Association of Mild Anemia with Cognitive, Functional, Mood and Quality of Life Outcomes in the Elderly: The “Health and Anemia” Study

BACKGROUND: In the elderly persons, hemoglobin concentrations slightly below the lower limit of normal are common, but scant evidence is available on their relationship with significant health indicators. The objective of the present study was to cross-sectionally investigate the association of mild grade anemia with cognitive, functional, mood, and quality of life (QoL) variables in community-dwelling elderly persons. METHODS: Among the 4,068 eligible individuals aged 65-84 years, all persons with mild anemia (n = 170) and a randomly selected sample of non-anemic controls (n = 547) were included in the study. Anemia was defined according to World Health Organization (WHO) criteria and mild grade anemia was defined as a hemoglobin concentration between 10.0 and 11.9 g/dL in women and between 10.0 and 12.9 g/dL in men. Cognition and functional status were assessed using measures of selective attention, episodic memory, cognitive flexibility and instrumental and basic activities of daily living. Mood and QoL were evaluated by means of the Geriatric Depression Scale-10, the Short-Form health survey (SF-12), and the Functional Assessment of Cancer Therapy-Anemia. RESULTS: In univariate analyses, mild anemic elderly persons had significantly worse results on almost all cognitive, functional, mood, and QoL measures. In multivariable logistic regressions, after adjustment for a large number of demographic and clinical confounders, mild anemia remained significantly associated with measures of selective attention and disease-specific QoL (all fully adjusted p<.046). When the lower limit of normal hemoglobin concentration according to WHO criteria was raised to define anemia (+0.2 g/dL), differences between mild anemic and non anemic elderly persons tended to increase on almost every variable. CONCLUSIONS: Cross-sectionally, mild grade anemia was independently associated with worse selective attention performance and disease-specific QoL ratings

Association of mild anemia with hospitalization and mortality in the elderly: the Health and Anemia population-based study

Mild anemia is a frequent laboratory finding in the elderly usually disregarded in clinical practice. This study shows that mild anemia is associated with increased risk of hospitalization and all-cause mortality in the elderly. See perspective article on page 1

Characteristics of mild anemic (WHO criteria) and non anemic individuals included in the impact study

*<p>Adjusted for oncological status.</p

Impact of mild grade anemia (WHO criteria) on cognitive, functional, mood, and quality of life variables in elderly individuals (65–84 years)

*<p>Between brackets score ranges with best scores on the right.</p>†<p>Model 1 includes mild anemic and oncological status only; Model 2 includes Model 1 plus age, sex, education, and (except: Geriatric Depression Scale, SF-12 Mental, and FACT scores) Geriatric Depression Scale score; Model 3 includes Model 2 plus hypertension, diabetes, heart failure, myocardial infarction, respiratory failure, neurologic disorders.</p

Impact of mild grade anemia (hemoglobin concentration: women, 10.0–12.1 g/dL; men, 10.0–13.1 g/dL) on cognitive, functional, mood, and quality of life variables in elderly individuals (65–84 years)

*<p>Between brackets score ranges with best scores on the right.</p>†<p>Model 1 includes mild anemic and oncological status only; Model 2 includes Model 1 plus age, sex, education, and (except: Geriatric Depression Scale, SF-12 Mental, and FACT scores) Geriatric Depression Scale score; Model 3 includes Model 2 plus hypertension, diabetes, heart failure, myocardial infarction, respiratory failure, neurologic disorders.</p

Flow chart of the study.

<p>Flow chart of the study.</p