Health Survey [SF-36v2] Physical Function score and Activities of Daily Living [ADL] dependencies). Results Median (interquartile range) hemoglobin concentrations at ICU and hospital discharge were 9.5 (8.5-10.7) and 10.0 (9.0-11.2) g/dL, respectively. In multivariable regression analyses, higher ICU discharge hemoglobin concentrations (per 1 g/dL) were associated with greater 3-month 6MWD mean percent of predicted (3.7% [95% confidence interval 0.8%-6.5%]; P = .01) and fewer ADL dependencies (−0.2 [−0.4 to −0.1]; P = .02), but not with percentage of maximal muscle strength (0.7% [−0.9 to 2.3]; P = .37) or SF-36v2 normalized Physical Function scores (0.8 [−0.3 to 1.9]; P = .15). The associations of physical outcomes and hospital discharge hemoglobin concentrations were qualitatively similar, but none were statistically significant. Conclusions In ARDS survivors, higher hemoglobin concentrations at ICU discharge, but not hospital discharge, were significantly associated with improved exercise capacity and fewer ADL dependencies. Future studies are warranted to further assess these relationships.
Article
Vascular endothelial growth factor (VEGF) is important for bone formation and has been associated with osteoporosis in humans. Therefore, we conducted a two‐sample Mendelian randomization study to test whether genetically decreased circulating VEGF was associated with decreased bone mineral density (BMD) and increased risk of fracture. Summary statistics from a genome‐wide association study (GWAS) meta‐analysis of circulating VEGF level (N = 16,112) were used to identify 10 genetic variants explaining up to 52% of the variance in circulating VEGF levels. GWAS meta‐analyses on dual X‐ray absorptiometry‐derived BMD of forearm, lumbar spine, and femoral neck (N = up to 32,735), and BMD estimated from heel calcaneus ultrasound (eBMD) (N = 426,824) were used to assess the effect of genetically lowered circulating VEGF levels on BMD. A GWAS meta‐analysis including a total of 76,549 cases and 470,164 controls was used to assess the effect of genetically lowered circulating VEGF levels on risk of fracture. A natural log‐transformed pg/mL decrease in circulating VEGF levels was not associated with a decrease in forearm BMD (0.02 standard deviations (SD), 95% CI: [−0.024, 0.064], p = 0.38), lumbar spine BMD (−0.005 SD, 95% CI: [−0.03, 0.019], p = 0.67), femoral neck BMD (0.004 SD, 95% CI: [−0.017, 0.026], p = 0.68), eBMD (−0.006 SD, 95% CI: [−0.012, −0.001], p = 0.031) or risk of fracture (odds ratio: 0.99, 95% CI: [0.98, 1.0], p = 0.37) in inverse‐variance weighted Mendelian randomization analyses. Sensitivity analyses did not provide evidence that our results were influenced by pleiotropy. Genetically lowered circulating VEGF was not associated with a decrease in BMD or increased risk of fracture, suggesting that efforts to influence circulating VEGF level are unlikely to have beneficial effects on osteoporosis outcomes and that previous observational associations of circulating VEGF with BMD were influenced by confounding or reverse causation. This article is protected by copyright. All rights reserved.
Article
Objectives: The objective of this study was to assess the diagnosis and management of anemic patients in free clinics around the Tampa Bay area. Methods: In this retrospective study we extracted data including demographics, chronic diseases, and laboratory values from medical charts of uninsured patients seen in 9 free clinics from January 2016 through December 2017 in the Tampa Bay area, FL, USA. Multiple logistic regression analysis was used to assess relationships between socioeconomic variables and a documented history of anemia. Results: From two years of documented data, 6971 patients were included, of which 367 (5%) had a documented diagnosis of anemia. Most were women (315, 86%), and the median age was 41 years (6-91). Among the 367 patients with anemia,191 (52%) patients had an unspecified type of anemia, 144 (39%) were diagnosed with IDA, 16 (4%) with anemia of chronic disease, and the remaining were other uncommon causes. Only 67% (97/144) of IDA patients had documented iron replacement. Colonoscopies were documented in only 32 (9%) of all patients with anemia, and in 23 (16%) IDA patients. Several chronic diseases were statistically associated and comorbid with a diagnosis of anemia. Conclusions: Uninsured patients with IDA are prescribed iron and undergo colonoscopies at sub-optimal rates. Increasing resources, awareness, and education of providers in these settings could lead to improved treatment practices and decrease the risk of morbidity and mortality.
Article
Anaemia is the most frequent haematological disease in older patients with prevalence up to 60% among patients hospitalized in acute geriatric ward. Furthermore, people aged 65 years and over receive more than half of the blood transfusion. The tolerance and the symptom of anaemia in older patients are very variable from one patient to another depending on ageing and comorbidities. The transfusion decision should not be based on haemoglobin levels but should be based on the benefit/risk balance taking into account patients’ symptoms due to anaemia, benefit and expected efficacy as well as risk of the transfusion in this comorbid population. Indeed, adverse events of red blood cell transfusion are more frequent in older patients. However, several studies showed a lower mortality in liberal transfusion strategy than restrictive strategy especially in surgical ward. Beside the development of alternative treatment of anaemia, further geriatric-specific studies which includes geriatric syndromes are needed to guide development of specific guidelines for older patients in surgical and in medical wards. With the lack of strong and comprehensive data, one should continue to evaluate the risk to benefit ratio in each older individual, bearing in mind that the blood should be transfused more slowly and on a unit by unit basis.
