Prevalence and predictors of anemia in a population-based study of octogenarians and centenarians in Georgia

Association of anemia with all-cause mortality in Chinese centenarians: a prospective cohort study

OBJECTIVES

This study aimed to examine the relationship between anemia and all-cause mortality in Chinese centenarians.

DESIGN

Prospective cohort study.

SETTING AND PARTICIPANTS

We included 1002 Chinese centenarians from the China Hainan Centenarian Cohort Study (CHCCS) MEASUREMENTS: Standard procedures were followed to perform blood analysis, home interviews, and physical examinations. Anemia was defined as a hemoglobin level of less than 130 g/L for men and less than 120 g/L for women.

RESULTS

During the 9-year follow-up period, a total of 929 (92.7%) deaths were identified. Cox proportional hazards regression models revealed that anemia (hazard ratio [HR] 1.289, 95% confidence interval [CI]: 1.117-1.489) was significantly associated with all-cause mortality. There was an apparent dose-response relationship between anemia and all-cause mortality. Centenarians with severe anemia had approximately 1.6 times higher likelihood of all-cause mortality than those without anemia (HR 1.662; 95% CI: 1.154-2.394).

CONCLUSION

Anemia is associated with an increased risk of all-cause mortality in Chinese centenarians. Further research will be needed to collect more comprehensive data on the etiology of anemia and causes of death in centenarians.

Development and validation of a postoperative bleeding complications prediction model in infective endocarditis

OBJECTIVES

Bleeding complications are one of the most serious postoperative complications after cardiac surgery and are associated with high mortality, especially in patients with infective endocarditis (IE). Our objectives were to identify the risk factors and develop a prediction model for postoperative bleeding complications in IE patients.

METHODS

The clinical data of IE patients treated from October 2013 to January 2022 were reviewed. Multivariate logistic regression analysis was used to evaluate independent risk factors for postoperative bleeding complications and develop a prediction model accordingly. The prediction model was verified in a temporal validation cohort. The performance of the model was evaluated in terms of its discrimination power, calibration, precision, and clinical utility.

RESULTS

A total of 423 consecutive patients with IE who underwent surgery were included in the final analysis, including 315 and 108 patients in the training cohort and validation cohort, respectively. Four variables were selected for developing a prediction model, including platelet counts, systolic blood pressure, heart failure and vegetations on the mitral and aortic valves. In the training cohort, the model exhibited excellent discrimination power (AUC = 0.883), calibration (Hosmer-Lemeshow test, P = 0.803), and precision (Brier score = 0.037). In addition, the model also demonstrated good discrimination power (AUC = 0.805), calibration (Hosmer-Lemeshow test, P = 0.413), and precision (Brier score = 0.067) in the validation cohort.

CONCLUSIONS

We developed and validated a promising risk model with good discrimination power, calibration, and precision for predicting postoperative bleeding complications in IE patients.

Prognostic relevance of normocytic anemia in elderly patients affected by cardiovascular disease

BACKGROUND

Anemia associated with cardiovascular diseases (CVD) is a common condition in older persons. Prevalence and prognostic role of anemia were extensively studied in patients with myocardial infarction (MI) or congestive heart failure (CHF) whereas limited data were available on patients with atrial fibrillation (AF). This study was conducted to assess the clinical prevalence and prognostic relevance of anemia in elderly patients affected by AF and other CVDs.

METHODS

A total of 866 elderly patients (430 men and 436 women, age: 65-98 years, mean age: 85 ± 10 years) were enrolled. Among these patients, 267 patients had acute non-ST-segment elevation MI (NSTEMI), 176 patients had acute CHF, 194 patients had acute AF and 229 patients were aged-matched healthy persons (CTR). All parameters were measured at the hospital admission and cardiovascular mortality was assessed during twenty-four months of follow-up.

RESULTS

The prevalence of anemia was higher in NSTEMI, CHF and AF patients compared to CTR subjects (50% vs. 15%, P < 0.05), with normocytic anemia being the most prevalent type (90%). Adjusted mortality risk was higher in anemic patient versus non-anemic patient in all the groups of patients [NSTEMI: hazard ratio (HR) = 1.81, 95% CI: 1.06-2.13; CHF: HR = 2.49, 95% CI: 1.31-4.75; AF: HR = 1.98, 95% CI: 1.01-3.88]. Decreased hemoglobin levels ( P = 0.001) and high reticulocyte index (P = 0.023) were associated with higher mortality in CVD patients.

