Prevalence of anemia among elderly inpatients and its association with multidimensional loss of function

The utility of inpatient work-up of incidental anemia during hospitalization for an acute medical condition: A retrospective cohort study

INTRODUCTION

The best timing for evaluation of anemia is not well defined and the clinical yield of performing workup during non-anemia-related hospitalization is unclear. We aimed to evaluate the prognostic value of inpatient laboratory anemia evaluation.

METHODS

This was a retrospective propensity-matched cohort study between the years 2013-2022 in Rabin Medical Center Israel. We included all patients admitted for non-anemia-related reasons and were found to be anemic. Patients were divided into groups based on basic laboratory anemia evaluation. Outcomes were cancer diagnosis, colonoscopy rate, duration of admission, and all-cause mortality. Multivariable analysis with competing risk of death was performed and a p-value of 5 % was considered significant.

RESULTS

Following matching, 4,238 patients were included in the evaluation group compared to 7,680 in the no-evaluation group. In-patient laboratory anemia evaluation was associated with gastrointestinal cancer and any cancer diagnosis - HR of 1.53 (95 % CI, 1.15- 2.05) and HR of 1.23 (95 % CI, 1.11-1.37) respectively. The rate of colonoscopy was higher, and anemia prevalence was lower in the evaluation group after 1-year follow-up. Intravenous iron treatment was more prevalent in the evaluation group. The laboratory anemia evaluation prolonged the admission (5 vs 4 days). There was no difference in the all-cause mortality across the 10-year follow-up.

CONCLUSION

Inpatient anemia evaluation with basic laboratory tests was found to be associated with an increase in outpatient gastrointestinal cancer diagnosis and showed clinical and diagnostic advantages. For patients who can benefit from early gastrointestinal cancer diagnosis, admission holds a valid opportunity to initiate the evaluation.

Mineral Supplements in Ageing

With advancing age, achievement of dietary adequacy for all nutrients is increasingly difficult and this is particularly so for minerals. Various factors impede mineral acquisition and absorption including reduced appetite, depressed gastric acid production and dysregulation across a range of signalling pathways in the intestinal mucosa. Minerals are required in sufficient levels since they are critical for the proper functioning of metabolic processes in cells and tissues, including energy metabolism, DNA and protein synthesis, immune function, mobility, and skeletal integrity. When uptake is diminished or loss exceeds absorption, alternative approaches are required to enable individuals to maintain adequate mineral levels. Currently, supplementation has been used effectively in populations for the restoration of levels of some minerals like iron, zinc, and calcium, but these may not be without inherent challenges. Therefore, in this chapter we review the current understanding around the effectiveness of mineral supplementation for the minerals most clinically relevant for the elderly.

[Profiling of patients in a specialized geriatric outpatient clinic]

BACKGROUND

In Germany geriatric outpatient care is predominantly done by family doctors and general practitioners (GP). There are regionally different concepts for additional specialized geriatric outpatient care but they have not yet been validated and established. Still, it remains unclear whether a geriatric patient has to be diagnosed rather in a specialized outpatient or inpatient setting. The aim of the present study is the profiling of geriatric outpatients to find key distinctions from geriatric patients that have to be admitted to hospital.

METHODS

Retrospective data analysis of patients sent to a specialized geriatric outpatient clinic by their GP, compared with data of geriatric inpatients sent to hospital by their GP during the same time period. Study parameters comprised elements of the comprehensive geriatric assessment as well as results of routinely applied laboratory tests.

RESULTS

Patients sent to the specialized geriatric outpatient clinic showed better results of functional assessments. Regression analysis: improvement of Barthel Index, GFR and total protein increased the chance of outpatient treatment.

CONCLUSION

Early identification of geriatric patients who can be treated in a specialized outpatient setting would ease the burden for GPs by interdisciplinary cooperation and prevent cost-intensive readmissions to hospital.

Investigation of optimum hemoglobin levels in older patients with chronic kidney disease

AIM

The aim of the present study is to determine target hemoglobin (Hgb) values ​​in older females and males with chronic kidney disease (CKD) according to best performance in mood, gait and balance, muscle strength and activities of daily living, which are important parameters of geriatric assessment.

METHOD

Patients' age, gender, education level, and comorbidities were recorded. All the participants underwent comprehensive geriatric assessment (CGA) including Basic and Instrumental Activities of Daily Living for functional evaluation, Tinetti Performance-Oriented Assessment of Mobility and Timed Up and Go Test for fall risk, and hand grip strength for muscle strength. Hgb levels and kidney functions were analyzed on the same day as CGA measurements. Receiver Operating Characteristic (ROC) analysis was used to detect the optimum level of Hgb according to the best performance of CGA parameters.

