The Relationship between Frailty and Anemia in Older Adults

Year 2021, , 78 - 83, 31.12.2021

Feyza Mutlay , Kübra Altunkalem Seydi

https://doi.org/10.47141/geriatrik.1033806

Cited By: 1

Abstract

Aim: Anemia is a common cause of morbidity and mortality in older adults. There is a strong association between anemia and poor physical performance. However, the effect of anemia on frailty is not known clearly. This study focuses on the relationship between anemia and frailty.

Material and Methods: Comprehensive geriatric assessment was performed on 383 patients who were followed up in the Geriatrics Clinic. All patients were questioned in terms of comorbidity. The diagnosis of anemia was accepted as a hemoglobin level below 12.2 g/dL in women and 13.2 g/dL in men.

Results: Anemia was detected in 103 (26.9%) patients. The mean age of the patients was significantly higher in the anemia group (p=0.01). It was determined that the individuals in the anemia group had a higher number of drug use, diabetes mellitus, and depression. According to the Fried frailty scale, the frailty score was significantly higher in anemic individuals (p<0.01). Poor results obtained from POMA (Mobility-Balance Evaluation Test in the Direction of Performance), Basic and Instrumental Activities of Daily Living, Up and Go Test, Mini Nutrition Assessment-Short Form tests used in Comprehensive geriatric assessment were found in the anemia group (p<0.01). When the participants' data were adjusted for age, gender, and duration of education, a significant correlation was found between the frequency of anemia and frailty (Odds Ratio 1.82 95% Confidence Interval 1.03-3.20 P=0.03).

Conclusion: Anemia is an easily screenable laboratory finding but may be associated with frailty and poor health outcomes in the elderly. Therefore, it is recommended that older individuals with anemia be evaluated comprehensively for diagnosis and treatment.

Keywords

Fraility, anemia, geriatric syndrome, older adult

Yaşlı Erişkinlerde Kırılganlık ve Anemi Arasındaki İlişki

Abstract

Amaç: Anemi yaşlı erişkinlerde morbidite ve mortalitenin yaygın bir nedenidir. Anemi ile düşük fiziksel performans arasında güçlü ilişki vardır. Ancak aneminin kırılganlık sendromu üzerindeki etkisi net olarak bilinmemektedir. Bu çalışma, anemi ve kırılganlık arasındaki ilişkiye odaklanmaktadır.

Gereç ve Yöntemler: Geriatri Kliniğinde takipli 383 hasta çalışmaya alınarak, hastalara ayrıntılı geriatrik değerlendirme uygulandı. Tüm hastalar komorbidite açısından sorgulandı. Anemi tanısı kadınlarda hemoglobin seviyesinin 12,2 g/dL ve erkeklerde 13,2 g/dL’nin altında olması olarak kabul edildi.

Bulgular: Hastaların 103’ünde (%26,9) anemi saptandı. Hastaların yaş ortalaması anemisi olan grupta anlamlı olarak daha yüksekti (p=0,01). Anemisi olan gruptaki bireylerin ilaç kullanım sayısının daha fazla olduğu, diabetes mellitus ve depresyonun daha yüksek olduğu saptandı. Fried kırılganlık ölçeğine göre anemik bireylerde kırılganlık skoru anlamlı olarak daha yüksekti (p<0,01). Ayrıntılı Geriatrik Değerlendirmede kullanılan POMA (Performans Doğrultusunda Mobilite-Denge Değerlendirme Testi), Temel ve Enstrumental Günlük Yaşam Aktiviteleri, Kalk ve Yürü Testi, Mini Nutrisyon Değerlendirme-Kısa Formu testlerinden alınan kötü sonuçların anemi grubunda daha fazla olduğu saptandı (p<0,01). Katılımcıların verilerinde yaş, cinsiyet, eğitim süresine göre düzeltme yapıldığında anemi ile kırılganlık (Odds Oranı 1,82 %95 Güven Aralığı 1,03-3,20 P=0,03) sıklığı arasında anlamlı ilişki olduğu görüldü.

Sonuç: Anemi, kolaylıkla taranabilen bir laboratuvar bulgusudur, ancak yaşlılarda kırılganlıkla ve kötü sağlık sonuçlarıyla ilişkili olabilir. Bu nedenle, anemisi olan yaşlı bireylerin tanı ve tedavi için çok yönlü değerlendirilmesi önerilir.

