Advertisement

Annals of Hematology

, Volume 93, Issue 12, pp 2057–2062 | Cite as

Prevalence of anemia and its impact on the state of frailty in elderly people living in the community: SADEM study

  • Teresa Juárez-CedilloEmail author
  • Lourdes Basurto-Acevedo
  • Sara Vega-García
  • Leticia Manuel-Apolinar
  • Emiliano Cruz-Tesoro
  • José Manuel Rodríguez-Pérez
  • Normand García-Hernández
  • Nonanzit Pérez-Hernández
  • José Manuel Fragoso
Original Article

Abstract

Anemia represents a global health problem that negatively impacts quality of life in elderly population; however, its impact on the geriatric syndrome of frailty is unclear. We examined the prevalence of anemia among elderly and sought a relationship between hemoglobin and the phenotype of frailty. Baseline hemoglobin quintiles and anemia were assessed in relation to frailty status in a prospective study with 1,933 older community-dwelling adults enrolled in the Study on Aging and Dementia in Mexico (SADEM). Logistic regression was used to model the relationship between frailty and Hb, adjusting for risk factors of frailty, sociodemographic data, cognitive decline, chronic diseases, and some risky habits. Prevalence of frailty was 8.3 %. Frailty risk was highest at the lowest hemoglobin quintile (<14.3 g/dL for men; <13.3 g/dL for women), and 160 (8.3 %) were anemic (<13 g/dL for men; <12 g/dL for women). The relationship between frailty and Hb levels, adjusted for age and sex, observed in the first and fifth quintiles, compared with the fourth quintile, were 1.53 (95 % confidence interval (CI), 1.46–1.60) and 1.05 (95 % CI, 1.01–1.15). After multivariate adjustment, the odds ratios (ORs) were 1.23 (95 % CI, 1.17–1.13) and 1.06 (95 % CI, 1.01–1.11). The association was not diminished by risk factors for frailty (body mass index (BMI), comorbidity, cognitive decline, smoking, alcohol consumption, etc.). In community-dwelling older adults, low hemoglobin concentrations and anemia were independently associated with increased frailty risk. This suggests that mild anemia and low Hb levels are independent, modifiable risk factors for frailty.

