| Conditions Associated with Anemia | Study | Type & Duration of Study | Sample Size & Age | Methodology | Results |
|---|---|---|---|---|---|
| Delirium | Joosten et al.Belgium2006 a | Longitudinal prospective study over 5 months |
190 elderly patients in acute geriatric ward. Mean age of the group was 82.5 yrs |
Study patients investigated with Mini Mental Status Exam (MMSE), Confusion Assessment Method (CAD), demographic, clinical and lab data |
18% of the patients identified by delirium. 50% of patients had anemia. Anemia, male sex, age > 82 yrs, dehydration and dementia were independent risk factors for delirium. |
| Axell et al.Sweden2002 b | Longitudinal prospective study: Data collected over 6.5 months |
19 ventilated patients in Intensive Care Unit (ICU) Median age 70 yrs |
Study patients had an ICU stay length of > 36 hrs and were closely observed during the stay. Patients were interviewed in depth twice after discharge. |
6 patients had severe delirium & 8 moderate delirium. Severity of delirium was associated with the degree of anemia. Patients with severe delirium had significantly lower Hb (7.5-9.5g/dl). Patients with severe delirium required higher doses of fentanyl and midazolam and a longer duration of ventilation & ICU stay. |
|
| Dementia | Hong et al. S. Korea& USA2013 c | Prospective Cohort Study: data collected over 11 years of follow up |
2552 community dwelling, ethnically diverse. Mean age: 76.1 yrs. Memphis TN & Pittsburgh Pennsylvania. |
Cognitive function assessed at 1,3, 5, 8,10, 11 years with a global test |
2552 subjects; 51.8% female, 38.9% were black. 393 (15.4%) had anemia at baseline and 455 (17.4%) developed dementia. Older adults with anemia at baseline had a higher risk of developing dementia (22.7%) as compared to those who did not have anemia (17%) After adjusting for age, race, sex, education, literacy, APOE ɛ4 status, mini-mental status exam, co-morbidities (stroke, HTN, DM and Myocardial Infarction), renal function, indices of anemia indices & C-Reactive Protein, the results remained statistically significant. |
| Shah et al. IL USA2011 d | Prospective study: participants followed for 3.3 yrs | 881 community dwelling: Mean age; 80.1 yrs Chicago, IL. | Cognitive decline assessed over a period of 3 years in participants of the Rush Memory and Aging project who did not have dementia. |
Follow up over a period of approximately three years was notable for development of dementia in 113 patients. Those who developed dementia were of older age and had poorer performance on MMSE. Their BMI and cognitive function were also relatively lower. In comparison to individuals without dementia, those with dementia were more likely to be depressed and had a smaller social circle. Subjects with Hb of 13.7 g/dl had the smallest rate of cognitive decline. Anemic participants had a faster decline in cognitive function in comparison to those without anemia. |
|
| Atti et al.Sweden & Italy2005 e | Prospective study (Kungsholman project); Subjects' data analyzed at baseline and at 3 years. |
1435 subjects without dementia. Age range: 75-95 years |
Comparison of data at baseline to 3 year follow up. |
At the end of 3 years, anemic patients with normal cognition had a two times higher risk of developing dementia than cognitively intact non-anemic patient after adjustment for gender, age and education. The association between anemia and development of dementia remained unchanged even after adjusting for chronic disease, inflammation and nutritional status. 189 subjects were diagnosed with dementia on follow up at 3 years; 77.2% were diagnosed with AD and 12.7 % with Vascular dementia. After adjusting for age, gender and level of education, subjects with anemia were two times more likely to develop AD. |
|
| Decline in Physical Performance | Thein et al.USA2009 | Multi-center cross-sectional survey performed over one year. | 328 patients: mean age 76.8 year | Three sites participated. Instruments used: SF-36 & Functional Assessment of Chronic Illness Therapy-Anemia (FACIT-An), IADL, GDS & Handgrip strength. Questionnaires and measurements performed within 1 month of serum Hb measurement. |
68% were women; age ranged from 65-103 yrs Older patients (75 yrs and above) had a lower mean Hb level (12.8 g/dl) in comparison to the younger (age range 65-74 yrs) patients whose mean Hb level was 13.3 g/dl. 90 (27%) patients had WHO defined anemia: 54 females and 36 (31%) males. There was almost a 10 point difference in the unadjusted mean SF-36 scores of patients with Hb of 15 g/dl (47.1) and those with Hb less than 12 g/dl (37.3). This decreasing trend was evident across all Hb groups as well as the five physical function subscales. |
| Penninx et al. Italy2004 f | Cross-sectional study over18 months | 1008 participants: mean age 75.4 years | Debility in 6 activities of daily living & 8 instrumental activities of daily living. SF36, knee extensor and handgrip strength assessments. | Men had an average Hb level of 14.4 g/dl and women's mean Hb level was 13.2 g/dl. 11.3% of the participants were anemic. Subjects with anemia had lower scores on SF 36, decreased handgripand knee extensor strength when compared to subjects without anemia. | |
