Diminished Quality of Life and Physical Function in Community-Dwelling Elderly With Anemia

Abstract

The occurrence of anemia in older adults has been associated with adverse outcomes including functional decline, disability, morbidity and mortality. It is not clear to what extent these outcomes are the result of the anemia or concurrent illness. We performed a cross-sectional, observational study to determine whether lower hemoglobin concentrations in older adults are associated with reduced health-related quality of life, functional status, depression, disability, and physical strength, independent of chronic disease. Three sites participated in this research; an academic geriatric practice, a hospital based geriatric out patient unit, and a community-based multi-specialty internal medicine group. Health-related quality of life and functional status were measured using the Short Form-36 Health Survey (SF-36) and the Functional Assessment of Chronic Illness Therapy-Anemia (FACIT-An). Disability and depression were assessed using the Instrumental Activities of Daily Living (IADL) and the Geriatric Depression Scale (GDS) questionnaires, respectively. Handgrip strength was used as a physical performance measure. Anemia was defined as hemoglobin < 13 g/ dL for men or < 12 g/dL for women. The mean SF-36 physical health component summary scores were 38.9 (with anemia) and 44.1 (without anemia), (P < 0.001). Anemia was associated with greater fatigue (P < 0.001), lower handgrip strength (P = 0.014), increased number of disabilities (P = 0.005) and more depressive symptoms (P = 0.002). Multivariate regression analysis, adjusted for demographic and clinical characteristics, demonstrated strong associations for reduced hemoglobin, even within the "normal" range, and poorer health-related quality of life across multiple domains. Thus, anemia was independently associated with clinically significant impairments in multiple domains of health-related quality of life, especially in measures of functional limitation. Mildly low hemoglobin levels, even when above the WHO anemia threshold, were associated with significant declines in quality of life among the elderly.

Health-related quality of life and anemia in hospitalized patients with heart failure

“…This is in accord with the literature: HR-QoL declines with any increasing burden of comorbidity in cardiac patients [2,39]. In general, older people with anemia experience a decline in functional status and physical strength as compared to non-anemic elderly [40]. In contrast to the study by Thein and colleagues, in which anemia was associated with depressive symptoms [40], we found no relationship between anemia and the mental aspects of HR-QoL.…”

“…In general, older people with anemia experience a decline in functional status and physical strength as compared to non-anemic elderly [40]. In contrast to the study by Thein and colleagues, in which anemia was associated with depressive symptoms [40], we found no relationship between anemia and the mental aspects of HR-QoL. We also did not find any significant association between anemia and the HR-QoL domain of vitality, which reflects feelings of energy and tiredness [21,22].…”

Prevalência de anemia e correlação da concentração de hemoglobina com fatores cognitivos em idosos

“…Na literatura, a anemia e as baixas concentrações de hemoglobina em idosos residentes na comunidade têm sido associadas ao declínio cognitivo 17,18 , como demência, depressão e comprometimento de memória, maior risco para o desenvolvimento da Doença de Alzheimer 19,20 , pior estado nutricional 4,21 e maior risco de mortalidade [22][23][24] . Os instrumentos comumente utilizados para a avaliação cognitiva em idosos são o Mini Exame do Estado Mental [25][26][27] , a Escala de Depressão Geriátrica [28][29][30] e o Questionário de Medidas de Queixas Subjetivas de Memória 17,31 . Estudo de base populacional realizado, na Itália, com 717 idosos, utilizando para a avaliação do declínio cognitivo, dentre outros instrumentos o Mini Exame do Estado Mental e a Escala de Depressão Geriátrica, verificou associação entre a anemia e o declínio cognitivo 29 .…”

Functional Capacity and Anemia in the Community Elderly

“…A low concentration of hemoglobin levels was associated to a worse quality of life even amongst the elderly who had mild anemia (hemoglobin levels between 10.0 to 12.0 g/dL). The results were the same after controlling, in regression analysis, socio-demographic variables and the presence of chronic diseases [16]. were measured by the researchers, as well as daily life activities and physical performance.…”