Article
Anemia is a common, yet often overlooked, geriatric syndrome characterized by reduced hemoglobin levels and associated with adverse health outcomes and early mortality. Evidence suggests that anemia is an independent risk factor for frailty in older adults. In this article, the authors review the evidence for the role of chronic inflammation in the pathogenesis of anemia in the frail elderly. Understanding the relationships between anemia, frailty, and chronic inflammation will pave the way for the development of novel interventional strategies for the treatment and prevention of anemia and, likely, also frailty in older adults.
Article
Anemia is a prevalent disease with multiple possible etiologies and resultant complications. Iron deficiency anemia is a common cause of anemia and is typically due to insufficient intake, poor absorption, or overt or occult blood loss. Distinguishing iron deficiency from other causes of anemia is integral to initiating the appropriate treatment. In addition, identifying the underlying cause of iron deficiency is also necessary to help guide management of these patients. We review the key components to an evidence-based, cost-conscious evaluation of suspected iron deficiency anemia.
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Falls warrant investigation as a risk factor for nursing home admission because falls are common and are associated with functional disability and because they may be preventable. We conducted a prospective study of a probability sample of 1103 people over 71 years of age who were living in the community. Data on demographic and medical characteristics, use of health care, and cognitive, functional, psychological, and social functioning were obtained at base line and one year later during assessments in the participants' homes. The primary outcome studied was the number of days from the initial assessment to a first long-term admission to a skilled-nursing facility during three years of follow-up. Patients were assigned to four categories during follow-up: those who had no falls, those who had one fall without serious injury, those who had two or more falls without serious injury, and those who had at least one fall causing serious injury. A total of 133 participants (12.1 percent) had long-term admissions to nursing homes. In an unadjusted model, the risk of admission increased progressively, as compared with that for the patients with no falls, for those with a single noninjurious fall (relative risk, 4.9; 95 percent confidence interval, 3.2 to 7.5), those with multiple noninjurious falls (relative risk, 8.5; 95 percent confidence interval, 3.4 to 21.2), and those with at least one fall causing serious injury (relative risk, 19.9; 95 percent confidence interval, 12.2 to 32.6). Adjustment for other risk factors lowered these ratios to 3.1 (95 percent confidence interval, 1.9 to 4.9) for one noninjurious fall, 5.5 (95 percent confidence interval, 2.1 to 14.2) for two or more noninjurious falls, and 10.2 (95 percent confidence interval, 5.8 to 17.9) for at least one fall causing serious injury, but the association between falls and admission to a nursing home remained strong and significant. The population attributable risk of long-term admission to a nursing home for these three groups (the proportion of admissions directly attributable to the three categories of falls) was 13 percent, 3 percent, and 10 percent, respectively. Among older people living in the community falls are a strong predictor of placement in a skilled-nursing facility; interventions that prevent falls and their sequelae may therefore delay or reduce the frequency of nursing home admissions.
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Depression may be a potential risk factor for subsequent cardiac death. The impact of depression on cardiac mortality has been suggested to depend on cardiac disease status, and to be stronger among cardiac patients. This study examined and compared the effect of depression on cardiac mortality in community-dwelling persons with and without cardiac disease. A cohort of 2847 men and women aged 55 to 85 years was evaluated for 4 years. Major depression was defined according to psychiatric DSM-III criteria. Minor depression was defined by Center for Epidemiologic Studies-Depression Scale scores of 16 or higher. Effects of minor and major depression on cardiac mortality were examined separately in 450 subjects with a diagnosis of cardiac disease and in 2397 subjects without cardiac disease after adjusting for demographics, smoking, alcohol use, blood pressure, body mass index, and comorbidity. Compared with nondepressed cardiac patients, the relative risk of subsequent cardiac mortality was 1.6 (95% confidence interval [CI], 1.0-2.7) for cardiac patients with minor depression and 3.0 (95% CI, 1.1-7.8) for cardiac patients with major depression, after adjustment for confounding variables. Among subjects without cardiac disease at baseline, similar increased cardiac mortality risks were found for minor depression (1.5 [95% CI, 0.9-2.6]) and major depression (3.9 [95% CI, 1.4-10.9]). Depression increases the risk for cardiac mortality in subjects with and without cardiac disease at baseline. The excess cardiac mortality risk was more than twice as high for major depression as for minor depression.
