Anemia in old age

The aim of this thesis was to study the impact and etiology of anemia in the oldest old in the general population, in order to support the development of evidence-based diagnostic and treatment recommendations for anemia in the oldest old. All studies presented in this thesis were embedded in the Leiden 85-plus Study and the Newcastle 85-plus Study. First, the impact of anemia was investigated. Anemia in old age appeared to be associated with an increased risk of death, independent of comorbidity, but the associated functional decline appeared to be attributed mainly to comorbidity. In various chapters, the etiology of anemia in old age was studied. An important finding was that, while folate deficiency at age 85 years was associated with the development of anemia during follow-up, vitamin B12 deficiency was not. In addition, low ferritin was associated with lower hemoglobin levels, but this association was more pronounced in participants with inflammation than in participants without inflammation. In the general discussion, a description of the possible clinical implications of this thesis and recommendations for further studies are provided.Financial support by the Nederlandse Vereniging voor Gerontologie (Dutch Society for Gerontology) for the publication of this thesis is gratefully acknowledgedUBL - phd migration 201

Should subclinical hypothyroidism in older persons be treated?

Subclinical hypothyroidism is a common finding in older persons. Clinical guidelines are inconsistent in providing recommendations for the treatment of subclinical hypothyroidism, especially in older persons. To date, there is no high-quality evidence from randomized controlled trials about the effects of treatment of subclinical hypothyroidism in older persons. Any definitive recommendations on treatment should be based on data from large randomized placebo-controlled trials.Geriatrics in primary car

Successfully meeting analytical expectations for the fast 0/1-h algorithm for NSTEMI by internal control procedures for cardiac troponin T

Cardiolog

A Postal Screener for Pain and Need for Treatment in Older Persons in Primary Care

Geriatrics in primary car

Comparison of quadriceps strength and handgrip strength in their association with health outcomes in older adults in primary care

Geriatrics in primary car

Clinically diagnosed infections predict disability in activities of daily living among the oldest-old in the general population: the Leiden 85-plus Study

BACKGROUND: ageing is frequently accompanied by a higher incidence of infections and an increase in disability in activities of daily living (ADL). OBJECTIVE: this study examines whether clinical infections [urinary tract infections (UTI) and lower respiratory tract infections (LRTI)] predict an increase in ADL disability, stratified for the presence of ADL disability at baseline (age 86 years). DESIGN: the Leiden 85-plus Study. A population-based prospective follow-up study. SETTING: general population.Participants: a total of 154 men and 319 women aged 86 years. METHODS: information on clinical infections was obtained from the medical records. ADL disability was determined at baseline and annually thereafter during 4 years of follow-up, using the 9 ADL items of the Groningen Activity Restriction Scale. RESULTS: in 86-year-old participants with ADL disability, there were no differences in ADL increase between participants with and without an infection (-0.32 points extra per year; P = 0.230). However, participants without ADL disability at age 86 years (n = 194; 41%) had an accelerated increase in ADL disability of 1.07 point extra per year (P < 0.001). For UTIs, this was 1.25 points per year (P < 0.001) and for LRTIs 0.70 points per year (P = 0.041). In this group, an infection between age 85 and 86 years was associated with a higher risk to develop ADL disability from age 86 onwards [HR: 1.63 (95% CI: 1.04-2.55)]. CONCLUSIONS: among the oldest-old in the general population, clinically diagnosed infections are predictive for the development of ADL disability in persons without ADL disability. No such association was found for persons with ADL disability.Geriatrics in primary car

PREDICTIVE VALUE OF LOW FERRITIN IN OLDER PERSONS WITH ANEMIA WITH AND WITHOUT INFLAMMATION: THE LEIDEN 85-PLUS STUDY

Pathophysiology, epidemiology and therapy of agein

No increased mortality risk in older persons with unexplained anaemia

Background: in older persons, anaemia is associated with a number of unfavourable outcomes. In approximately 30% of older persons with anaemia, the cause of the anaemia is unexplained. We assessed the clinical differences between subjects with explained and unexplained anaemia and investigated whether these subjects have different mortality patterns compared with subjects without anaemia.Design: observational prospective follow-up study.Setting: the Leiden 85-plus study.Participants: four hundred and ninety-one persons aged 86 years.Methods: the study population was divided in three groups: (i) no anaemia (reference group, n = 377), (ii) explained anaemia (iron deficiency, folate deficiency, vitamin B12 deficiency, signs of myelodysplastic syndrome or renal failure, n = 74) and (iii) unexplained anaemia, (n = 40). Mortality risks were estimated with Cox-proportional hazard models.Results: haemoglobin levels were significantly lower in subjects with explained anaemia than in subjects with unexplained anaemia (P < 0.01). An increased risk for mortality was observed in subjects with explained anaemia [HR: 1.93 (95% CI: 1.47-2.52), P < 0.001], but not in subjects with unexplained anaemia [HR: 1.19 (95% CI: 0.85-1.69), P = 0.31]. Adjusted analyses (sex, co-morbidity, MMSE, institutionalised and smoking) did not change the observed associations for both explained and unexplained anaemic subjects.Conclusion: older subjects with unexplained anaemia had similar survival compared with non-anaemic subjects. Increased mortality risks were observed in subjects with explained anaemia compared with non-anaemic subjects.Public Health and primary careGeriatrics in primary car