| Penninx et al.USA2003 | Prospective cohort study over 4 yrs. | 1146 subjects: mean age: 77 yrs | Evaluation of balance, a timed 2.4-m walk, and a timed test of five chair rises for assessment of physical function; these were incorporated into scale: 0 (poor) to 12 (excellent) |
There was a significant association between anemia and mean decline in physical function over a period of 4 years; 2.3 in anemic subjects and 1.4 non-anemic subjects (P = 0.003) This association between anemia and increased functional decline was also seen in participants without chronic illnesses associated with anemia (malignancy, infectious disease and renal insufficiency) and after adjusting for lipid, iron and albumin levels. Subjects with borderline anemia, a Hb level within 1 g/dL over the WHO defined anemia, also showed a higher mean physical decline (1.8) vs those with greater Hb levels (P = 0.02). |
|
| Hospital-ization & Mortality | Culleton et al.Canada2006g | Prospective cohort study over 3 yrs | 17030 community dwelling subjects: ≥ 66 yrs | Cox potential analyses performed to assess associations between anemia (defined as HB less than 11 mg/dl) and hemoglobin and all-cause mortality. |
1983 mortalities and 7278 first hospitalizations were recorded. Analysis showed a higher risk of mortality, first all-cause hospitalization, and first hospitalization for cardiovascular causes (HR, 2.49; 95%) in anemic patients with normal kidney function. The association between Hb and all-cause mortality was evident as an inverse J-Shaped curve. Women with Hb level 13-15 mg/dl and men with Hb level between14-17 mg/dl had the smallest risk for mortality. |
| Riva et al.Italy2009h | Prospective population based study over 4 years | 7536 elderly with mean age between 73.6-74.9 yrs | Data from 7536 elderly utilized to determine mortality. Complete health information available for 4501 subjects. | There was an increased risk of hospitalizationand mortality in the elderly subjects with mild anemia versus subjects who did not have anemia. | |
| Denny et al.NC USA2006i | Prospective cohort study | 1744 community dwelling elderly: mean age: 78 yrs | Hb assessed at baseline. Physical performance, using Katz, IADL and cognition using Sort Portable Mental Status Questionnaire were assessed at baseline and 4 year follow up interview. |
33% of women and 31% of men had anemia. Anemic subjects were of older age more often had African American ethnicity, were less educated, had suboptimal kidney function and a hospitalization in the previous year. Caucasians in all age cohorts assessed had a higher Hb level in comparison to their African American age cohorts. A statistically significant rise in mortality was observed in all subjects with anemia in comparison to those without anemia. This was unchanged even after adjusting for sex. At 8 years, women with Hb level between 13 and 14 g/dl men with hemoglobin level between 14 and 15 g/dl had the greatest survival percentage. The lowest rate of survival was notable in Hb levels at both extremes. |
|
| Penninx et al. USA2006j | Longitudinal prospective study over 4 years | 3607 participants of EPESE study with mean age of 78 years | Anemia as per WHO criteria. Data regarding death and hospital admissions over 4 years accessed from death records and the Medicare database. |
12.5% of the subjects had anemia. Participants with anemia had a greater likelihood of death and hospitalization than those without anemia in the follow-up period. After adjusting for demographics and co-morbid illnesses, anemia was found to have statistically significant association with subsequent death and hospitalization. Anemia alsoshowed a statistically significant association with mortality and hospitalization in participants without co-morbidities at baseline. |
|
| Mortality | Elzen et al.Netherlands2009k | Longitudinal prospective study (Leiden 85-plus Study): patients followed over 5 years | 562 people Age: 85 years | Anemia per WHO definition. 3 aspects of functional state assessed at baseline and once every year for 5 years: debility in basic and instrumental activities of daily living, cognitive function and presence of low mood. Data on death accessed from the municipal registry. |
26.7% of the elderly participants had anemia at baseline. At baseline, anemic subjectshad greater debility in physical function, lower cognitive function and more symptoms of depression than the non-anemic participants. These differences were not significantafter adjustment for comorbid illnesses. On subsequent follow up, anemia was associated with a decrease in Instrumental Activities of Daily Living, which remained significant after adjusting for comorbid conditions. Subjects in whom new onset of anemia was found on follow up (n = 99) also had an increase in disability. Both categories of anemia patients, new-onset and previous diagnosis, had higher mortality rates after adjusting for various demographical variables including education level, gender, socioeconomic status, and other variables (living in long-term care facility, CRP level, creatinine clearance and disease status) |