RESULTS

622 elderly CKD patients (69.3% female, 55.7% with anemia) were included. After adjustment for confounders, those with anemia had dynapenia (OR 1.60), high risk of falls (OR 1.60), and decreased functional capacity (OR 1.83) among females and those with anemia had dynapenia (OR 4.31), a high risk of falling (OR 2.42) and decreased functional capacity (OR 2.94) among males. The optimum value of Hgb level is 11.8-12.1 in females and 12.6-12.8 in males according to ROC analysis.

CONCLUSION

Anemia is associated with dynapenia, high risk of falls, and decreased functional capacity in older CKD patients regardless of genericity. To prevent these negative outcomes, Hgb should be kept in the range of 11.8-12.1 in older females with CKD and 12.6-12.8 in older males with CKD.

Community Pharmacists’ Perceptions of Their Role in Provision of Anemia Management in Jazan Region, Saudi Arabia, and the Associated Barriers

Background: As a result of the lack of research exploring community pharmacists’ perspectives on anemia care, this study examined the perceived practices and barriers to anemia management services in Saudi Arabia. Methods: A questionnaire was administered to community pharmacists to validate pharmacist perceptions of their role in anemia care. Using an 11-item role test, pharmacists were asked about their perceptions of anemia management. Pharmacy anemia management barriers were explored using 20 items, and their perceptions of inter-professional contact were examined by two items. Data analyses were performed using SPSS version 22. Results: This research involved 324 community pharmacists, 62.3% of whom were males. There were significant differences between the location of pharmacy education and the perceived practice of anemia management. The most common barriers to anemia counseling were patients’ lack of knowledge about anemia, health beliefs, patients’ perceptions that their doctor takes care of them, and time constraints. The majority of respondents said they would like to have more contact with other healthcare professionals regarding the care of anemia patients. Conclusions: A positive perception of pharmacists’ role in anemia management is prevalent among Saudi pharmacists in the Jazan region. Anemia management is challenging due to time limitations and patient-related problems.

Transfusion in Older Anemic Patients: Should the Troponin Value Be Taken into Account?

BACKGROUND

Anemia is common in older individuals, but it is not known whether the prognostic impact of transfusion differs according to cardiac troponin concentration.

METHODS

During this 2-year retrospective study in an acute geriatric unit, 514 patients with hemoglobin <10 g/dL and troponin sampling were included. Thirty-day and 1-year mortality were compared according to transfusion status and troponin and hemoglobin levels.

RESULTS

Of the 514 anemic patients included (median age 88 years), 157 (31%) had elevated troponin concentrations. These patients were more likely to die at 30 days (49% vs 27%, P < .001) and 1 year (65% vs 51%, P = .004) than patients with normal values. Among patients with elevated troponin concentrations, 30-day mortality tended to be lower in transfused than in not-transfused patients (hazard ratio 0.48; 95% confidence interval, 0.21-1.08; P = .07). This association was not found in patients without troponin elevation (hazard ratio 1.09; 95% CI, 0.61-1.93; P = .8). Transfusion was associated with 30-day survival in patients with hemoglobin ≤8 g/dL. It was also associated with excess 1-year mortality in patients with hemoglobin >8 g/dL.

CONCLUSIONS

This pilot study suggests that transfusion could be associated with better 30-day outcomes in older anemic patients with anemia-related myocardial injury. Thus, troponin levels could be involved in decision-making relative to transfusion in anemic older patients. Clinical trials are needed to establish the benefit of transfusion in patients with elevated troponins.

The prevalence of anemia and its associations with other geriatric syndromes in subjects over 65 years old: data of Russian epidemiological study EVKALIPT

Background. A low hemoglobin level in older adults impairs cognitive ability and functional status and associates with risk of falls and fractures, sarcopenia, malnutrition, depression, frailty, and decreased autonomy. Epidemiological data on the anemia prevalence in the geriatric population in our country is not available. Aim. To assess the prevalence of anemia and analyze its associations with geriatric syndromes (GS) in subjects aged 65 years. Materials and methods. 4308 subjects (30% of men) aged 65107 years, living in 11 regions of the Russian Federation, were examined and divided into age groups (6574 years, 7584 years and 85 years). All the participants underwent a comprehensive geriatric assessment and determined hemoglobin level. Results. The anemia prevalence in older adults was 23.9%. It has been shown that with an increase in age per 1 year, the risk of anemia detection increases by 4%. The incidence of anemia was higher in males than females (28.1% versus 22.1%; p0.001). In most cases, anemia was mild. The results of a comprehensive geriatric assessment show that patients with anemia had lower hand grip force, Barthel Index, the sum of points on Lawton instrumental activities of daily living scale, Mini Nutritional Assessment scale, the Mini-Cog test and higher the sum of points on the Geriatric Depression Scale (GDS-15) and the Age Is No Barrier scale. Patients with anemia were more likely to use hearing aids, absorbent underwear, and assistive devices during movement. Patients with anemia had a higher incidence of all GS, except for orthostatic hypotension and chronic pain syndrome. The presence of GS is associated with an increased risk of anemia by 1.33.4 times. Conclusion. EVKALIPT study obtained domestic data on the prevalence of anemia in older patients and examined its associations with other GS.