CONCLUSIONS

The significant associations between CVD and anemia and the prognostic relevance of anemia for elderly patients with CVD were confirmed in this study. The presence of anemia in AF patients is associated with a two-fold increased mortality risk compared with non-anemic AF patients. Low hemoglobin and high reticulocyte count independently predict mortality in elderly patients with CVD.

Associations Between Anemia, Cognitive Impairment, and All-Cause Mortality in Oldest-Old Adults: A Prospective Population-Based Cohort Study

Objective: To evaluate the combined effects of anemia and cognitive function on the risk of all-cause mortality in oldest-old individuals. Design: Prospective population-based cohort study. Setting and Participants: We included 1,212 oldest-old individuals (men, 416; mean age, 93.3 years). Methods: Blood tests, physical examinations, and health questionnaire surveys were conducted in 2012 were used for baseline data. Mortality was assessed in the subsequent 2014 and 2018 survey waves. Cox proportional hazards models were used to evaluate anemia, cognitive impairment, and mortality risk. We used restricted cubic splines to analyze and visualize the association between hemoglobin (Hb) levels and mortality risk. Results: A total of 801 (66.1%) deaths were identified during the 6-year follow-up. We noted a significant association between anemia and mortality (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.14-1.54) after adjusting for confounding variables. We also observed a dose-response relationship between the severity of anemia and mortality (P < 0.001). In the restricted cubic spline models, Hb levels had a reverse J-shaped association with mortality risk (HR 0.88, 95% CI 0.84-0.93 per 10 g/L-increase in Hb levels below 130 g/L). The reverse J-shaped association persisted in individuals without cognitive impairment (HR 0.88, 95% CI 0.79-0.98 per 10 g/L-increase in Hb levels below 110 g/L). For people with cognitive impairment, Hb levels were inversely associated with mortality risk (HR 0.83, 95% CI 0.78-0.89 per 10 g/L-increase in Hb levels below 150 g/L). People with anemia and cognitive impairment had the highest risk of mortality (HR 2.60, 95% CI 2.06-3.27). Conclusion: Our results indicate that anemia is associated with an increased risk of mortality in oldest-old people. Cognitive impairment modifies the association between Hb levels and mortality.

Anemia in centenarians: prevalence and association with kidney function

Objectives: Although anemia is a widespread condition that leads to an increase in morbidity and mortality, particularly as people age, little information on anemia in centenarians is available. The objective of this study was to determine the prevalence of anemia and examine the relationship between anemia and a decline in kidney function in Chinese centenarians.Methods: We conducted a population-based cross-sectional study of a sample of 1002 Chinese centenarians (180 men and 822 women) from 2014 to 2016. Anemia was defined as a hemoglobin level of <130 g/L for men and <120 g/L for women.Results: The prevalence of anemia and severe anemia (<100 g/L) were 68.5% (men, 76.1%; women, 66.8%) and 19.6% (men, 16.1%; women, 20.3%), respectively. The risk of anemia and estimated glomerular filtration rate (eGFR) showed a nonlinear relationship (nonlinear P = 0.021). The interaction analysis revealed that ethnicity and diabetes mellitus played a role in the association between the eGFR (<60 mL/min/1.73 m²) and anemia.Conclusion: Anemia is highly prevalent in Chinese centenarians, particularly among men. Decreased kidney function was an independent determinant of anemia, especially in Han participants and participants with diabetes mellitus. The possibility of decreased kidney function needs to be considered in the evaluation and treatment of anemia in centenarians.

Association of Anemia with Activities of Daily Living in Chinese Female Centenarian

OBJECTIVES

Although anemia and activities of daily living (ADL) disability in female elderly are common conditions and are more likely to occur as people age, little is known about the association of anemia with ADL in female centenarians. The objective of this study was to examine the relationship between anemia and ADL disability in Chinese female centenarians.

DESIGN, SETTING AND PARTICIPANTS

We conducted a population-based cross-sectional study of a sample of 822 Chinese female centenarians from 2014 to 2016.

