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

Abstract

BackgroundIn 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.MethodsAmong 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.ResultsIn 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.ConclusionsCross-sectionally, mild grade anemia was independently associated with worse selective attention performance and disease-specific QoL ratings.

Association between Mean Corpuscular Hemoglobin Concentration and Future Depressive Symptoms in Women

“…In stroke patients, hemoglobin levels were associated with depressive symptoms at both 12 months and 18 months following stroke, but hemoglobin levels were not associated with depressive symptoms 6 months later (Ormstad et al 2012). In a study with an elderly population in Italy, mild anemia had a higher odds ratio of depression symptoms than those who did not have anemia (Lucca et al 2008). However, the association failed to show statistical significance after adjustment for chronic disease status.…”

“…Prior studies about hemoglobin and depression have been conducted; However, the study populations involved mostly the elderly (Onder et al 2005;Lucca et al 2008;Hamer and Molloy 2009;Umegaki et al 2011;Chen et al 2012;Pan et al 2012;Stewart and Hirani 2012) or patients with specific diseases such as acute coronary syndrome (Steptoe et al 2012), beta-thalassemia (Keskek et al 2013), postpartum (Corwin et al 2003), stroke (Ormstad et al 2012), and depression (Maes et al 1996). Because previous studies were limited to specific populations, epidemiologic evidence for such a link in the general or a younger population is still inadequate.…”

“…Because previous studies were limited to specific populations, epidemiologic evidence for such a link in the general or a younger population is still inadequate. Most of these studies used a cross-sectional study design (Maes et al 1996;Corwin et al 2003;Onder et al 2005;Lucca et al 2008;Umegaki et al 2011;Chen et al 2012;Pan et al 2012;Stewart and Hirani 2012;Keskek et al 2013). There were only three prospective studies with follow-up length of 3 weeks (Steptoe et al 2012), 12 to 18 months (Ormstad et al 2012), and 2 years (Hamer and Molloy 2009).…”

Effect of anemia and comorbidity on functional status and mortality in old age: results from the Leiden 85-plus Study

“…As a result, as in other observational studies, we do not know which model -the crude model or the fully adjusted model -was the best reflection of the true effect of anemia on functional decline. This may well explain the inconsistent results in other population-based studies of anemia and disability, [23][24][25][26][27] anemia and cognitive impairment or dementia, 3,23,28,29 and anemia and depression 23,24,30 in elderly individuals. These studies all used different levels of control for the confounding effects of comorbidity.…”

DDS, 4,4′-diaminodiphenylsulfone, extends organismic lifespan

“…Anemia occurs commonly with aging and is a frequent medical problem. In elderly persons, hemoglobin concentrations tend to be slightly low under the lower limit of normal range (29). Because the main side effect of DDS is anemia (30), we monitored hemoglobin levels of each group.…”