The Prevalence of Anaemia in a District General Hospital in the United Kingdom

Aim Investigating the prevalence of hospital-acquired anaemia in a United Kingdom (UK) secondary care setting to describe the level of appropriate management prior to discharge back to primary care. Design and settings An observational study of 13 medical and surgical wards in a UK district general hospital. Method Single-day examination of notes, blood results and drug charts, with a 30-day follow up, using pre-set definitions of anaemia and exclusion criteria. Results Two hundred and sixty-seven patients were included. Of them, 52% were anaemic on admission, 62.2% were anaemic on the study day, 16% had hospital-acquired anaemia and 49%-82% had no biochemical indices checked during the admission or in the last 12 months. Also, 53% of anaemic patients are being discharged without appropriate treatment, with over a third being under-investigated. Conclusion The prevalence of anaemia in a UK district general hospital is high. Causes of anaemia are complex, posing a potentially modifiable risk factor for falls, readmission and mortality.

Extremely Old Patients Hospitalized in Internal Medicine: What about Their Anemia?

In western countries, about half of the hospitalized patients are anemic. Generally, these patients are old, often with multiple diseases, and anemia worsens the prognosis, finally increasing the risk of death. We describe a monocentric observational study that evaluates 249 consecutive adult patients (160 women and 89 men) with anemia admitted in the internal medicine department over five months. They represent 71.5% of all patients admitted in the study period. Demographic, historical, and clinical data, laboratory tests, duration of hospitalization, readmission at 30 days, and death were recorded. Patients were stratified by age (75-84=old, >85 years=oldest-old), anemia severity, and etiology of anemia. Anemia was found in 67.5% of old and in 77.2% of oldest-old patients. In 37% of old and 32% of oldest-old patients, anemia was mild, in 43% old and 59% of oldest-old moderate and in 20% old and 9% of oldest-old severe in agreement with WHO criteria. Moderate anemia was significantly more common in the oldest-old (p=0.01). The causes of anemia were iron deficiency in 10.6% of patients, other deficiencies in 2.8%, chronic diseases in 38.2%, hematologic neoplasms in 6.1%, multifactorial in 24.1%, and undetermined in 19.9%. The oldest-old have a higher frequency of multifactorial anemia (p=0.04), while hematologic neoplasms were more common in old patients (p=0.03). Most patients with undetermined anemia had mild/moderate forms. An anti-anemic treatment, mainly blood transfusion, was adopted in 100% of oldest-old patients and in 60% of old (p= 0.04). Anemia (and/or its treatment) was reported in the discharge letter in 19% of old and in 28.2% of oldestold patients. From a general point of view, physicians seem to disregard anemia in the context of more important pathologic conditions. In oldest-old patients, multifactorial anemia seems to be considered only "one more cause of disability." When borderline anemia occurs, even if it can represent a relevant adverse condition in frailty, it is poorly considered.

Comparing the Short-Term Outcome after Polytrauma and Proximal Femur Fracture in Geriatric Patients

Because of demographic change, geriatric patients are becoming a major challenge for traumatology. Multiple trauma patients and patients with proximal femoral fractures are important groups of patients in geriatric traumatology. This retrospective study compares two patient groups with different severities of injuries, and analyzes their patient characteristics and short-term outcomes, focusing on functionality upon discharge. The investigation aims to present the characterizing features of both patient groups, and to identify the potential risk factors for early functionality after trauma. The patient collective comprises two patient groups: a polytrauma group with 91 patients, and a femoral fracture group with 132 patients. Under the control of potential influencing factors, the present study showed no significant influence of belonging to either of the patient groups (multiple trauma or proximal femoral fracture) on the mobility status at discharge. Age, known dementia, pre-clinical intubation, and the lowest Hb value were identified as significant influencing factors. Despite their old age and vulnerability, the majority of geriatric patients survive accidents. Further prospective investigations concerning the maintenance or restoration of functionality after an accident are therefore desirable.