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A decline in muscle mass and muscle strength characterizes normal aging. As clinical and animal studies show a relationship between higher cytokine levels and low muscle mass, the aim of this study was to investigate whether markers of inflammation are associated with muscle mass and strength in well-functioning elderly persons. We used baseline data (1997-1998) of the Health, Aging, and Body Composition (Health ABC) Study on 3075 black and white men and women aged 70-79 years. Midthigh muscle cross-sectional area (computed tomography), appendicular muscle mass (dual-energy x-ray absorptiometry), isokinetic knee extensor strength (KinCom), and isometric grip strength were measured. Plasma levels of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) were assessed by enzyme-linked immunosorbent assay (ELISA). Higher cytokine levels were generally associated with lower muscle mass and lower muscle strength. The most consistent relationship across the gender and race groups was observed for IL-6 and grip strength: per SD increase in IL-6, grip strength was 1.1 to 2.4 kg lower (p <.05) after adjustment for age, clinic site, health status, medications, physical activity, smoking, height, and body fat. An overall measure of elevated cytokine level was created by combining the levels of IL-6 and TNF-alpha. With the exception of white men, elderly persons having high levels of IL-6 (>1.80 pg/ml) as well as high levels of TNF-alpha (>3.20 pg/ml) had a smaller muscle area, less appendicular muscle mass, a lower knee extensor strength, and a lower grip strength compared to those with low levels of both cytokines. Higher plasma concentrations of IL-6 and TNF-alpha are associated with lower muscle mass and lower muscle strength in well-functioning older men and women. Higher cytokine levels, as often observed in healthy older persons, may contribute to the loss of muscle mass and strength that accompanies aging.
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To develop a classification tree for predicting the risk of recurrent falling in community-dwelling older persons using tree-structured survival analysis (TSSA). A prospective cohort study. A community in the Netherlands. One thousand three hundred sixty-five community-dwelling older persons (>/=65) from the Longitudinal Aging Study Amsterdam (LASA). In 1995, physical, cognitive, emotional, and social aspects of functioning were assessed. Subsequently, a prospective fall follow-up, specifically on recurrent falls (two falls within 6 months) was conducted for 3 years. The classification tree included 11 end groups differing in risk of recurrent falling based on a minimum of two and a maximum of six predictors. The first split in the tree involved two or more falls versus fewer than two falls in the year preceding the interview. Respondents with two or more falls in the year preceding the interview (n=193) and with at least two functional limitations (n=98) had a 75% risk of becoming a recurrent faller, whereas respondents with fewer than two functional limitations were further divided into a group with regular dizziness (n=11, risk of 68%) and a group with no regular dizziness (n=84, risk of 30%). In respondents with fewer than two falls in the year preceding the interview (n=1,172), the risk of becoming a recurrent faller varied between 9% and 70%. Predictors in this branch of the tree were low performance, low handgrip strength, alcohol use, pain, high level of education, and high level of physical activity. This classification tree included 11 end groups differing in the risk of recurrent falling based on specific combinations of a maximum of six easily measurable predictors. The classification tree can identify subjects who are eligible for preventive measures in public health strategies.
Article
Background: Studies documenting that depressed elderly persons report more physical disability over time than those without depression included only a one-time measure of depressed mood. This study assessed depression and physical ability at 2 timepoints to determine the effect that remitting, emerging, or chronic depression has on the physical function of elderly persons. Methods: A total of 2121 community-dwelling elderly subjects were assessed for depression using the Center for Epidemiologie Studies Depression scale (CES-D) at the beginning and end of a 3-year interval, allowing for the categorization of subjects into 4 groups: those with no depression, those with remitting depression, those with newly emerging depression, and those with chronic depression. Physical function was assessed at both timepoints both by self-report and by observer-rated measures. Results: Subjects with chronic depression had a significantly greater decline in self-reported physical function (odds ratio [OR] = 2.83, 95% confidence interval [CI] = 1.86 to 4.30) and, among the oldest old, in observed physical performance (OR = 2.22, 95% CI = 1.43 to 3.79) than those who had no depression. Emerging depression was associated with a similar decline in physical performance: remitted depression, however, showed no association with such decline. Conclusions: Chronicity of depression was associated with decline in physical ability over time. The absence of a like association between remitted depression and physical decline suggests that elderly individuals for whom depression is recognized early and treated promptly mav avoid subsequent physical decline.
Article
To test whether accelerated sarcopenia in older persons with high interleukin (IL)-6 serum levels plays a role in the prospective association between inflammation and disability found in many studies. Cohort study of older women with moderate to severe disability. Six hundred twenty older women from the Women's Health and Aging Study in whom information on baseline IL-6 serum level was available. Self-report of functional status, objective measures of walking performance, and knee extensor strength were assessed at baseline and over six semiannual follow-up visits. Potential confounders were baseline age, race, body mass index, smoking, depression, and medical conditions. At baseline, women with high IL-6 were more often disabled and had lower walking speed. After adjusting for confounders, women in the highest IL-6 tertile (IL-6>3.10 pg/mL) were at higher risk of developing incident mobility disability (risk ratio (RR) = 1.50, 95% confidence interval (CI) = 1.01-2.27), disability in activities of daily living (RR = 1.41, 95% CI = 1.01-1.98), and severe limitation in walking (RR = 1.61, 95% CI = 1.09-2.38) and experienced steeper declines in walking speed (P <.001) than women in the lowest IL-6 tertile (IL-6 < or =1.78 pg/mL). Decline in knee extensor strength was also steeper, but differences across IL-6 tertiles were not significant. After adjusting for change over time in knee extensor strength, the association between high IL-6 and accelerated decline of physical function was no longer statistically significant. Older women with high IL-6 serum levels have a higher risk of developing physical disability and experience a steeper decline in walking ability than those with lower levels, which are partially explained by a parallel decline in muscle strength.
