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Prevalence of Anemia and Its Association with Frailty, Physical Function and Cognition in Community-Dwelling Older Adults: Findings from the HOPE Study

The journal of nutrition, health & aging volume 25, pages 679–687 (2021)Cite this article

Abstract

Objectives

The prevalence of anemia and its impact on frailty and physical function amongst the multiethnic older populations in the Southeast Asian (SEA) countries are often not well studied. Singapore, a nation comprised of multiethnic communities, is one of the most rapidly aging population globally. We aim to evaluate the prevalence of anemia and its impact on frailty, and physical function in Healthy Older People Everyday (HOPE)- an epidemiologic population-based study on community-dwelling older adults in Singapore.

Design

Cross-sectional study.

Setting

Community.

Participants

480 adults ≥ 65 years old.

Measurements

Data were collected from interviewers-administered questionnaires on socio-demographics, FRAIL scale, Mini-Mental State Examination, EQ-5D, Barthel Index, and Lawton index. Hemoglobin concentration and physical assessments, including anthropometry, grip strength, timed up-and-go (TUG) were measured.

Results

The overall prevalence of anemia was 15.2% (73 out of 480). The Indian ethnic group had the highest prevalence of anemia (32%, OR=3.02; 95%CI= 1.23–7.41) with the lowest hemoglobin concentration compared to the overall population (13.0±1.3g/L and 13.5±1.4g/L, p=0.02). Hemoglobin levels and anemia were significantly associated with frailty (OR=2.28; 95% CI=1.02–5.10), low grip strength (OR=1.79; 95% CI=1.01–3.03), ≥ one IADL impairment (OR=2.35; 95% CI=1.39–3.97). Each 1 g/dL increase in hemoglobin was associated with a 6% decrease in frailty odds after adjusting for potential covariates (OR = 0.94, 95% CI: 0.90–0.99). There was a significant difference in the mean TUG between the non-anemic (11.0±3.4 seconds) and anemic (12.3±6.0 seconds, p=0.01) counterparts, but no difference in the number of falls.

Conclusion

In our multiethnic Asian population, anemia was adversely associated with frailty, decreased muscle strength, and IADL impairment. Health policies on anemia screening should be employed to avoid or potentially delay or reverse these adverse outcomes associated with anemia. Recognition, evaluation, and treatment of anemia amongst this vulnerable population is warranted.

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Funding

Funding: Research grant from Roche Global Pharmaceuticals, Ministry of Health, Singapore and Dr. Oon Chiew Seng Professorship fund supported this work. None of the sponsors had any role in the study design, methods, analyses, interpretation, or preparation of the manuscript and the decision to submit it for publication.

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Authors and Affiliations

  1. Fast and Chronic Program, Alexandra Hospital, National University Health System (NUHS), Singapore, Singapore

    Chun-Tsu Lee

  2. Department of Hematology-Oncology, National University Cancer Institute, Singapore (NCIS), NUHS, Singapore, Singapore

    Chun-Tsu Lee, E. S. Yap & S. Y. Lee

  3. Department of Laboratory Medicine, Alexandra Hospital, National University Health System (NUHS), Singapore, Singapore

    Chun-Tsu Lee

  4. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Chun-Tsu Lee & R. A. Merchant

  5. Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore

    M. Z. Chen & R. A. Merchant

  6. Department of Laboratory Medicine, National University Hospital, National University Health System (NUHS), Singapore, Singapore

    C. Y. C. Yip, E. S. Yap & S. Y. Lee

  7. FAMS, Fast and Chronic Program, Alexandra Hospital, National University Health System, 378 Alexandra Road, Singapore, 159964, Singapore

    Chun-Tsu Lee

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  1. Chun-Tsu Lee
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Correspondence to Chun-Tsu Lee.

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Lee, CT., Chen, M.Z., Yip, C.Y.C. et al. Prevalence of Anemia and Its Association with Frailty, Physical Function and Cognition in Community-Dwelling Older Adults: Findings from the HOPE Study. J Nutr Health Aging 25, 679–687 (2021). https://doi.org/10.1007/s12603-021-1625-3

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  • DOI: https://doi.org/10.1007/s12603-021-1625-3

Key words

  • Anemia
  • hemoglobin
  • older adults
  • frailty
  • instrumental activities of daily living