The effect of red blood cell transfusion on fatigability after hospital discharge

In patients with anemia, there is interest in understanding the impact of red blood cell (RBC) transfusion on patient-reported outcomes such as fatigue. However, data from previous studies are mixed as to whether transfusion improves fatigue. One explanation for this is that prior studies have not examined whether changes in fatigue from transfusion may also affect patient activity levels. This is important because if transfusion reduces fatigue, patients may become more active, which could increase their fatigue. Thus, testing whether transfusion affects patients' fatigability, a measure of fatigue in the context of activity, may be more useful than testing the effect of transfusion on fatigue alone. The objective of this study was to test the effect of transfusion during hospitalization on patients' fatigability 7 days postdischarge. This prospective observational study included hospitalized general medicine patients with hemoglobin levels <10 g/dL. Patient-reported fatigability was collected during hospitalization and by telephone 7 days after discharge. Multivariable linear regression was used to test the association between receipt of a transfusion and fatigability 7 days postdischarge. Among the 350 patients participating, larger reductions in fatigability were observed with more transfused RBCs. Receipt of 1 U of RBCs was associated with a smaller reduction in fatigability, whereas receipt of 2 to 3 U of RBCs was associated with reductions in fatigability nearly 1 standard deviation from baseline and 3 times greater than patients receiving 1 U of RBCs. In hospitalized patients with anemia, receipt of a transfusion is associated with reductions in fatigability 7 days after hospital discharge.

Association of anemia with mobility capacity in older adults: a Korean nationwide population-based cross-sectional study

BACKGROUND

Over 10% of adults aged ≥65 years have anemia, as defined by the World Health Organization (WHO). As the timed up and go (TUG) test is one of the most widely used tests of mobility, this study investigated whether anemia was associated with mobility capacity assessed using the TUG test in older adults.

METHODS

Subjects belonging to the Korean National Health Insurance Service-National Health Screening Cohort of the National Health Information Database were reviewed. Subjects were included if they had completed the TUG test as part of the National Screening Program for Transitional Ages in Korea. An abnormal TUG test result was defined as a time of ≥10 s and anemia was defined according to the WHO criteria as a hemoglobin (Hb) concentration of < 13.0 g/dL in men and < 12.0 g/dL in women. The association between anemia and TUG test results was evaluated using four multiple logistic regression models with different levels of adjustment. Stratified analysis according to risk factors was performed.

RESULTS

The 81,473 subjects included 41,063 (50.4%) women and 40,410 (49.6%) men. Mean TUG time was 8.44 ± 3.08 s, and abnormal TUG test results were observed in 22,138 (27.2%) subjects. Mean Hb concentration was 13.72 ± 1.41 g/dL, and 10,237 (12.6%) subjects had anemia. U-shaped associations between Hb concentration and TUG test results were observed in both sexes. Subjects with anemia were 19% more likely to have abnormal TUG test results, according to the fully adjusted model (adjusted odds ratio: 1.192, 95% confidence interval: 1.137-1.247). Similar results were observed for both sexes. Stratified analysis showed that subjects with anemia were more likely to have abnormal TUG test results regardless of risk factors.

CONCLUSIONS

Individuals with anemia are more likely to have abnormal TUG test results, regardless of risk factors, than individuals without anemia. U-shaped relationships between Hb concentrations and TUG test results were observed in both sexes, although the optimal Hb concentration differed between men and women.

Prevalence and Causes of Anemia in Hospitalized Patients: Impact on Diseases Outcome

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.

[Perioperative patient blood management in the aged-more than only transfusion? : Review of the 4th symposium of the working group on anemia on the occasion of the annual meeting of the German Geriatric Society in Frankfurt 2019]

Anemia is frequent in older people with one in two geriatric inpatients being affected. Therefore, in elective surgery, such as endoprosthetic treatment it is very likely that anemia is already present in a preoperative setting. So far there are no particular guidelines about perioperative management of anemia in geriatric patients. The existing recommendations of the Patient Blood Management (PBM) network cooperation and the current Association of the Scientific Medical Societies in Germany (AWMF) S3 guidelines on preoperative anemia refer to all patients aged >18 years but without particular consideration of the growing number of oldest old orthogeriatric patients. This is more problematic as anemia in the aged has been shown to be different from anemia in younger patients in terms of diagnostics and treatment. Based on several interdisciplinary lectures, this year the symposium of the working group on anemia of the German Geriatric Society (DGG) focused on the problems of perioperative PBM in orthogeriatric patients and encouraged the discussion about developing PBM treatment recommendations for this patient group.