Study protocol: a randomised controlled trial on the clinical effects of levothyroxine treatment for subclinical hypothyroidism in people aged 80 years and over

Background: Subclinical hypothyroidism is common in older people and its contribution to health and disease needs to be elucidated further. Observational and clinical trial data on the clinical effects of subclinical hypothyroidism in persons aged 80 years and over is inconclusive, with some studies suggesting harm and some suggesting benefits, translating into equipoise whether levothyroxine therapy provides clinical benefits. This manuscript describes the study protocol for the Institute for Evidence-Based Medicine in Old Age (IEMO) 80-plus thyroid trial to generate the necessary evidence base. Methods: The IEMO 80-plus thyroid trial was explicitly designed as an ancillary experiment to the Thyroid hormone Replacement for Untreated older adults with Subclinical hypothyroidism randomised placebo controlled Trial (TRUST) with a near identical protocol and shared research infrastructure. Outcomes will be presented separately for the IEMO and TRUST 80-plus groups, as well as a pre-planned combined analysis of the 145 participants included in the IEMO trial and the 146 participants from the TRUST thyroid trial aged 80 years and over. The IEMO 80-plus thyroid trial is a multi-centre randomised double-blind placebo-controlled parallel group trial of levothyroxine treatment in community-dwelling participants aged 80 years and over with persistent subclinical hypothyroidism (TSH ≥4.6 and ≤ 19.9 mU/L and fT4 within laboratory reference ranges). Participants are randomised to levothyroxine 25 or 50 micrograms daily or matching placebo with dose titrations according to TSH levels, for a minimum follow-up of one and a maximum of three years. Primary study endpoints: hypothyroid physical symptoms and tiredness on the thyroid-related quality of life patient-reported outcome (ThyPRO) at one year. Secondary endpoints: generic quality of life, executive cognitive function, handgrip strength, functional ability, blood pressure, weight, body mass index, and mortality. Adverse events will be recorded with specific interest on cardiovascular endpoints such as atrial fibrillation and heart failure. Discussion: The combined analysis of participants in the IEMO 80-plus thyroid trial with the participants aged over 80 in the TRUST trial will provide the largest experimental evidence base on multimodal effects of levothyroxine treatment in 80-plus persons to date

The effects of single and a combination of determinants of anaemia in the very old: results from the TULIPS consortium

Background and objectives Nutritional deficiencies, renal impairment and chronic inflammation are commonly mentioned determinants of anaemia. The aim of this study was to investigate the effects of these determinants, singly and in combination, on anaemia in the very old. Method The TULIPS Consortium consists of four population-based studies in oldest-old individuals: Leiden 85-plus Study, LiLACS NZ, Newcastle 85+ study, and TOOTH. Five selected determinants (iron, vitamin B12, and folate deficiency; low estimated glomerular filtration rate (eGFR); and high C-reactive protein (CRP)) were summed. This sum score was used to investigate the association with the presence and onset of anaemia (WHO definition). The individual study results were pooled using random-effects models. Results In the 2216 participants (59% female, 30% anaemia) at baseline, iron deficiency, low eGFR and high CRP were individually associated with the presence of anaemia. Low eGFR and high CRP were individually associated with the onset of anaemia. In the cross-sectional analyses, an increase per additional determinant (adjusted OR 2.10 (95% CI 1.85-2.38)) and a combination of >= 2 determinants (OR 3.44 (95% CI 2.70-4.38)) were associated with the presence of anaemia. In the prospective analyses, an increase per additional determinant (adjusted HR 1.46 (95% CI 1.24-1.71)) and the presence of >= 2 determinants (HR 1.95 (95% CI 1.40-2.71)) were associated with the onset of anaemia. Conclusion Very old adults with a combination of determinants of anaemia have a higher risk of having, and of developing, anaemia. Further research is recommended to explore causality and clinical relevance.Prevention, Population and Disease management (PrePoD)Public Health and primary car