Article
Objectives: The World Health Organization (WHO) and other currently used criteria for defining anemia in older women are mainly based on statistical distribution considerations. To explore their clinical appropriateness, we evaluated the relationship between hemoglobin (Hb) concentration, prevalent mobility difficulty, and the Summary Performance Score (SPS). Design: Cross-sectional study. Setting: Two population-based studies, the Women's Health and Aging Studies I and II, Baltimore, Maryland. Participants: Six hundred thirty-three community-dwelling women aged 70 to 80 with Hb levels obtained within 90 days from baseline assessment. Measurements: Mobility difficulty (self-reported difficulty walking one-quarter of a mile or climbing 10 steps (primary outcome)). SPS, a performance-based summary measure of lower extremity function that combines the results of walking, chair stands, and balance tests (secondary outcome). Results: Mobility difficulty prevalence was not constant within the WHO "normal" Hb range (12.0-16.0 g/dL). For example, a Hb of 13.5 g/dL was associated with a significantly lower mobility difficulty prevalence than a Hb of 12.0 g/dL (OR=0.68, 95% CI=0.47-0.93), even after adjustment for chronic diseases and other relevant health indicators. A consistent trend of improvement in performance-based scores with increasing Hb categories less than 12.0 g/dL, 12.0 to 13.0g/dL, and 13.0-14.0 g/dL was observed. Conclusion: Our findings raise two hypotheses: (1) Hb currently perceived as "mildly-low" and even "low-normal" might have an independent, adverse effect on mobility function, and (2) Hb of 12.0 g/dL might be a suboptimal criterion for defining anemia in older women. Formal testing of these hypotheses might prove relevant for anemia- and mobility disability-related clinical decision-making.
Article
Several preventive strategies have proven effective at reducing the occurrence and rate of falling. It remains to be determined, however, whether, and to what extent, falls and/or fall injuries are independent determinants of adverse functional outcomes in older persons. A probability sample of 1,103 community-dwelling persons over age 71 years was followed for 3 years. The 957 cohort members (87%) who participated in at least one follow-up interview while residing in the community were included in this study. Outcome measures included one and three year change in basic and instrumental activities of daily living (BADLs-IADLs), social activities, and physical activities. Based on daily calendars and hospital surveillance, participants were placed into one of four levels of fall status: no falls, one fall without serious injury, at least two falls without serious injury, and one or more falls with serious injury. Hierarchical linear regression models, sequentially adding six domains of covariates, were constructed to examine fall status as a risk factor for change in function. One noninjurious fall (beta = -.437; p < .01), at least two noninjurious falls (beta = -.877; p < .001); and at least one injurious fall (beta = -1.254; p < .001) were each associated with decline in BADL-IADL function over 3 years after adjusting for covariates (model R2 = .2617). Experiencing two or more noninjurious falls (beta = -.538; p < .05) was associated with decline in social activities (model R2 = .2779) while experiencing at least one injurious fall (beta = -.580; p < .01) was associated with decline in physical activity (model R2 = .4231). Falls and fall injuries appear to be independent determinants of functional decline in community-dwelling older persons. Falling is a health condition meeting all criteria for prevention: high frequency, evidence of preventability, and high burden of morbidity.
Article
High-altitude exposure impairs both maximal aerobic and anaerobic (lactic and alactic) performances. The maximal aerobic power (VO2max) decreases exponentially with increasing altitude. At 5,350 m, a sudden rise in inspired O2 pressure (PIO2) was found to raise the VO2max of acclimatized lowlanders from 70 to only 92% of the control sea-level value. Since the hemoglobin concentration was about 35% higher than that of the controls, hemoglobin O2 saturation was restored to about 100%, and maximal cardiac output was only 10-20% lower than at sea level, the above result can only be the consequence: (1) of a reduced muscle mass and/or of muscle deterioration, and (2) of impaired muscle perfusion. In muscle biopsies taken from the vastus lateralis muscles of mountaineers after a 6- to 8-week sojourn at high altitude, a reduction in the fiber cross-sectional area was found which was accompanied by a decrease in the volume density of the mitochondria and by a lower tissue oxidative capacity. In acclimatized lowlanders, the maximal blood lactate concentration after exhausting exercise was halved compared to sea-level conditions. On the other hand, the peak anaerobic power was not affected by severe hypoxia within the first 3 weeks of exposure; thereafter, it decreased by about 25%, probably as a consequence of muscle deterioration. It is concluded that, whereas in acute hypoxia VO2max is primarily reduced by a lack of O2, in chronic hypoxia muscle deterioration may become an important factor contributing to the limitation of the maximal aerobic performance.