Gender differences in blood transfusion strategy for patients with hip fractures - a retrospective analysis

Background: In the last decades, transfusion therapy with allogenic blood has progressively shifted to a more restrictive approach. The current study analyzed the transfusion practice and transfusion-associated factors in a regional trauma center over the course of five years. Methods: Retrospective analysis of all patients undergoing surgery for hip fractures in a level 1 trauma center of an academic teaching hospital from 2010 to 2014 (n=650). The number of transfused packed red blood cells (PRBCs), preoperative Hb concentrations, and intensive care unit (ICU) and hospital length of stay (LOS) were analyzed. A logistic regression analysis was performed to evaluate transfusion and ICU LOS-associated risk factors. (Ethical Review Board approval: 2015-497-f-S). Results: From 2010 to 2014 the average number of PRBCs transfused per patient decreased continuously despite similar preoperative Hb levels. During the same period, ICU LOS increased while hospital LOS decreased. Advanced patient age, preoperative Hb concentrations, surgical complications, and ICU LOS were associated with increased transfusion requirements. Although preoperative Hb levels were lower, females received fewer PRBCs compared to males. Conclusion: Over the course of five years, a restrictive transfusion strategy was implemented within clinical practice in patients undergoing surgery for hip fractures. In parallel, a significant reduction in the hospital LOS and an increased ICU LOS was noted. Whether there is an association between increased ICU LOS and decreasing hospital LOS and whether there is a gender effect on transfusion requirements in patients with surgery for hip fractures should be subject to further research.

[Anemia in the aged]

Anemia in the aged is still often an underestimated clinical problem; however, in recent years increasing research on this topic has permitted deeper insights, allowing a differentiated approach to anemia in the aged. Meanwhile, multicausality and a negative impact on functional outcome have become characteristics of anemia in older people. This has led to a scientific discussion on the question of accepting anemia as a geriatric syndrome. The present article gives a concise overview of the current state of research on this clinically relevant subject.

[Prevalence of anemia and correlation between the concentration of hemoglobin and cognitive factors among the elderly]

The scope of this study was to determine the prevalence of anemia and the correlation between the concentration of hemoglobin and cognitive factors in an elderly population group resident in Campina Grande, Paraiba, Brazil. It was a cross-sectional study with individuals aged 60 or older. Men with hemoglobin levels <13 g / dL and women with levels <12 g / dL were considered anemic. Sociodemographic, cognitive condition and nutritional status variables were analyzed. Statistical analysis was performed by means of simple and multiple linear regression. Among the 360 elderly patients evaluated (67.2% women), the prevalence of anemia was 12.5%. The average concentration of hemoglobin found was 13.5 g / dL and was correlated to sex variables (β = -0.44, 95% CI: -1.35, -0.85), age (β = -0.14 ; 95% CI: -0.03, -0.01), nutritional status (β = 0.16; 95% CI: 0.01, 0.06), memory impairment (β = 0.12; 95% CI: - 0.06, -0.01), and dementia (β = -0.13, 95% CI: -0.06, -0.01). Routine blood testing among the elderly makes it possible to detect and treat anemia at an early stage. Actions geared towards the elderly who show a cognitive decline should be developed in the Basic Family Health Units in order to improve the quality of life of this population.

The impact of treatment for iron deficiency and iron deficiency anemia on nutritional status, physical performance, and cognitive function in geriatric patients

OBJECTIVE

Iron deficiency in older people is common and affects physical and cognitive performance. The effects of iron deficiency on nutrition and cognitive status are well established. However, there are few studies demonstrating the impact of iron deficiency treatment on functional and cognitive outcomes in the geriatric population. The aim of this study was to determine whether iron replacement treatment was associated with an improvement in the nutritional, cognitive, and functional status of older patients with iron deficiency (ID) and iron deficiency anemia (IDA).

METHODS

Geriatric patients with iron deficiency and iron deficiency anemia presenting to the geriatric clinic were included in the study. Comprehensive geriatric assessment (CGA) and blood samples to investigate iron deficiency were performed at baseline and 6 month later. 81 patients were included in the study and were evaluated at follow-up in the 6th month. The CGA included the following tests: the Katz Index of Independence in Activities of Daily Living Scale (Katz ADL), the Lawton-Brody Instrumental Activities of Daily Living Scale (IADL), the Mini-Mental State Examination (MMSE), and the Mini Nutritional Assessment Short-Form (MNA-SF), as well as the assessments of hand grip strength and walking speed.

RESULTS

Of the 81 participating patients, 69.1% were women and 30.9% were men. The mean age was 76.8 ± 7.28 years. Follow-up after iron supplementation treatment was performed with a mean of 6.23 ± 1.58 months. Improvements occurred in the following geriatric and laboratory assessments: Lawton-Brody (IADL), MNA-SF, MMSE, hand grip strength, and walking speed evaluations and the levels of hemoglobin, iron, total iron-binding capacity, transferrin saturation, and ferritin.

CONCLUSIONS

It was shown that iron replacement treatment has a positive impact on functional and cognitive status and nutritional parameters in older patients with ID and IDA.

