Abstract
The purpose of this cross-sectional prospective study was to determine the prevalence of anemia among elderly hospitalized patients in Germany and to investigate its association with multidimensional loss of function (MLF). One hundred participants aged 70 years or older from two distinct wards (50 each from an emergency department and a medical ward, respectively) underwent a comprehensive geriatric assessment (CGA) consisting of the following six tools: Barthel Index, mini-mental state examination, clock-drawing test, timed up and go test, Esslinger transfer scale, and Daniels test. MLF as an aggregated outcome was diagnosed when three or more tests of the CGA showed an abnormal result. Anemia was defined according to WHO criteria as a hemoglobin (Hb) concentration of <13 g/dL for men and <12 g/dL for women. The prevalence of anemia was 60 %. Overall, 61 % of patients presented with three or more abnormal results in the six tests of the CGA and, thus, with MLF. Using logistic regression, we found a significant association of both anemia and low Hb concentrations with abnormal outcomes in five tests of the CGA and, therefore, with domain-specific deficits like mobility limitations, impaired cognition, and dysphagia. Furthermore, being anemic increased the odds of featuring MLF more than fourfold. This significant relationship persisted after adjustment for various major comorbidities. Both anemia and geriatric conditions are common in the hospitalized elderly. Given the association of anemia with MLF, Hb level might serve as a useful geriatric screening marker to identify frail older people at risk for adverse outcomes.
Similar content being viewed by others
References
Beghé C, Wilson A, Ershler WB (2004) Prevalence and outcomes of anemia in geriatrics: a systematic review of the literature. Am J Med 116(Suppl 7A):3S–10S
Landi F, Russo A, Danese P, Liperoti R, Barillaro C, Bernabei R, Onder G (2007) Anemia status, hemoglobin concentrations, and mortality in nursing home older residents. J Am Med Dir Assoc 8(5):322–327
Mitrache C, Passweg JR, Libura J, Petrikkos L, Seiler WO, Gratwohl A, Stähelin HB, Tichelli A (2001) Anemia: an indicator for malnutrition in the elderly. Ann Hematol 80(5):295–298
Maraldi C, Volpato S, Cesari M, Cavalieri M, Onder G, Mangani I, Woodman RC, Fellin R, Pahor M (2006) Anemia and recovery from disability in activities of daily living in hospitalized older persons. J Am Geriatr Soc 54(4):632–636
Röhrig G, Schulz RJ (2012) Anemia in the elderly. Urgent need for guidelines. Z Gerontol Geriatr 45(3):182–185
Boyd CM, Xue QL, Simpsons CF, Guralnik JM, Fried LP (2005) Frailty, hospitalization, and progression of disability in a cohort of disabled older women. Am J Med 118(11):1225–1231
Covinsky KE, Palmer RM, Fortinsky RH, Counsell SR, Stewart AL, Kresevic D, Burant CJ, Landefeld CS (2003) Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc 51(4):451–458
Boyd CM, Ricks M, Fried LP, Guralnik JM, Xue QL, Xia J, Bandeen-Roche K (2009) Functional decline and recovery of activities of daily living in hospitalized, disabled older women: the Women’s Health and Aging Study I. J Am Geriatr Soc 57(10):1757–1766
Fortinsky RH, Covinsky KE, Palmer RM, Landefeld CS (1999) Effects of functional status changes before and during hospitalization on nursing home admission of older adults. J Gerontol A Biol Sci Med Sci 54(10):M521–M526
Inouye SK, Peduzzi PN, Robison JT, Hughes JS, Horwitz RI, Concato J (1998) Importance of functional measure in predicting mortality among older hospitalized patients. JAMA 279(15):1187–1193
Landefeld CS, Palmer RM, Kresevic DM, Fortinsky RH, Kowal J (1995) A randomized trial of care in a hospital medical unit especially designed to improve the functional outcomes of acutely ill older patients. N Engl J Med 332(20):1338–1344
Shah RC, Wilson RS, Tang Y, Dong X, Murray A, Bennett DA (2009) Relation of hemoglobin to level of cognitive function in older persons. Neuroepidemiology 32(1):40–46
