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

Abstract

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.

Inflammatory markers in geriatric anemia: A study from North India

“…Due to the chronic and intractable nature of these conditions, anemia is more likely to persist despite therapeutic interventions. [ 11 , 28 , 29 ] Yet, a significant subset of cases of geriatric anemia possess an inflammatory state “without a chronic inflammatory disorder.”…”

“…While the complete cure of the underlying chronic inflammatory state may not be feasible, a targeted approach toward symptomatic and supportive care at the primary level can greatly impact the geriatric health care. [ 11 , 29 ]…”

“…For instance, there is a strong association of raised CRP levels with anemia. [ 11 ] Both geriatric anemia and inflammatory state have similar causes of mortality in geriatrics. Thus, there is a strong relationship between the elevated pro-inflammatory cytokines and the development of geriatric anemia, pointing toward a possibility of potential overlap between the two entities as echoed in a few studies.…”