Iron status in the elderly: A review of recent evidence

A comprehensive literature review of iron status in the elderly was undertaken in order to update a previous review (Fairweather-Tait et al, 2014); 138 summarised papers describe research on the magnitude of the problem, aetiology and age-related physiological changes that may affect iron status, novel strategies for assessing iron status with concurrent health conditions, hepcidin, lifestyle factors, iron supplements, iron status and health outcomes (bone mineral density, frailty, inflammatory bowel disease, kidney failure, cancer, cardiovascular, and neurodegenerative diseases). Each section of this review concludes with key points from the relevant papers. The overall findings were that disturbed iron metabolism plays a major role in a large number of conditions associated with old age. Correction of iron deficiency/overload may improve disease prognosis, but diagnosis of iron deficiency requires appropriate cut-offs for biomarkers of iron status in elderly men and women to be agreed. Iron deficiency (with or without anemia), anemia of inflammation, and anemia of chronic disease are all widespread in the elderly and, once identified, should be investigated further as they are often indicative of underlying disease. Management options should be reviewed and updated, and novel therapies, which show potential for treating anemia of inflammation or chronic disease, should be considered.

Anemia in the aged is not ageing related: position paper on anemia in the aged by the "working group anemia" of the German Geriatric Society (DGG)

Anemia in the aged is a frequent but still under-estimated problem in geriatric patients. However, in recent years increasing research on anemia in the aged has improved awareness and interest in this clinically relevant problem. Guidelines for diagnostic and therapeutic steps are now required to improve the treatment of anemic aged patients. For encouraging the development of diagnostic and therapeutic recommendations, the "working group anemia" of the German Geriatric Society (DGG) has issued a position paper on anemia in the aged, based on the current literature. The statements are (1) that anemia has to be considered a highly prevalent but not a physiologic finding in aged persons; (2) that reference values for hemoglobin concentration are independent of age, indicating that WHO reference values for anemia definition are valid for aged persons; (3) that anemia in the aged is associated with functional and cognitive impairment based on comprehensive geriatric assessment (CGA), requiring diagnosis and treatment.

Magnitude of Anemia in Geriatric Population Visiting Outpatient Department at the University of Gondar Referral Hospital, Northwest Ethiopia: Implication for Community-Based Screening

Objective

This study is aimed at assessing the magnitude and its associated factors of anemia in geriatric population visiting outpatient department at the University of Gondar referral hospital, northwest Ethiopia.

Method

A cross-sectional study was conducted among elder patients in Gondar town, North Gondar District, in May 2013. A total of 200 randomly selected geriatric population participated in the study. Summary statistics were computed and presented in tables and figure. Both bivariate and multivariable binary logistic regression were fitted to identify associated factors. A P value < 0.05 was considered as statistically significant.

Result

The median age of the study participants was 65 years (Interquartile range (IQR): 8 years). The prevalence of anemia in the geriatric patients was 54.5% (n = 109), of which 61.5% (n = 67) were males. Mild type anemia was predominant, 55.96% (n = 61). Geriatric patients with an elevated erythrocyte sedimentation rate (AOR = 9.04, 95% CI: 4.2–19.7) and who are vegetarians (AOR = 2.2, 95% CI: 1.03–4.71) were at high risk of developing anemia.

Conclusion

The magnitude of anemia was high in geriatrics. Mild anemia was the predominant type. Vegetarians and geriatrics with elevated erythrocyte sedimentation rate were more likely to develop anemia. Hence, early diagnosis and management of anemia have paramount importance to prevent adverse outcomes in geriatrics.

The Relationship between Anaemia and Frailty: A Systematic Review and Meta-Analysis of Observational Studies

BACKGROUND

There is increasing evidence that frailty may play a role in chronic diseases, but the associations with specific chronic disorders are still unclear.

OBJECTIVES

To conduct a systematic review and meta-analysis assessing the association of anaemia and frailty in observational studies.

METHODS

The review was performed according to PRISMA guidelines. We searched PubMed, Web of Science, and Embase from 01/01/2002-10/09/2017. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Homogeneity was assessed with the I2 statistic. Publication bias was assessed with Egger's and Begg's tests.

RESULTS

Nineteen studies were included; two longitudinal, seventeen cross-sectional. All studies except three reported an association between anaemia and frailty. The pooled prevalence of prefrailty in individuals with anaemia was 49% (95% CI=38-59%; I2=89.96%) and 24% (95% CI=17-31%; I2= 94.78%) for frailty. Persons with anaemia had more than a twofold odds of frailty (pooled OR=2.24 95% CI=1.53-3.30; I2=91.8%). Only two studies longitudinally examined the association between anaemia and frailty, producing conflicting results.

CONCLUSIONS

Frailty and prefrailty are common in anaemic persons. Older persons with anaemia have more than a two-fold increased odds of frailty. These results may have clinical implications, as they identify the need to assess frailty in anaemic people and investigate any potential negative effects associated with the co-occurrence of both conditions. Longitudinal research that examines temporal changes in anaemia and effect of treatment are needed to further clarify the relationship between anaemia and frailty.