MEASUREMENTS

Blood analysis, home interview, and physical examination were performed following standard procedures. ADL disability was defined as a Barthel Index total score≤60.

RESULTS

The prevalence of anemia and ADL disability were 66.8% and 29.7% respectively in Chinese female centenarians. Multiple logistic regression analyses revealed that inflammation (OR = 2.280, 95% CI, 1.524-3.410), underweight (OR = 1.653, 95% CI, 1.186-2.303), anemia (OR = 1.775, 95% CI, 1.250-2.521), and living with family (OR = 0.518, 95% CI, 0.302-0.888) were significant factors related to ADL disability. Centenarians with severe anemia had an approximately fourfold greater likelihood of ADL disability than those without anemia (OR =3.747; 95% CI 1.525-9.206). An apparent dose-response relationship was found between anemia and ADL disability.

CONCLUSION

These findings may provide some insights into targeted intervention for maintaining ADL independence in female centenarians, especially encouraging the interventions of anemia to improve ADL.

Cardiovascular health and cognitive functioning among centenarians: a comparison between the Tokyo and Georgia centenarian studies

ABSTRACTObjectives:Centenarians have survived into very late life, but whether they reach very old age in good health remains unclear. The purpose of this study was to compare the cardiovascular health status and cognitive functioning of centenarians in the United States with centenarians in Japan.

DESIGN, SETTING, AND PARTICIPANTS

This cross-national design compared centenarians from the United States and Japan. The sample of U.S. centenarians was recruited from the Georgia Centenarian Study and included 287 centenarians. The sample of Japanese centenarians was recruited from the Tokyo Centenarian Study and included 304 centenarians.

MEASUREMENTS

Cognitive functioning was assessed with a mental status questionnaire, and cardiovascular disease by a health history assessment, blood pressure, and selected blood parameters.

RESULTS

The results suggest that Tokyo centenarians had lower disease experiences and BMI values, when compared to Georgia centenarians, but blood pressure was higher among Japanese centenarians. Lower levels of hemoglobin in Japanese centenarians and higher levels of C-reactive protein in Georgia were also found. The positive association of hypertension and albumin levels with cognitive functioning and the negative association of stroke occurrence with cognitive functioning were replicated in both countries. Differential effects were obtained for heart problems, BMI, and C-reactive protein (with positive effects for Tokyo centenarians, except for C-reactive protein).

CONCLUSION

For extremely old individuals, some markers of cardiovascular disease are replicable across countries, whereas differential effects for cardiovascular health also need to be considered in cardiovascular health.

Eryptosis in health and disease: A paradigm shift towards understanding the (patho)physiological implications of programmed cell death of erythrocytes

During the course of their natural ageing and upon injury, anucleate erythrocytes can undergo an unconventional apoptosis-like cell death, termed eryptosis. Eryptotic erythrocytes display a plethora of morphological alterations including volume reduction, membrane blebbing and breakdown of the membrane phospholipid asymmetry resulting in phosphatidylserine externalization which, in turn, mediates their phagocytic recognition and clearance from the circulation. Overall, the eryptosis machinery is tightly orchestrated by a wide array of endogenous mediators, ion channels, membrane receptors, and a host of intracellular signaling proteins. Enhanced eryptosis shortens the lifespan of circulating erythrocytes and confers a procoagulant phenotype; this phenomenon has been tangibly implicated in the pathogenesis of anemia, deranged microcirculation, and increased prothrombotic risk associated with a multitude of clinical conditions. Herein, we reviewed the molecular mechanisms dictating eryptosis and erythrophagocytosis and critically analyzed the current evidence leading to the pathophysiological ramifications of eryptotic cell death in the context of human disease.

Frailty Assessment in Hospitalized Older Adults Using the Electronic Health Record

INTRODUCTION

Frailty, a clinical syndrome of decreased physiologic reserve and dysregulation in multiple physiologic systems, is associated with increased risk for adverse outcomes.

PURPOSE

The aim of this retrospective, cross-sectional, correlational study was to characterize frailty in older adults admitted to a tertiary-care hospital using a biopsychosocial frailty assessment and to determine associations between frailty and time to in-hospital mortality and 30-day rehospitalization.