Keywords

Anemia Frailty Mexican Aging Community-dwelling people 

Notes

Acknowledgments

This project was supported by grants from SSA/IMSS/ISSSTE-CONACYT (México), SALUD-2009-C01-114716, and the Fund for the Promotion of Health Research, Mexican Institute of Social Security, FIS/IMSS/PROT/G10/824.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Blanc B, Finch CA, Hallberg L et al (1968) Nutritional anemia. Report of a WHO scientific group. World Health Organ Tech Rep Ser 405:5–37Google Scholar
  2. 2.
    Beghe C, Wilson A, Ershler WB (2004) Prevalence and outcomes of anemia in geriatrics: a systematic review of the literature. Am J Med 5(116 Suppl 7A):3S–10SCrossRefGoogle Scholar
  3. 3.
    Penninx BW, Pahor M, Woodman RC et al (2006) Anemia in old age is associated with increased mortality and hospitalization. J Gerontol Ser 61(5):474–479CrossRefGoogle Scholar
  4. 4.
    Deal JA, Carlson MC, Xue QL (2009) Anemia and 9 years domain-specific cognitive decline in community-dwelling older women. The Women’s Health and Aging Study II. J Am Geriatr Soc 57(9):1604–1611PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Roy CN (2011) Anemia in frailty. Clin Geriatr Med 27:67–78PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Fried LP, Ferrucci L, Darer J et al (2004) Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 57(3):255–263CrossRefGoogle Scholar
  7. 7.
    Rockwood K, Mitnitski A (2007) Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci 62(7):722–727PubMedCrossRefGoogle Scholar
  8. 8.
    Morley JE, Perry HM 3rd, Miller DK (2002) Editorial: something about frailty. J Gerontol Med Sci 57(1):M698–M704CrossRefGoogle Scholar
  9. 9.
    Cesari M, Penninx BW, Lauretani F et al (2004) Hemoglobin levels and skeletal muscle: results from the InCHIANTI study. J Gerontol Med Sci 59(3):249–254CrossRefGoogle Scholar
  10. 10.
    Penninx BW, Pahor M, Cesari M et al (2004) Anemia is associated with disability and decreased physical performance and muscle strength in the elderly. J Am Geriatr Soc 52(5):719–724PubMedCrossRefGoogle Scholar
  11. 11.
    Penninx BW, Guralnik JM, Onder G et al (2003) Anemia and decline in physical performance among older persons. Am J Med 115(2):104–110PubMedCrossRefGoogle Scholar
  12. 12.
    Ferrucci L, Penninx BW, Volpato S et al (2002) Change in muscle strength explains accelerated decline of physical function in older women with high interleukin-6 serum levels. J Am Geriatr Soc 50(12):1947–1954PubMedCrossRefGoogle Scholar
  13. 13.
    Collins AJ (2002) Influence of target hemoglobin in dialysis patients on morbidity and mortality. Kidney Int Suppl 80:44–48, ReviewPubMedCrossRefGoogle Scholar
  14. 14.
    Juarez-Cedillo T, Sanchez-Arenas R, Sanchez-Garcia S et al (2012) Prevalence of mild cognitive impairment and its subtypes in the Mexican population. Dement Geriatr Cogn Disord 34(5–6):271–281PubMedCrossRefGoogle Scholar
  15. 15.
    Sánchez-García S, Sánchez-Arenas R, García-Peña C et al (2014) Frailty among community-dwelling elderly Mexican people: prevalence and association with sociodemographic characteristics, health state and the use of health services. Geriatr Gerontol Int 14(2):395–402PubMedCrossRefGoogle Scholar
  16. 16.
    Fried LP, Walston J (1999) Frailty and failure to thrive. In: Hazzard W, Blass J, Ettinger WH, Halter J, Ouslander J (eds) Principles of geriatric medicine and gerontology. McGraw-Hill Professional, New York, pp 1387–1402Google Scholar
  17. 17.
    Ottenbacher KJ, Ostir GV, Peek MK et al (2005) Frailty in older Mexican Americans. J Am Geriatr Soc 53(9):1524–1531PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Katz S, Ford AB, Moskowitz RW et al (1963) Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 185:914–919PubMedCrossRefGoogle Scholar
  19. 19.
    Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9(3):179–186PubMedCrossRefGoogle Scholar
  20. 20.
    Reyes-Ortega M, Soto-Hernández A, Milla-Kegel J et al (2003) Actualización de la Escala de Depresión del Centro de Estudios Epidemiológicos (CES-D). Estudio piloto en una muestra geriátrica mexicana. Salud Ment 26(1):59–68Google Scholar
  21. 21.
    Franco-Marina F, García-González JJ, Wagner-Echeagaray F et al (2010) The mini-mental state examination revisited: ceiling and floor effects after score adjustment for educational level in an aging Mexican population. Int Psychogeriatr 22(1):72–81PubMedCrossRefGoogle Scholar
  22. 22.
    Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383PubMedCrossRefGoogle Scholar
  23. 23.
    World health Organization (1994) International Classifications of Diseases (ICD-10). Geneva: WHO; [Cited 24 Dec 2013]. http://www.who.int/classifications/icd/en/
  24. 24.
    Douketis JD, Paradis G, Keller H et al (2005) Canadian guidelines for body weight classification in adults: application in clinical practice to screen for overweight and obesity and to assess disease risk. CMAJ 172(8):995–998PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Guralnik JM, Eisenstaedt RS, Ferrucci L et al (2004) Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. Blood 104(8):2263–2268PubMedCrossRefGoogle Scholar
  26. 26.
    Artz AS (2008) Anemia and the frail elderly. Semin Hematol 45(4):261–266PubMedCrossRefGoogle Scholar
  27. 27.
    Ferrucci L, Bandinelli S, Benvenuti E et al (2000) Subsystems contributing to the decline in ability to walk: bridging the gap between epidemiology and geriatric practice in the InCHIANTI study. J Am Geriatr Soc 48(12):1618–1625PubMedGoogle Scholar
  28. 28.
    Li M, Bertout JA, Ratchiffe SJ et al (2010) Acute anemia elicits cognitive dysfunction and evidence of cerebral cellular hypoxia in older rats with systemic hypertension. Anesthesiology 113(4):845–858PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Chaves PH, Semba RD, Leng SX et al (2005) Impact of anemia and cardiovascular disease on frailty status of community-dwelling older women: the Women’s Health and Aging Studies I and II. J Gerontol A Biol Sci Med Sci 60:729PubMedCrossRefGoogle Scholar
  30. 30.
    Denny SD, Kuchibhatla MN, Cohen HJ (2006) Impact of anemia on mortality, cognition, and function in community-dwelling elderly. Am J Med 119(4):327–334PubMedCrossRefGoogle Scholar
  31. 31.
    Penninx BW, Pahor M, Woodman RC et al (2006) Anemia in old age is associated with increased mortality and hospitalization. J Gerontol A Biol Sci Med Sci 64(5):474–479CrossRefGoogle Scholar
  32. 32.
    Dong X, Mendes de Leon C, Artz A et al (2008) A population-based study of hemoglobin, race, and mortality in elderly persons. J Gerontol A Biol Sci Med Sci 63(8):873–878PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Teresa Juárez-Cedillo
    • 1
    Email author
  • Lourdes Basurto-Acevedo
    • 2
  • Sara Vega-García
    • 2
  • Leticia Manuel-Apolinar
    • 2
  • Emiliano Cruz-Tesoro
    • 3
    • 4
  • José Manuel Rodríguez-Pérez
    • 5
  • Normand García-Hernández
    • 6
  • Nonanzit Pérez-Hernández
    • 5
  • José Manuel Fragoso
    • 5
  1. 1.Epidemiologic and Health Service Research Unit, Aging Area, Mexican Institute of Social SecurityNational Medical Center Century XXI, Edificio CORCE, Tercer pisoMexico CityMexico
  2. 2.Endocrine Research Unit, National Medical CenterMexican Institute of Social SecurityMexico CityMexico
  3. 3.Department of Research and Animal FacilityInstituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”Mexico CityMexico
  4. 4.Immunology Research Unit, National Medical CenterMexican Social Security InstituteMexico CityMexico
  5. 5.Department of Molecular Biology and Interventional Genetic Study GroupInstituto Nacional de Cardiología Ignacio ChávezMexico CityMexico
  6. 6.Medical Research Unit in Human Genetics, Pediatric HospitalMexican Institute of Social SecurityMexico CityMexico

Personalised recommendations