Anemia in the elderly population has been associated to clinical manifestations such as functional dependence, low cognitive performance, increased mortality and geriatric syndromes (dementia, delirium, depression and falls). Recent investigations have shown an association between low hemoglobin levels, reduction in muscular strength and physical fitness. The objective of this review was to identify, in the scientific literature, evidence of an association between anemia and functional capacity among older persons. PubMed and Bireme were used as references source. The most relevant evidence pointing towards this association was identified in the epidemiological studies Women's Health and Aging Studies I and II (WHAS I and II). Functional capacity was evaluated by the walking, balance and sitting back and getting out of the chair tests. Elderly women with either 13 or 14 g/dl have a better performance compared to women with 12 g/dl of hemoglobin, respectively. This study also reported an increase in the mortality risk among women (65 years old and plus) living in community with less than 13.4 g/dl of hemoglobin. Participants were followed for 11 years. WHAS I and II investigators suggested a new criterion, already adopted by the World Health Organization (WHO), to define anemia among elderly women. Conclusion: anemia is common among the elderly and may have an involvement in the impairment of their functional capacity. However, in spite of the importance of these findings, it should be emphasized that an etiologic association (anemia as a cause of functional impairment) has yet to be demonstrated.
The purpose of this review is to evaluate the role of chronic anemia on neuropsychiatric symptoms and conditions among the elderly. Anemia is defined as hemoglobin levels below 120 and 130 g/L for women and men, respectively. Anemia is not a consequence of the aging process. It is common in the elderly and easily overlooked. Nevertheless, chronic anemia is a risk factor associated with increased mortality, several geriatric syndromes including functional and cognitive impairments. Investigations have shown that anemic elderly and those with hemoglobin borderline levels may present higher proportion of neuropsychiatric impairment, such as Executive Function Disorder and Alzheimer disease. The association between anemia and depression is well established, but its causal pathway is not known: anemia can be regarded as cause or consequence of depression. There is evidence that dementia due to anemia can be prevented; renal chronic anemic patients who received erythropoietin (EPO) replacement therapy showed a lower risk for dementia, compared to those who did not receive it. Anemia may be associated with chronic psychiatric diseases such as bipolar disorders and cause their symptoms to become more severe.
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