METHODS

The sample included 278 patients ≥55 years old admitted to medicine units. Frailty was determined using clinical data from the electronic health record (EHR) for symptoms, syndromes, and conditions and laboratory data for four serum biomarkers. A frailty risk score (FRS) was created from 16 risk factors, and relationships between the FRS and outcomes were examined.

RESULTS

The mean age of the sample was 70.2 years and mean FRS was 9.4 ( SD, 2.2). Increased FRS was significantly associated with increased risk of death (hazard ratio = 1.77-2.27 for 3 days ≤ length of stay (LOS) ≤7 days), but depended upon LOS ( p < .001). Frailty was marginally associated with rehospitalization for those who did not die in hospital (adjusted odds ratio = 1.18, p = .086, area under the curve [AUC] = 0.66, 95% confidence interval for AUC = [0.57, 0.76]).

DISCUSSION

Clinical data in the EHR can be used for frailty assessment. Informatics may facilitate data aggregation and decision support. Because frailty is potentially preventable and treatable, early detection is crucial to delivery of tailored interventions and optimal patient outcomes.

[Hematopoietic stem cell exhaustion and advanced glycation end-products in the unexplained anemia of the elderly]

INTRODUCTION

More than 10% of the aged 65 years and over in the western world suffers anemia and in one third of them the cause of the anemia remains obscure. The unexplained anemia of the elderly (UAE) is considered an exclusion diagnosis, without the existence of a clear consensus to its clinical or experimental approach. There is an association between aging and anemia in studies performed in animals and in humans.

OBJECTIVES

To determine if there is evidence in the literature that supports hematopoietic stem cells (HSC) exhaustion and the advanced glycation end-products (AGE's) as a cause of UAE.

METHOD

A total of 32 combined texts (28 for HSC exhaustion and 4 for AGEs) were selected after an intensive review. Conclusions were associated with causes and effects of the HSC exhaustion and circulating AGE's over aging and anemia.

RESULTS

Only three works try to establish an association between UAE and HSC exhaustion, two of them disagreed in their conclusions, with the third one differing in the type of study. There is a relationship between anemia and AGEs increase and accumulation.

CONCLUSIONS

There is evidence in the literature that links the aging molecular and cellular mechanisms with the HSC exhaustion and the increase of AGE's. Furthermore; there is some evidence that both conditions determine the emergence of anemia associated with age in animals and in humans. There is little evidence in the literature to clarify the relationship between aging and UAE.

Prevalence and related factors of chronic kidney disease (CKD) among long-lived individuals (LLI) over 95 years of age

BACKGROUND

CKD, a functional decline or break down of kidney, has been increasingly recognized as a public health problem and a predictor of poor outcomes (i.e., cardiovascular disease, dementia) and mortality among general populations. However, little is known regarding the prevalence and related factors of CKD among Chinese LLI over 95 years of age.

METHODS

We used data of LLI from the Rugao longevity cohort, a population-based association study conducted in Rugao, a longevity town of China. CKD was defined as an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2. Demographic exposures and biochemical markers were correlated with CKD.

RESULTS

The prevalence of CKD among LLI in Rugao is 23.8%. Traditional risk factors for CKD among general population, such as hypertension, diabetes, and dyslipidemia, did not have associations with CKD. However, overweight, central adiposity, and hyperuricemia were associated with increased risk of CKD, with crude odds ratios of 2.41 (95% CI=1.23-4.69), 2.61 (95% CI=1.42-4.77), and 5.69 (95% CI=2.75-11.76), respectively. In addition, higher magnesium and filtration marker β2 microglobulin (β2M) were associated with CKD, with crude odds ratios of 2.47 (95% CI=1.38-4.43) and 16.38 (95% CI=6.76-39.64), respectively.

CONCLUSIONS

We observe a high prevalence and unique related factors of CKD among the LLI in Rugao, which suggest that early screening and risk intervention of CKD are imperative to maintain a high quality of life and postpone the occurrence of poor outcomes.

Profiles of cognitive functioning in a population-based sample of centenarians using factor mixture analysis

BACKGROUND/STUDY CONTEXT: The goal of the study was to identify and characterize latent profiles (clusters) of cognitive functioning in centenarians and the psychometric properties of cognitive measures within them.