Article
Of 732 consecutive patients admitted to an acute geriatric ward, 178 (24%) were found to be anaemic (haemoglobin of 115 g/l or below). An appropriate cause responsible for anaemia was identified in 83%. The anaemia of chronic disorders (ACD) (35%) and iron deficiency anaemia (15%) were the commonest causes. The spectrum of disorders associated with ACD is much broader than the classical category of infectious, inflammatory and malignant disorders. The relatively high prevalence of the myelodysplastic syndrome (5%) is striking and this syndrome as a cause of anaemia in geriatric patients deserves more attention than it has so far received. No obvious cause was found in 17%. The clinical significance of this finding remains unclear.
Article
To determine the relationship of hemoglobin levels and anemia with age and health status in older adults. Survey. Community. Hematologic tests were obtained from 3,946 adults aged greater than or equal to 71 years in three communities (East Boston, MA; Iowa and Washington counties, IA; and New Haven, CT). Hemoglobin level was inversely associated with age, although this was more pronounced in men than in women. The proportion anemic was equal for men and women aged 71-74 years (8.6%) and increased differentially with age, reaching 41% and 21% for men and women aged greater than or equal to 90 years, respectively. Hemoglobin and anemia were independently associated with age, race, body-mass index, smoking, cancer, hospitalization, renal insufficiency, and hypoalbuminemia. The adjusted relative odds of anemia for a 5-year increase in age was 1.5 (95% confidence interval [CI] 1.3-1.8) for men and 1.2 (95% CI 1.1-1.4) for women. Age is significantly associated with both hemoglobin levels and anemia, with a stronger effect in men compared with women, even after simultaneously adjusting for demographic characteristics and health status. The decline of hemoglobin and concomitant increased anemia with age is not necessarily a result of "normal aging" so the detection of anemia in an older person should prompt appropriate clinical attention.
Article
Falls are a major threat to the health of older persons. We evaluated potential risk factors for falls in 325 community-dwelling persons aged 60 years or older who had fallen during the previous year, then followed up weekly for 1 year to ascertain nonsyncopal falls and their consequences. Risk factors for having a single fall were few and relatively weak, but multiple falls were more predictable. In multivariate analyses, we found increased odds of two or more falls for persons who had difficulty standing up from a chair, difficulty performing a tandem walk, arthritis, Parkinson's disease, three or more falls during the previous year, and a fall with injury during the previous year, and for whites. The proportion of subjects with two or more falls per year increased from 0.10 for those with none or one of these risk factors to 0.69 for those with four or more risk factors. Among older persons with a history of a recent fall, the risk of multiple nonsyncopal falls can be predicted from a few simple questions and examinations. (JAMA. 1989;261:2663-2668)
Article
To study risk factors for falling, we conducted a one-year prospective investigation, using a sample of 336 persons at least 75 years of age who were living in the community. All subjects underwent detailed clinical evaluation, including standardized measures of mental status, strength, reflexes, balance, and gait; in addition, we inspected their homes for environmental hazards. Falls and their circumstances were identified during bimonthly telephone calls. During one year of follow-up, 108 subjects (32 percent) fell at least once; 24 percent of those who fell had serious injuries and 6 percent had fractures. Predisposing factors for falls were identified in linear-logistic models. The adjusted odds ratio for sedative use was 28.3; for cognitive impairment, 5.0; for disability of the lower extremities, 3.8; for palmomental reflex, 3.0; for abnormalities of balance and gait, 1.9; and for foot problems, 1.8; the lower bounds of the 95 percent confidence intervals were 1 or more for all variables. The risk of falling increased linearly with the number of risk factors, from 8 percent with none to 78 percent with four or more risk factors (P less than 0.0001). About 10 percent of the falls occurred during acute illness, 5 percent during hazardous activity, and 44 percent in the presence of environmental hazards. We conclude that falls among older persons living in the community are common and that a simple clinical assessment can identify the elderly persons who are at the greatest risk of falling.