Analysis of cytopenia in geriatric inpatients

BACKGROUND

Peripheral blood dyscrasias in older patients are repeatedly seen in geriatric clinical practice; however, there is substantial lack of data about the epidemiology, possible causes and treatment options in this patient group. Proton pump inhibitors (PPI) are extensively used in older patients and associated with leukopenia. The primary objective of this study was the assessment of encoded cytopenia prevalence in a geriatric patient cohort and the secondary objective was the assessment of putative causes and the analysis of PPI administration in patients with cytopenia.

METHODS

Retrospective evaluation of patients admitted to the geriatric department of a German urban hospital between 2010 and 2012. Electronic patient data were screened for encoded diagnosis of cytopenia according to the International Classification of Diseases (ICD) 10. Inclusion criteria were ICD code D69.0-9 and/or D70.0-7, age ≥60 years and exclusion criteria were no ICD code D69.0-9 and/or D70.0-7 and age <60 years. Out of 9328 screened inpatients 54 patients remained for analysis. Study parameters included hemoglobin (Hb), red blood cell count (RBC), leucocytes, platelets, mean cell volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW), presence of leukopenia (<4000/µl), presence of thrombocytopenia (<140,000/µl) and presence of anemia according to the World Health Organization (WHO). Substitution of blood products, medication with PPI and potential causes for dyscrasias were evaluated based on electronic patient records.

RESULTS

The mean age was 78.3 ± 6.5 years (27 females, 27 males), anemia was seen in 78%, leukopenia was encoded in13% and thrombocytopenia in 44.4%. In most of the patients no substitution of blood products was documented. In most of the patients (20.4%) cytopenia was attributed to either heparin-induced thrombocytopenia (HIT) or hemato-oncologic (20.4%) diseases, followed by drug association in 18.5%. In 70.8% of the study patients PPIs were administered but the indication for PPI administration remained unclear in 20.4%.

CONCLUSION

The results encourage accurate assessment of blood dyscrasias and appropriate documentation as well as indication check for PPI treatment in geriatric inpatients.

Effect of anaemia on hand grip strength, walking speed, functionality and 1 year mortality in older hospitalized patients

Background

Anaemia is a common problem in hospitalized older patients and is recognized as a risk factor for a significant number of adverse outcomes. Data of the effect of anaemia on functional status during hospitalization and mortality after discharge are limited. Aim of the study is to examine whether there is an association between anaemia, hand grip strength, gait speed and basic activities of daily living (ADL) during hospitalization and mortality 1 year after discharge in geriatric patients.

Methods

In a prospective study, data on age, sex, body mass index, Mini-Mental State Examination (MMSE), main clinical diagnosis, number of comorbidities, hand grip strength, gait speed, ADL, haemoglobin, C-reactive protein and estimated Glomerular filtration ratio (eGFR) were recorded in 220 older patients, admitted to the acute geriatric ward of a university hospital. Anaemia was defined as a haemoglobin level <13 g/dL for men and <12 g/dL for women and was further specified into severe (haemoglobin level <10 g/dL for both men and women) and moderate anaemia (haemoglobin between 10 and 12 g/dL for women and 10 and 13 g/dL for men). Gait speed (in meters per second) was calculated after a 4.5 m walk and hand grip strength (in kilogram) was assessed with a hydraulic hand dynamometer. Functionality was assessed in the six basic activities of daily living. Information about the vital status was obtained 1 year after discharge with a telephone call. Analysis of covariance (ANCOVA) was used to examine the effect of the anaemia status on the walking speed, hand grip strength and premorbid ADL index and logistic regression analysis was used to examine whether anaemia could be identified as risk factors for mortality 12 months after discharge.

Results

Overall, 106 (48 %) patients had anaemia. Hand-grip strength, gait speed and ADL score were not significantly different between anaemic and non-anaemic hospitalized geriatric patients. After adjustment for age, sex, body mass index, eGFR, MMSE, number of comorbidities and main clinical diagnosis, the means for hand-grip strength were 17.3, 19.9 and 19.1 kg (p = 0.38); for gait speed 0.57, 0.52 and 0.47 m/s (p = 0.28); and for the ADL score 3.50, 3.05 and 3.30 (p = 0.75) in patients with severe, moderate and without anaemia, respectively. In the unadjusted model, the odds ratio for mortality 1 year after discharge was 2.72 (95 % CI 1.20–6.14) and 4.70 (95 % CI 1.91–11.77) for moderate and severe anaemia, respectively, with no anaemia as the reference group. After adjustment for several confounders, a haemoglobin level less than 10 g/dl (OR 3.87; 95 % CI 1.25–11.99) remained significantly associated with an increased mortality over that 1 year period.

