Anaemia and physical and mental health in the very old: An individual participant data meta-analysis of four longitudinal studies of ageing

Palapar, Leah; Kerse, Ngaire; Rolleston, Anna; Elzen, Wendy P. J. den; Gussekloo, Jacobijn; Blom, Jeanet W.; Robinson, Louise; Martin‐Ruiz, Carmen; Duncan, Rachel; Arai, Yasumichi; Takayama, Midori; Teh, Ruth

doi:10.1093/ageing/afaa178

Cited by 14 publications

(12 citation statements)

References 26 publications

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“…This study showed that a combination of determinants of anaemia is associated with the presence and development of anaemia in the very old. Since anaemia in the very old is common and associated with poor outcomes [ 43 ], health professionals need to be aware that individuals over 85 years of age with a combination of determinants of anaemia present with a high risk of prevalent and incident anaemia. However, further research is needed to explore the underlying pathophysiological mechanisms, either on the specific combinations of determinants, or on the effects within different ethnicities and in younger populations.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…Figure 1 contains the flow chart of study identification. We included 18 publications of IPD-MA of NRSs evaluating continuous outcomes (12,13,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31), more than half (61%) published since 2018. Table 1 lists the characteristics of the studies we included: 10 (56%) used change score; seven (39%) used ANCOVA, and one (5%) used propensity score.…”

Section: Systematic Review Of Ipd-mas Of Nrssmentioning

confidence: 99%

Incorporating Baseline Outcome Data in Individual Participant Data Meta-Analysis of Non-randomized Studies

et al. 2022

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BackgroundIn non-randomized studies (NRSs) where a continuous outcome variable (e.g., depressive symptoms) is assessed at baseline and follow-up, it is common to observe imbalance of the baseline values between the treatment/exposure group and control group. This may bias the study and consequently a meta-analysis (MA) estimate. These estimates may differ across statistical methods used to deal with this issue. Analysis of individual participant data (IPD) allows standardization of methods across studies. We aimed to identify methods used in published IPD-MAs of NRSs for continuous outcomes, and to compare different methods to account for baseline values of outcome variables in IPD-MA of NRSs using two empirical examples from the Thyroid Studies Collaboration (TSC).MethodsFor the first aim we systematically searched in MEDLINE, EMBASE, and Cochrane from inception to February 2021 to identify published IPD-MAs of NRSs that adjusted for baseline outcome measures in the analysis of continuous outcomes. For the second aim, we applied analysis of covariance (ANCOVA), change score, propensity score and the naïve approach (ignores the baseline outcome data) in IPD-MA from NRSs on the association between subclinical hyperthyroidism and depressive symptoms and renal function. We estimated the study and meta-analytic mean difference (MD) and relative standard error (SE). We used both fixed- and random-effects MA.ResultsTen of 18 (56%) of the included studies used the change score method, seven (39%) studies used ANCOVA and one the propensity score (5%). The study estimates were similar across the methods in studies in which groups were balanced at baseline with regard to outcome variables but differed in studies with baseline imbalance. In our empirical examples, ANCOVA and change score showed study results on the same direction, not the propensity score. In our applications, ANCOVA provided more precise estimates, both at study and meta-analytical level, in comparison to other methods. Heterogeneity was higher when change score was used as outcome, moderate for ANCOVA and null with the propensity score.ConclusionANCOVA provided the most precise estimates at both study and meta-analytic level and thus seems preferable in the meta-analysis of IPD from non-randomized studies. For the studies that were well-balanced between groups, change score, and ANCOVA performed similarly.

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“…While typically mild, anemia negatively impacts physical and cognitive function, depression, and self-rated health status. 70 Although there is no conclusive evidence that the treatment of anemia has a positive impact on any of the associated adverse outcomes, 51 novel agents, such as hypoxia-inducible factor stabilizers, hepcidin modulators and activin type II receptor agonists, are being introduced in the clinical setting. 71 With an increased understanding of the etiology of anemia and the availability of innovative anti-anemic drugs, future research will assess the potential benefits of therapeutic interventions for anemia in terms of quality of life and reduced morbidity and mortality, along with further investigation of the causes of unexplained anemia.…”

Section: Future Perspectivesmentioning

confidence: 99%

“…Anemia is common in older persons, and is associated with frailty, [1][2][3] falls, 4 cognitive decline, [5][6][7] depression, 6 worsening functional ability 6 and early mortality. 8 The definition of anemia in adults was proposed by the World Health Organization (WHO) more than 50 years ago among a cohort of people aged >65 years, where anemia was defined as hemoglobin (Hb) level <13.0 g/dL in men and <12.0 g/dL in women.…”

Section: Introductionmentioning

confidence: 99%

Anemia in older adults as a geriatric syndrome: A review

Katsumi

Abe

Tamura

et al. 2021

Geriatrics Gerontology Int

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Anemia, a frequently occurring condition in older patients, has no standard definition; however, in most studies, it is defined as hemoglobin level <12 and <13 g/dL in women and men, respectively. Approximately 10% of older adults living in the community have anemia. The prevalence of anemia is significantly correlated with advanced age and male sex. Anemia is associated with falls, frailty and other negative outcomes, including early mortality. However, there remains little consensus regarding whether anemia treatment favorably affects these adverse outcomes. Therefore, this article reviews the prevalence of anemia, and provides updates on its common causes and treatments in older adults. While excluding wellestablished hematopoietic diseases, the etiology of anemia in older adults has been grouped into four categories: (i) nutritional deficiency; (ii) inflammation; (iii) clonal hematopoiesis; and (iv) "unexplained anemia," when there is no clear mechanism to account for the anemia. Recently, clonal leukocytes were detected in a considerable number of older individuals. The number of somatic mutations in blood leukocytes increases with age; however, single mutations of DNMT3A, TET2 and ASXL1 are not correlated with the presence of unexplained anemia in older adults. With an increased understanding of anemia etiology and the availability of innovative anti-anemic drugs, future studies that evaluate the causes and benefits of treatment are required.

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Anaemia and physical and mental health in the very old: An individual participant data meta-analysis of four longitudinal studies of ageing

Cited by 14 publications

References 26 publications

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

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

Incorporating Baseline Outcome Data in Individual Participant Data Meta-Analysis of Non-randomized Studies

Anemia in older adults as a geriatric syndrome: A review

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