Article
The effect of recombinant human erythropoietin (EPO) on hospitalization of patients with end-stage renal disease (ESRD) was evaluated in a controlled clinical trial. A cohort of 67 new hemodialysis patients prescribed EPO shortly after the clinical availability of EPO were the treatment group. The control group was a cohort of 67 new hemodialysis patients matched for clinical center, age, cardiovascular disease and transfusion history. These patients had not been prescribed EPO as they had started hemodialysis prior to the clinical availability of EPO. There were 21 pairs without hospitalization and 46 pairs with at least 1 member of the pair experiencing hospitalization. Among the latter group, the median follow-up was 174 and 184 days for the EPO and control patients respectively. For all hospitalizations, those treated with EPO were hospitalized 15.3 days per year compared to 23.2 days for the control patients. The difference (EPO-control) was -7.9 days (95% CI: -21.0; 7.8) for all cause hospitalization. For hospitalizations due to cardiac, infectious disease and gastrointestinal disease, the differences were 1.6, 1.8 and 1.2 days favouring EPO treated patients. For hospitalizations related to vascular access complications, the difference was 0.9 days favoring the control group. All other causes favoured EPO treated patients by 4 days. There had been 58 hospitalizations in the EPO group compared to 97 in the control group. The mean duration of hospitalization was 8.0 days for the EPO and 9.6 for the control group. The direction and magnitude of the change in all cause hospitalization represents an improvement in morbidity and an important decrease in health resource utilization.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
This investigation was designed to describe alterations in O2 uptake (VO2) and tension development in a contracting in situ gastrocnemious-plantaris muscle preparation during three conditions of reduced O2 delivery [arterial O2 concentration X blood flow (Q)]. The three conditions, hypoxemia (H), ischemia (I), and anemia (A), were matched for O2 delivery. A normoxic normal flow condition was also utilized for comparison. H was produced by respiring the animals with 9% O2 in N2; I was produced by lowering Q, and A was produced by hemodilution with 6% dextran. The stimulation pattern for the isometric tetanic contractions used was 1 train/s, and each train was 200 ms, 70 Hz, and 6 V. The muscle was maximally contracted during each of the experimental conditions, and the conditions were administered in random order. In each bout the contractions continued for 5 min with 30 min of rest between bouts. Samples of arterial and muscle venous blood were obtained during the last 30 s of each bout. VO2 during I (125 ml.kg-1.min-1) was less than during N (145 ml.kg-1.min-1; P < 0.05) and greater than during H or A (104 and 101 ml.kg-1.min-1, respectively; P < 0.05). Venous PO2 (PVO2) was significantly lower during H (17.1 Torr) compared with the other conditions; no differences existed between N, I, and A (26.8, 26.0, and 28.1 Torr, respectively). Tension development was reduced by the reduction of O2 delivery during I, H, and A compared with N. Tension developed among the reduced O2 delivery groups was not significantly different.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
To evaluate the association between selected chronic medical conditions (CMCs) and fall injury events at home among community-dwelling older persons. Population-based case-control study. The general community. Persons aged 65 and older living at home, excluding those using a wheelchair; 467 cases and 691 control subjects were studied. The main independent variables were self-reported histories of 10 CMCs: diabetes, high blood pressure, anemia, heart attack, Parkinson's disease, stroke, emphysema, cancer (other than skin), cataracts, and glaucoma. The final multivariate model included variables for age, sex, body mass, dependency in activities of daily living, current exercise (three or more times per week), mental status scores, and three CMCs. Persons with a history of stroke or anemia had an increased risk of a fall injury event: for stroke the adjusted odds ratio (aOR) equalled 1.7 (95% confidence interval (CI), 1.0-3.0); for anemia the aOR equalled 1.5 (95% CI, 1.0-2.2). Those with a history of high blood pressure had decreased risk (aOR = .7, 95% CI 0.5-0.9). Persons 65 and older with a self-reported history of anemia or stroke are at increased risk of a fall injury event in the home, whereas those with a self-reported history of high blood pressure are at decreased risk.
Article
To assess the incidence and clinical spectrum of anemia among older people. Inception cohort assembled and followed by medical records linkage until death or last clinical contact through January 1994. Population-based study in Olmsted County, Minnesota. All 618 Olmsted County men and women aged 65 years or more with anemia by World Health Organization criteria that was first recognized in 1986. Age- and sex-adjusted incidence rates, corrected for prevalent anemia, and survival estimates using the Kaplan-Meier method, with calculation of standardized mortality ratios for specific causes of death. The corrected annual incidence of anemia rose with age, and rates were higher in men (90.3 per 1000; 95% CI, 79.2-101.4) than women (69.1 per 1000; 95% CI, 62.3-75.8). In 465 cases (75%), anemia was detected in conjunction with a hospitalization, but admission was due to anemia in only 57 instances. Half of the cases were caused by blood loss, two-thirds of these as a result of surgery. The cause of anemia was uncertain in 102 cases (16%). One-third of the patients were transfused with a median of 3 units each. Overall survival was worse than expected but was better among those with anemia caused by blood loss. Mortality attributable to malignancy, mental disorders, circulatory and respiratory diseases, ill-defined conditions, and injuries was significantly increased among these older patients with anemia. The incidence of anemia among older people is 4 to 6 times greater than that suspected clinically, rises with age, and is higher in men than in women. The apparent cause in half the cases is blood loss. Even mild anemia is associated with reduced survival, especially during the first year, but this could relate to underlying comorbid conditions.