Hong CH, Falvey C, Harris TB, Simonsick EM, Satterfield S, Ferrucci L, Metti AL, Patel KV, Yaffe K (2013) Anemia and risk of dementia in older adults: findings from the Health ABC study. Neurology 81(6):528–533
Penninx BW, Pahor M, Cesari M, Corsi AM, Woodman RC, Bandinelli S, Guralnik JM, Ferrucci L (2004) Anemia is associated with disability and decreased physical performance and muscle strength. J Am Geriatr Soc 52(5):719–724
Chaves PH, Ashar B, Guralnik JM, Fried LP (2002) Looking at the relationship between hemoglobin concentration and prevalent mobility difficulty in older women. Should the criteria currently used to define anemia in older people be reevaluated? J Am Geriatr Soc 50(7):1257–1264
Cesari M, Penninx BW, Lauretani F, Russo CR, Carter C, Bandinelli S, Atkinson H, Onder G, Pahor M, Ferrucci L (2004) Hemoglobin levels and skeletal muscle: results from the InCHIANTI study. J Gerontol A Biol Sci Med Sci 59(3):249–254
Umegaki H, Yanagawa M, Endo H (2011) Association of lower hemoglobin level with depressive mood in elderly women at high risk of requiring care. Geriatr Gerontol Int 11(3):262–266
Chaves PH (2008) Functional outcomes of anemia in older adults. Semin Hematol 45(4):255–260
Artz AS (2008) Anemia and the frail elderly. Semin Hematol 45(4):261–266
Blanc B, Finch CA, Hallberg L et al (1968) Nutritional anaemias. Report of a WHO Scientific Group. WHO Tech Rep Ser 405:1–40
World Health Organization (2011) Institutional repository for information sharing: Haemoglobin concentrations for the diagnosis of anemia and assessment of severity. http://apps.who.int/iris/bitstream/10665/85839/3/WHO_NMH_NHD_MNM_11.1_eng.pdf. Accessed 24 Sept 2013
Collins C, Wade DT, Davies S, Horne V (1988) The Barthel ADL index: a reliability study. Int Disabil Stud 10(2):61–63
Bundesarbeitsgemeinschaft klinisch-geriatrischer Einrichtungen e.V. (2002). Hamburger Einstufungsmanual zum Barthel-Index. Version 1.0. Berlin: Bundesverband Geriatrie. http://www.bv-geriatrie.de/Dokumente/Hamburger%20Manual_11_2004.pdf. Accessed 24 Sept 2013
Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental-state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198
Tombaugh TN, McIntyre NJ (1992) The mini-mental state examination: a comprehensive review. J Am Geriatr Soc 40(9):922–935
Folstein MF, Folstein SE, McHugh PR (2001) Mini-mental state examination user’s guide. Psychological Assessment Resources, Odessa
Hatfield CF, Dudas RB, Dening T (2009) Diagnostic tools for dementia. Maturitas 63(3):181–185
Connor DJ, Seward JD, Bauer JA, Golden KS, Salmon DP (2005) Performance of three clock scoring systems across different ranges of dementia severity. Alzheimer Dis Assoc Disord 19(3):119–127
Brodaty H, Moore CM (1997) The clock drawing test for dementia of the Alzheimer’s type: a comparison of three scoring methods in a memory disorders clinic. Int J Geriatr Psychiatry 12(6):619–627
Shulman KI, Gold DP, Cohen CA, Zucchero CA (1993) Clock-drawing and dementia in the community: a longitudinal study. Int J Geriatr Psychiatry 8:487–496
Shumway-Cook A, Brauer S, Woollacott M (2000) Predicting the probability of falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther 80(9):896–903
Runge M, Rehfeld G (1995) Geriatrische Rehabilitation im Therapeutischen Team. Thieme, Stuttgart
Daniels SK, McAdam CP, Brailey K, Foundas AL (1997) Clinical assessment of swallowing and prediction of dysphagia severity. Am J Speech Lang Pathol 6:17–24
Robinson B, Artz AS, Culleton B, Critchlow C, Sciarra A, Audhya P (2007) Prevalence of anemia in the nursing home: contribution of chronic kidney disease. J Am Geriatr Soc 55(10):1566–1570
Anpalahan M, Gibson SJ (2008) Geriatric syndromes as predictors of adverse outcomes of hospitalization. Intern Med J 38(1):16–23
Buurman BM, Hoogerduijn JG, de Haan RJ, Abu-Hanna A, Lagaay AM, Verhaar HJ, Schuurmans MJ, Levi M, de Rooij SE (2011) Geriatric conditions in acutely hospitalized older patients: prevalence and one-year survival and functional decline. PLoS One 6(11):e26951