Keywords

Kırılganlık, anemi, geriatrik sendrom, yaşlı

References

• 1. Lanier JB, Park JJ, Callahan RC. Anemia in Older Adults. Am Fam Physician. 2018 Oct;98(7):437–42.
• 2. Anía BJ, Suman VJ, Fairbanks VF, et al. Incidence of anemia in older people: an epidemiologic study in a well defined population. J Am Geriatr Soc. 1997 Jul;45(7):825–31.
• 3. Artz AS. Anemia and the frail elderly. Semin Hematol. 2008 Oct;45(4):261–6.
• 4. Chaves PHM, Ashar B, Guralnik JM, et al. 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. 2002 Jul;50(7):1257–64.
• 5. Culleton BF, Manns BJ, Zhang J, et al. Impact of anemia on hospitalization and mortality in older adults. Blood. 2006 May;107(10):3841–6.
• 6. Clegg A, Young J, Iliffe S, et al. Frailty in elderly people. Lancet (London, England). 2013 Mar;381(9868):752–62.
• 7. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001 Mar;56(3):M146-56.
• 8. Leng S, Chaves P, Koenig K, et al. Serum interleukin-6 and hemoglobin as physiological correlates in the geriatric syndrome of frailty: a pilot study. J Am Geriatr Soc. 2002 Jul;50(7):1268–71.
• 9. Sachdev PS, Mohan A, Taylor L, et al. DSM-5 and Mental Disorders in Older Individuals: An Overview. Harv Rev Psychiatry. 2015;23(5):320–8.
• 10. Haider SI, Johnell K, Weitoft GR, et al. The influence of educational level on polypharmacy and inappropriate drug use: a register-based study of more than 600,000 older people. J Am Geriatr Soc. 2009 Jan;57(1):62–9.
• 11. Unutmaz GD, Soysal P, Tuven B, et al. Costs of medication in older patients: Before and after comprehensive geriatric assessment. Clin Interv Aging. 2018;13.
• 12. Ates Bulut E, Soysal P, Isik AT. Frequency and coincidence of geriatric syndromes according to age groups: Single-center experience in Turkey between 2013 and 2017. Clin Interv Aging. 2018;13:1899–905.
• 13. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001 Mar;56(3):M146-56.
• 14. Cesari M, Leeuwenburgh C, Lauretani F, et al. Frailty syndrome and skeletal muscle: results from the Invecchiare in Chianti study. Am J Clin Nutr. 2006 May;83(5):1142–8.
• 15. Cereda E. Mini Nutritional Assessment. Curr Opin Clin Nutr Metab Care. 2012;15(1).
• 16. Guigoz Y. The Mini Nutritional Assessment (MNA) review of the literature--What does it tell us? J Nutr Health Aging. 2006;10(6):466–7.
• 17. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3):179–86.
• 18. Mahoney FI, Barthel DW. Functıonal evaluation: The Barthel Index. Md State Med J. 1965 Feb;14:61–5.
• 19. Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc. 1986 Feb;34(2):119–26.
• 20. Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991 Feb;39(2):142–8.
• 21. Durmaz B., Soysal P, Ellidokuz H, et al. Validity and Reliability of Geriatric Depression Scale - 15 (Short Form) in Turkish older adults. North Clin Istanbul. 2017;5(3):216–20.
• 22. Chang SS, Weiss CO, Xue Q-L, et al. Association between inflammatory-related disease burden and frailty: results from the Women’s Health and Aging Studies (WHAS) I and II. Arch Gerontol Geriatr. 2012;54(1):9–15.
• 23. Juárez-Cedillo T, Basurto-Acevedo L, Vega-García S, et al. Prevalence of anemia and its impact on the state of frailty in elderly people living in the community: SADEM study. Ann Hematol. 2014 Dec;93(12):2057–62.
• 24. Ruan Y, Guo Y, Kowal P, et al. Association between anemia and frailty in 13,175 community-dwelling adults aged 50 years and older in China. BMC Geriatr. 2019 Dec;19(1):327.
• 25. Tiainen K, Hurme M, Hervonen A, et al. Inflammatory markers and physical performance among nonagenarians. J Gerontol A Biol Sci Med Sci. 2010 Jun;65(6):658–63.
• 26. Denny SD, Kuchibhatla MN, Cohen HJ. Impact of anemia on mortality, cognition, and function in community-dwelling elderly. Am J Med. 2006 Apr;119(4):327–34.
• 27. Patel K V, Longo DL, Ershler WB, et al. Haemoglobin concentration and the risk of death in older adults: differences by race/ethnicity in the NHANES III follow-up. Br J Haematol. 2009 May;145(4):514–23.
• 28. Thomas MC, Cooper ME, Tsalamandris C, et al. Anemia with impaired erythropoietin response in diabetic patients. Arch Intern Med. 2005 Feb;165(4):466–9.
• 29. Hidese S, Saito K, Asano S, et al. Association between iron-deficiency anemia and depression: A web-based Japanese investigation. Psychiatry Clin Neurosci. 2018 Jul;72(7):513–21.
• 30. Aung KCY, Feng L, Yap KB, et al. Serum albumin and hemoglobin are associated with physical function in community-living older persons in Singapore. J Nutr Health Aging. 2011 Dec;15(10):877–82.
• 31. Joosten E, Detroyer E, Milisen K. Effect of anaemia on hand grip strength, walking speed, functionality and 1 year mortality in older hospitalized patients. BMC Geriatr. 2016 Aug;16(1):153.
• 32. Lee C-T, Chen MZ, Yip CYC, 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. 2021;25(5):679–87.
• 33. Cesari M, Penninx BWJH, Lauretani F, et al. Hemoglobin levels and skeletal muscle: results from the InCHIANTI study. J Gerontol A Biol Sci Med Sci. 2004 Mar;59(3):249–54.