Article
The objective of this study was to identify easily measurable predictors for falls, recurrent falls, and fractures using a population-based prospective cohort study of 1469 elderly, born before 1931, in three regions of the Netherlands. The baseline at-home interview was in 1992. In 1995, falls experienced in the preceding year and fractures over the preceding 38-month period were registered. In a period of 1 year, 32% of the participants fell at least once, and 15% fell two or more times. The rate of recurrent falls was similar in men and women up until the age of 75 years. The total number of fractures was 85, including 23 wrist fractures, 12 hip fractures, and 9 humerus fractures. The incidence density per 1000 person-years for any fracture was 25.1 (95% confidence interval [CI], 18.9-31.4) for women and 8.2 (95% CI, 4.5-12.0) for men, respectively. Multiple logistic regression identified urinary incontinence, impaired mobility, use of analgetics, and use of antiepileptic drugs as the predictors most strongly associated with recurrent falls. Female gender, living alone, past fractures, inactivity, body height, and use of analgetics proved to be the predictors most strongly associated with fractures. The probabilities of recurrent falls were 4.7% (95% CI, 2.9-7.5%) to 59. 2% (95% CI, 24.1-86.9%) with zero to four predictors, respectively. The probability of fractures ranged from 0.0% (95% CI, 0.0-0.4%) without any of the identified predictors to 12.9% (95% CI, 4.4-32. 2%) with all six predictors present. Our study shows that the risk of recurrent falls and of fractures can be predicted using up to, respectively, four and six easily measurable predictors. This study emphasizes the importance of impaired mobility and inactivity as predictors for falls and fractures.
Article
Whether hemoglobin concentrations defined as anemia by the World Health Organization (WHO) are associated with increased mortality in older persons is not known. To investigate the association between hemoglobin concentration and cause-specific mortality in older persons. Community-based study conducted from 1986 to 1996 (follow-up period, 10 years). Leiden, the Netherlands. A total of 1016 community residents aged 85 years and older were eligible and 872 agreed to have a blood sample taken. Hemoglobin concentration was measured in 755 persons (74%). Hemoglobin concentration, 10-year survival, and primary cause of death. According to the WHO criteria, anemia was defined as a hemoglobin concentration below 7.5 mmol/L (120 g/L) in women and below 8.1 mmol/L (130 g/L) in men. Compared with persons with a normal hemoglobin concentration, the mortality risk was 1.60 (95% confidence interval [CI], 1.24-2.06; P<.001) in women with anemia, and 2.29 (95% CI, 1.60-3.26; P<.001) in men with anemia. In both sexes, the mortality risk increased with lower hemoglobin concentrations. In persons without self-reported clinical disease at baseline, the mortality risk of anemia was 2.21 (95% CI, 1.37-3.57; P=.002). Mortality from malignant and infectious diseases was higher in persons with anemia. Anemia defined by the WHO criteria was associated with an increased mortality risk in persons aged 85 years and older. The criteria are thus appropriate for older persons. A low hemoglobin concentration at old age signifies disease.
Article
This study evaluated the prevalence and severity of anemia in patients with congestive heart failure (CHF) and the effect of its correction on cardiac and renal function and hospitalization. The prevalence and significance of mild anemia in patients with CHF is uncertain, and the role of erythropoietin with intravenous iron supplementation in treating this anemia is unknown. In a retrospective study, the records of the 142 patients in our CHF clinic were reviewed to find the prevalence and severity of anemia (hemoglobin [Hb] <12 g). In an intervention study, 26 of these patients, despite maximally tolerated therapy of CHF for at least six months, still had had severe CHF and were also anemic. They were treated with subcutaneous erythropoietin and intravenous iron sufficient to increase the Hb to 12 g%. The doses of the CHF medications, except for diuretics, were not changed during the intervention period. The prevalence of anemia in the 142 patients increased with the severity of CHF, reaching 79.1% in those with New York Heart Association class IV. In the intervention study, the anemia of the 26 patients was treated for a mean of 7.2 +/- 5.5 months. The mean Hb level and mean left ventricular ejection fraction increased significantly. The mean number of hospitalizations fell by 91.9% compared with a similar period before the study. The New York Heart Association class fell significantly, as did the doses of oral and intravenous furosemide. The rate of fall of the glomerular filtration rate slowed with the treatment. Anemia is very common in CHF and its successful treatment is associated with a significant improvement in cardiac function, functional class, renal function and in a marked fall in the need for diuretics and hospitalization.
Article
The impact of chronicity and changes in depression on physical decline over time in older persons has not been elucidated. This prospective cohort study of 2121 community-dwelling persons aged 55-85 years uses two measurement occasions of depression (CES-D scale) over 3 years to distinguish persons with chronic, remitted, or emerging depression and persons who were never depressed. Physical function is assessed by self-reported physical ability as well as by observed performance on a short battery of tests. After adjustment for baseline physical function, health status and sociodemographic factors, chronic depression was associated with significantly greater decline in self-reported physical ability over 3 years when compared to never depressed persons (odds ratio (OR)=2.83, 95% confidence interval (CI)=1.86-4. 30). In the oldest old, but not in the youngest old, chronic depression was also significantly predictive of greater decline in observed physical performance over 3 years (OR=2.22, 95% CI=1.43-3. 79). Comparable effects were found for older persons with emerging depression. Persons with remitted depression did not have greater decline in reported physical ability or observed performance than persons who were never depressed. Our findings among community-dwelling older persons show that chronicity of depression has a large impact on physical decline over time. Since persons with remitted depression did not have greater physical decline than never depressed persons, these findings suggest that early recognition and treatment of depression in older persons could be protective for subsequent physical decline.