Cigolle CT, Langa KM, Kabeto MU, Tian Z, Blaum CS (2007) Geriatric conditions and disability: the Health and Retirement Study. Ann Intern Med 147(3):156–164
Lucca U, Tettamanti M, Mosconi P, Apolone G, Gandini F, Nobili A, Tallone MV, Detoma P, Giacomin A, Clerico M, Tempia P, Guala A (2008) Association of mild anemia with cognitive, functional, mood and quality of life outcomes in the elderly: the “health and anemia” study. PLoS One 3(4):e1929
Chaves PH, Carlson MC, Ferrucci L, Guralnik JM, Semba R, Fried LP (2006) Association between mild anemia and executive function impairment in community-dwelling older women: the Women’s Health and Aging Study II. J Am Geriatr Soc 54(9):1429–1435
Joosten E, Lemiengre J, Nelis T, Verbeke G, Milisen K (2006) Is anaemia a risk factor for delirium in an acute geriatric population? Gerontology 52(6):382–385
Inzitari M, Studenski S, Rosano C, Zakai NA, Longstreth WT Jr, Cushman M, Newman AB (2008) Anemia is associated with the progression of white matter disease in older adults with high blood pressure: the cardiovascular health study. J Am Geriatr Soc 56(10):1867–1872
Abramson JL, Jurkovitz CT, Vaccarino V, Weintraub WS, McClellan W (2003) Chronic kidney disease, anemia, and incident stroke in a middle-aged, community-based population: the ARIC Study. Kidney Int 64(2):610–615
Metivier F, Marchais SJ, Guerin AP, Pannier B, London GM (2000) Pathophysiology of anaemia: focus on the heart and blood vessels. Nephrol Dial Transplant 15(Suppl 3):14–18
Evans WJ (2002) Physical function in men and women with cancer. Effects of anemia and conditioning. Oncology (Williston Park) 16(9 Suppl 10):109–115
Butler SG, Stuart A, Leng X, Wilhelm E, Rees C, Williamson J, Kritchevsky SB (2011) The relationship of aspiration status with tongue and handgrip strength in healthy older adults. J Gerontol A Biol Sci Med Sci 66(4):452–458
Bang SM, Lee JO, Kim YJ, Lee KW, Lim S, Kim JH, Park YJ, Chin HJ, Kim KW, Jang HC, Lee JS (2013) Anemia and activities of daily living in the Korean urban elderly population: results from the Korean Longitudinal Study on Health and Aging (KLoSHA). Ann Hematol 92(1):59–65
Bailey RA, Reardon G, Wasserman MR, McKenzie RS, Hord RS (2012) Association of anemia with worsened activities of daily living and health-related quality of life scores derived from the minimum data set in long-term care residents. Health Qual Life Outcomes 10:129
Terekeci HM, Kucukardali Y, Onem Y, Erikici AA, Kucukardali B, Sahan B, Sayan O, Celik S, Gulec M, Sanisoglu YS, Nalbant S, Top C, Oktenli C (2010) Relationship between anaemia and cognitive functions in elderly people. Eur J Intern Med 21(2):87–90
den Elzen WP, Willems JM, Westendorp RG, de Craen AJ, Assendelft WJ, Gussekloo J (2009) Effect of anemia and comorbidity on functional status and mortality in old age: results from the Leiden 85-plus Study. CMAJ 181(3–4):151–157
Ishine M, Wada T, Akamatsu K, Cruz MR, Sakagami T, Kita T, Matsubayashi K, Okumiya K (2005) No positive correlation between anemia and disability in older people in Japan. J Am Geriatr Soc 53(4):733–734
Walston J, McBurnie MA, Newman A, Tracy RP, Kop WJ, Hirsch CH, Gottdiener J, Fried LP (2002) Frailty and activation of the inflammation and coagulation system with and without clinical comorbidities: results from the Cardiovascular Health Study. Arch Intern Med 162(20):2333–2341
Ranieri P, Rozzini R, Franzoni S, Barbisoni P, Trabucchi M (1998) Serum cholesterol levels as a measure of frailty in elderly patients. Exp Aging Res 24(2):169–179
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zilinski, J., Zillmann, R., Becker, I. et al. Prevalence of anemia among elderly inpatients and its association with multidimensional loss of function. Ann Hematol 93, 1645–1654 (2014). https://doi.org/10.1007/s00277-014-2110-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00277-014-2110-4