METHODS

Data were collected from cross-sectional, population-based sample of 244 centenarians (aged 98 to 108, 15.8% men, 20.5% African American, 38.0% community-dwelling) from 44 counties in northern Georgia participating in the Georgia Centenarian Study (2001-2008). Measures included the Mini-Mental State Examination (MMSE), Severe Impairment Battery (SIB), Wechsler Adult Intelligence Scale-III Similarities subtest (WAIS), Hand Tapping, Behavioral Dyscontrol Scale (BDS), Controlled Oral Word Association Test (COWAT), and Fuld Object Memory Evaluation (FOME). The Global Deterioration Rating Scale (GDRS) was used to independently evaluate criterion-related validity for distinguishing cognitively normal and impaired groups. Relevant covariates included directly assessed functional status for basic and instrumental activities of daily living (DAFS), race, gender, educational attainment, Geriatric Depression Scale Short Form (GDS), and vision and hearing problems.

RESULTS

Results suggest two distinct classes of cognitive performance in this centenarian sample. Approximately one third of the centenarians show a pattern of markedly lower cognitive performance on most measures. Group membership is independently well predicted (area under the curve [AUC] = .83) by GDRS scores (sensitivity 67.7%, specificity 82.4%). Membership in the lower cognitive performance group was more likely for individuals who were older, African Americans, had more depressive symptoms, lower plasma folate, carriers of the apolipoprotein E (APOE) ε4 allele, facility residents, and individuals who died in the 2 years following interview.

CONCLUSIONS

In a population expected to have high prevalence of dementia, latent subtypes can be distinguished via factor mixture analysis that provide normative values for cognitive functioning. The present study allows estimates for normative cognitive performance in this age group.

Metabolic syndrome and hemoglobin levels in elderly adults: the Invecchiare in Chianti Study

OBJECTIVES

To assess the association between metabolic syndrome (MetS) and hemoglobin levels in older adults.

DESIGN

The Invecchiare in Chianti (InCHIANTI) Study, a cohort study with a 6-year follow-up.

SETTING

Tuscany, Italy.

PARTICIPANTS

Adults aged 65 and older (N = 1,036).

MEASUREMENTS

MetS was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III criteria. The adjusted association between baseline hemoglobin and MetS was assessed using multivariable linear regression with hemoglobin as a continuous variable and using logistic regression with median hemoglobin level as the reference. Logistic regression was also performed with any incident decline in hemoglobin levels as the dependent variable.

RESULTS

MetS was diagnosed in 263 (25%) participants. At baseline, MetS was associated with higher hemoglobin levels (B = 0.18, 95% confidence interval (CI) = 0.03-0.33, P = .02) and with hemoglobin levels above the median value (odds ratio (OR) = 1.65, 95% CI = 1.17-2.32, P = .004) after adjusting. After 6 years, MetS was associated with lower adjusted probability of lower hemoglobin levels (OR = 0.34, 95% CI = 0.15-0.79, P = .012) but only in the oldest tertile of participants.

CONCLUSION

MetS is associated with higher hemoglobin levels in older subjects and with lower probability of hemoglobin loss over 6 years in those in the oldest age group.

Biochemical markers of aging for longitudinal studies in humans

Much progress has been made in the past decades in unraveling the mechanisms that are responsible for aging. The discovery that particular gene mutations in experimental species such as yeast, flies, and nematodes are associated with longevity has led to many important insights into pathways that regulate aging processes. However, extrapolating laboratory findings in experimental species to knowledge that is valid for the complexity of human physiology remains a major challenge. Apart from the restricted experimental possibilities, studying aging in humans is further complicated by the development of various age-related diseases. The availability of a set of biomarkers that really reflect underlying aging processes would be of much value in disentangling age-associated pathology from specific aging mechanisms. In this review, we survey the literature to identify promising biochemical markers of aging, with a particular focus on using them in longitudinal studies of aging in humans that entail repeated measurements on easily obtainable material, such as blood samples. Our search strategy was a 2-pronged approach, one focused on general mechanisms of aging and one including studies on clinical biomarkers of age-related diseases.