Article
Bone mass declines and the risk of fractures increases as people age, especially as women pass through the menopause. Hip fractures, the most serious outcome of osteoporosis, are becoming more frequent than before because the world's population is ageing and because the frequency of hip fractures is increasing by 1-3% per year in most areas of the world. Rates of hip fracture vary more widely from region to region than does the prevalence of vertebral fractures. Low bone density and previous fractures are risk factors for almost all types of fracture, but each type of fracture also has its own unique risk factors. Prevention of fractures with drugs could potentially be as expensive as medical treatment of fractures. Therefore, epidemiological research should be done and used to identify individuals at high-risk of disabling fractures, thereby allowing careful allocation of expensive treatments to individuals most in need.
Article
Anemia is prevalent in old age and is potentially modifiable, but its effects on physical function have not been determined. We examined whether anemia in older persons increases the risk of subsequent decline in physical function, as measured by objective performance-based tests. Participants in this 4-year prospective cohort study included 1146 participants, aged 71 years or older, living in Iowa and Washington counties, Iowa. Anemia was defined according to World Health Organization (WHO) criteria as a hemoglobin concentration below 12 g/dL in women and below 13 g/dL in men. An assessment of standing balance, a timed 2.4-m walk, and a timed test of five chair rises were used to assess physical performance; these were combined into a 0 (poor) to 12 (excellent) summary scale. After adjustment for baseline performance score, health status, and demographic characteristics, anemia was associated with greater mean decline in physical performance over 4 years; the adjusted mean decline was 2.3 (95% confidence interval [CI]: 1.7 to 2.8) in subjects with anemia and 1.4 (95% CI: 1.2 to 1.5) in those without anemia (P = 0.003). The association between anemia and greater physical decline was also present in participants who were free of diseases associated with anemia (cancer, infectious disease, and renal failure), and after adjustment for serum cholesterol, iron, and albumin levels. Persons with borderline anemia, a hemoglobin concentration within 1 g/dL above the WHO criteria, also showed greater mean physical decline (1.8; 95% CI: 1.5 to 2.2) than did those with higher hemoglobin concentrations (P = 0.02). This study suggests that anemia in old age is an independent risk factor for decline in physical performance.
Article
To examine the association between anemia and disability, physical performance, and muscle strength in older persons. Cross-sectional. Community-dwelling older persons in the Chianti area in Italy. A total of 1,156 persons aged 65 and older participating in the InChianti Study ("Invecchiare in Chianti," i.e., Aging in the Chianti Area). Anemia was defined according to World Health Organization criteria as a hemoglobin concentration below 12 g/dL in women and below 13 g/dL in men. Disability in six basic and eight instrumental activities of daily living was assessed. Physical performance was assessed using the short physical performance battery (4-m walk, balance, and chair stands), which yields a summary performance score ranging from 0 to 12 (high). Muscle strength was determined using knee extensor and handgrip strength assessments. Overall, 11.1% of the men and 11.5% of the women had anemia. After adjustment for age, sex, body mass index, Mini-Mental State Examination score, creatinine level, and presence of various comorbid conditions, anemic persons had more disabilities (1.71 vs 1.04, P=.002) and poorer performance (8.8 vs 9.6, P=.003) than persons without anemia. Anemic persons also had significantly lower knee extensor strength (14.1 vs 15.2 kg, P=.02) and lower handgrip strength (25.3 vs 27.1 kg, P=.04) than persons without anemia. Further adjustment for inflammatory markers (interleukin-6, C-reactive protein, tumor necrosis factor-alpha) did not change these associations. Anemia is associated with disability, poorer physical performance, and lower muscle strength. Further research should explore whether treating anemia has a beneficial effect on the functional status of older persons.
Article
Clinicians frequently identify anemia in their older patients, but national data on the prevalence and causes of anemia in this population in the United States have been unavailable. Data presented here are from the noninstitutionalized US population assessed in the third National Health and Nutrition Examination Survey (1988-1994). Anemia was defined by World Health Organization criteria; causes of anemia included iron, folate, and B(12) deficiencies, renal insufficiency, anemia of chronic inflammation (ACI), formerly termed anemia of chronic disease, and unexplained anemia (UA). ACI by definition required normal iron stores with low circulating iron (less than 60 microg/dL). After age 50 years, anemia prevalence rates rose rapidly, to a rate greater than 20% at age 85 and older. Overall, 11.0% of men and 10.2% of women 65 years and older were anemic. Of older persons with anemia, evidence of nutrient deficiency was present in one third, ACI or chronic renal disease or both was present in one third, and UA was present in one third. Most occurrences of anemia were mild; 2.8% of women and 1.6% of men had hemoglobin levels lower than 110 g/L (11 g/dL). Therefore, anemia is common, albeit not severe, in the older population, and a substantial proportion of anemia is of indeterminate cause. The impact of anemia on quality of life, recovery from illness, and functional abilities must be further investigated in older persons.
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Should the criteria currently used to define anemia in older people be reevaluated?
Should the criteria currently used to define anemia in older people be reevaluated? J Am Geriatr Soc 2002;50:1257-1264.
Anemia and hemoglobin levels in older persons
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Prevalence of anemia in persons 65 years and older in the United States
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Incidence of anemia in older people
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Depression and cardiac mortality
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