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.

Frailty is a clinical condition related to changes in metabolism, to sarcopenia, and to decline in muscle mass and strength, bone mineral density, and physical function with aging. The pathophysiology of frailty is multifactorial and associated with comorbidities. Testosterone is implicated in regulating metabolic functions, maintenance of muscle and bone, and inhibition of adipogenesis. In older individuals, reduced testosterone is thought to contribute to an altered state of metabolism, loss of muscle and bone, and increased fat, leading to sarcopenia, sarcopenic obesity, and frailty. While no direct relationship between testosterone deficiency (commonly known as hypogonadism) and frailty has been established (due to the multifactorial nature of frailty), clinical evidence suggests that testosterone deficiency is associated with increased sarcopenia and obesity. Testosterone treatment in frail older men with limited mobility and with testosterone deficiency improved insulin resistance, glucose metabolism, and body composition. These changes contribute to better physical function and improved quality of life. Because frailty increases disability, comorbidities, and the risk of hospitalization, institutionalization, and mortality in older men, it is warranted to explore the potential usefulness of testosterone treatment in frail men with hypogonadism in order to attenuate the progression of sarcopenia and frailty. In this paper, we will discuss the impact of testosterone deficiency on frailty and the potential role of testosterone treatment in ameliorating and reducing the progression of frailty. Such an approach may reduce disability and the risk of hospitalization and increase functional independence and quality of life.

PurposeFalls are a common cause of morbidity and mortality in older people, and identification of risk indicators and risk factors to prevent falling is essential. Dry mouth (xerostomia and hyposalivation) can exacerbate conditions known to be fall risk indicators, such as nutritional status and sarcopenia. But there is little evidence regarding whether it is an independent risk factor for falling. We explored xerostomia prevalence and intensity and objective salivation rates in hospitalized geriatric patients to determine whether they were associated with an increased risk of falling.Patients and methodsHospitalized geriatric patients with and without a fall history were compared. We investigated several oral health issues including xerostomia, stimulated and unstimulated salivation rates, total number of teeth and prosthetics, periodontal status, and oral health-related quality of life.ResultsForty patients were included, 28 in the fall history group and 12 in the control group. All patients had oral health issues that impacted on their oral health-related quality of life. However, there were no significant differences between the groups, including xerostomia and hyposalivation, apart from increased dysphagia and less flavor in food in patients with a fall history.ConclusionDry mouth does not appear to be an independent risk factor for falling in this population, but oral health was impaired. Thus, it is important that dentists and geriatricians are aware of and investigate these conditions in their patients and that appropriate action is taken to reduce the consequences of impaired oral health, including a potential reduction in falls.

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The basis of nutritional therapy and thus an adequate nutrient intake is the assessment of energy need. On the other end, the assessment of individual energy requirements based on the gold standard, indirect calorimetry, is associated with feasibility difficulties in geriatric settings. To identify the most accurate predictive equations for resting energy expenditure (REE) in older subjects with overweight, 17 predictive equations were compared to indirect calorimetry measurement in a study population of 20 obese older subjects (mean BMI 33.7±4.5kg/m(2); mean age 79.8±8.1 years; gender 5 males and 15 females) and 20 age-matched controls with a normal body weight (mean BMI 24.9±2.5 kg/m(2); mean age 82.1±6.6 years; gender 9 males and 11 females). The comparison led to two significant observations: the predictive equations used led to a much better estimation of the REE in the control group than in the obese older subjects. In addition, the most accurate equation for estimating the REE in the obese older subjects has been shown to be that by Lührmann et al. Further studies are needed to assess the feasibility of using this equation in a routine geriatric setting.

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Background Data on peripheral blood cell values in older subjects are rare. While hemoglobin (Hb) values are supposed to change with rising age, little is known about reference values for other erythrocytic blood cell counts. This cross-sectional study was initiated to analyze hematologic laboratory parameters among subjects aged ≥60 years. Methods This was a retrospective cross-sectional study of outpatient laboratory data between January 1st and December 31st, 2015 originating from a German countrywide laboratory group; inclusion criteria: age ≥60 years, normal C-reactive protein (CRP), transferrin saturation, reticulocytes, lactate dehydrogenase, haptoglobin and soluble transferrin receptor; exclusion criteria: glomerular filtration rate (GFR)<60 mL/min, lack of inclusion criteria; primary objective: assessment of the mean Hb value; secondary objective: assessment of mean values of red blood cell (RBC) counts. Results Of 30,611 subjects ≥60 years, 4641 met the inclusion criteria and were thus considered hematologically healthy; the following age groups were formed: 60–69 years (2094), 70–79 years (2171), 80–89 years (360), >90 years (16); median values for male/female subjects were: Hb 15.2/14.0 g/dL, RBC 5.0/4.6/μL, mean cellular volume (MCV) 89/89/fl, mean corpuscular hemoglobin (MCH) 31/30 pg/RBC, mean corpuscular hemoglobin concentration (MCHC) 34/34 g/dL, hematocrit (hct) 44/41%. Statistical evaluation revealed a slight but significant decrease in values over age decades for all parameters except for MCH. However, all values remained within the recommended German Society of Hematology and Oncology (DGHO) reference ranges. Hb values remained above the recommended World Health Organization (WHO) cut-offs for definition of anemia. Conclusions The results confirm the WHO reference values and are in accordance with the recommended DGHO reference values and previous results of other study cohorts outside Germany. There seems to be no need for establishing age-specific RBC or erythrocytic reference ranges for subjects >60 years.