Conclusion

Our results do not support that anaemia on admission is associated with a decline in physical performance (hand grip strength and gait speed) and functionality (ADL) during hospitalization in older patients. However, severe anaemia is a significant risk factor for an increased mortality over a 1 year period after discharge.

Association of anemia with functional and nutritional status in the German multicenter study "GeriAnaemie2013"

OBJECTIVES

Anemia and malnutrition are risk factors for frailty in older people but data from multicenter studies among German geriatric inpatients are lacking. This analysis evaluated data from the multicenter study "GerAnaemie2013" commissioned by the German Geriatric Society.

PATIENTS AND METHODS

The study involved an analysis of the 579 geriatric inpatients recruited in the context of the German multicenter study "GeriAnaemie2013". Study parameters: Barthel index (BI), handgrip strength, nutritional data (e.g. loss of appetite, loss of weight and decreased food intake).

INCLUSION CRITERIA

in-patient age ≥70 years, exclusion criteria: current cancer disease or cancer-associated treatment. Anemia was defined according to the World Health Organization (WHO) criteria.

RESULTS

The mean age of patients was 81.9 years, overall prevalence of anemia 55.1 %, mean hemoglobin (Hb) level 11.9 g/dl, average BI 50.8 points and 30.3 % of all patients were at risk of malnutrition. While univariate analysis revealed a significantly lower BI in anemic patients, this association was no longer seen in multivariate analysis. Regression analysis revealed that a drug intake of > 5 drugs/day doubles the chance of suffering from anemia with an adjusted odds ratio (OR) of 2.17 (confidence interval (CI) 1.28-3.68, p = 0.004) as well as a serum albumin level below 3.5 g/dl with an adjusted OR of 2.11 (range 1.40-3.19, p < 0.001).

CONCLUSION

Polymedication and low serum albumin were independent risk factors for anemia in geriatric patients, probably reflecting disease severity.

Anemia in the frail, elderly patient

Anemia and frailty are two common findings in geriatric patients and have been shown to be associated with poor outcomes in this patient group. Recent studies have contributed to the growing evidence of a possible association with the age-related chronic inflammatory status known as “inflammaging”. These findings do not only give a better insight into the pathogenesis of anemia in frailty, but also offer new treatment options. The present article focuses on this assumed association between anemia, frailty, and inflammaging and summarizes current management options for anemia in frail patients.

Sleep Quality and Associated Factors in Older Turkish Adults With Hypertension: A Pilot Study

PURPOSE

The purpose of this study was to evaluate sleep quality and to explore its associations with participant characteristics, anemia, excessive daytime sleepiness, and physical activity in older Turkish adults with hypertension.

METHOD

This cross-sectional study included 128 adults aged 60 years or older with hypertension. Data were collected by using a personal information form, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, and the International Physical Activity Questionnaire. Anemia was assessed by hemoglobin levels.

RESULTS

Eighty-one patients (63.3%) reported poor sleep quality. Anemia was present in 35.2% of the patients (defined as hemoglobin <13 g/dL for males and <12 g/dL for females). Female gender, the presence of anemia, and low levels of physical activity were associated with poor sleep quality. Conclusion/Implication: The majority of the participants had poor sleep quality. Better understanding of risk factors associated with poor sleep quality may contribute to more effective interventions to improve health and well-being.

Association of anemia and hypoalbuminemia in German geriatric inpatients: Relationship to nutritional status and comprehensive geriatric assessment

BACKGROUND

Anemia and hypoalbuminemia (HA) are acknowledged independent risk factors for morbidity and mortality in geriatric patients and are associated with nutritional status and frailty. Data exist regarding the association between albumin and frailty, anemia and frailty as well as frailty and nutritional status; however, there is a lack of information on the association between HA, anemia and nutritional status in older people.

PATIENTS AND METHODS

This study retrospectively analyzed 626 patients admitted to a German geriatrics department (average age 81.1 years, 68.2% female and 31.8% male) for anemia and HA. Data from the comprehensive geriatric assessment (CGA) and from the mini-nutritional assessment (MNA) were available in all patients.

RESULTS

Patients with anemia suffered significantly more often from HA (p<0.001) than patients without anemia, with an odds ratio (OR) of 1.99 (95% confidence interval CI: 1.2-3.2) and of 5.41 (CI 95%: 2.3-12.6) in patients at risk for malnutrition and in malnourished patients, respectively. A moderately significant association was seen between hemoglobin (Hb) and albumin values (Pearson's correlation r=0.330; p<0.001) as well as between albumin values and the Barthel index (Spearman's correlation r=0.210; p<0.001).

CONCLUSION

Anemia appears to be a risk factor for HA in inpatients with malnutrition and the observed association between albumin and Hb warrants further research. Geriatric inpatients with anemia should be evaluated in terms of the presence of malnutrition risk and HA.