Hemoglobin concentration is associated with self-reported disability and reduced physical performance in a community dwelling population of nonagenarians: the Mugello Study

Nomogram model for predicting frailty of patients with hematologic malignancies - A cross-sectional survey

Objective

This study aimed to develop and validate an assessment tool for predicting and mitigating the risk of frailty in patients diagnosed with hematologic malignancies.

Methods

A total of 342 patients with hematologic malignancies participated in this study, providing data on various demographics, disease-related information, daily activities, nutritional status, psychological well-being, frailty assessments, and laboratory indicators. The participants were randomly divided into training and validation groups at a 7:3 ratio. We employed Lasso regression analysis and cross-validation techniques to identify predictive factors. Subsequently, a nomogram prediction model was developed using multivariable logistic regression analysis. Discrimination ability, accuracy, and clinical utility were assessed through receiver operating characteristic (ROC) curves, C-index, calibration curves, and decision curve analysis (DCA).

Results

Seven predictors, namely disease duration of 6-12 months, disease duration exceeding 12 months, Charlson Comorbidity Index (CCI), prealbumin levels, hemoglobin levels, Generalized Anxiety Disorder-7 (GAD-7) scores, and Patient Health Questionnaire-9 (PHQ-9) scores, were identified as influential factors for frailty through Lasso regression analysis. The area under the ROC curve was 0.893 for the training set and 0.891 for the validation set. The Hosmer-Lemeshow goodness-of-fit test confirmed a good model fit. The C-index values for the training and validation sets were 0.889 and 0.811, respectively. The DCA curve illustrated a higher net benefit when using the nomogram prediction model within patients threshold probabilities ranging from 10% to 98%.

Conclusions

This study has successfully developed and validated an effective nomogram model for predicting frailty in patients diagnosed with hematologic malignancies. The model incorporates disease duration (6-12 months and>12 months), CCI, prealbumin and hemoglobin levels, GAD-7, and PHQ-9 scores as predictive variables.

Serum Erythropoietin level in anemia of elderly with unclear etiology

Anemia is a common condition, but its causes are often unclear, especially in elderly adults. Erythropoietin (EPO) levels are known to be elevated in myelodysplastic syndrome and hematologic malignancies, but decreased in chronic benign anemia. This study aimed to investigate whether EPO levels could be used to identify underlying bone marrow diseases including malignancies, among elderly anemic patients with unclear etiology. This single centered retrospective study included patients presented with isolated anemia and had their EPO levels measured at their first visit. Patients were divided into two groups: bone marrow disease and benign etiologic anemia, based on observation and bone marrow test results. Out of 1180 patients reviewed, 81 patients with anemia of unclear etiology were identified, including 67 with benign anemia and 14 with bone marrow disease. Statistically significant difference in EPO levels between these two groups (P < 0.001) were observed. The receiver operating characteristic curve analysis showed that an EPO cut-off value of 36.4 mU/mL had a sensitivity and specificity of 92.8% and 94.0% for detecting underlying bone marrow disease, respectively. We suggest measuring serum EPO levels can aid in the early detection of benign anemia from bone marrow disease, including malignancies, with high sensitivity and specificity.

Empowering frail older adults: multicomponent elastic-band exercises and BCAA supplementation unleash physical health and preserve haematological biomarkers

The effectiveness of Branched Chain Amino Acids (BCAAs) supplementation on enhancing exercise performance in both young and older adults remains a topic of debate. Recent research suggests that BCAAs combined with regular exercise might have an impact on human erythropoiesis, blood dynamics, and iron homeostasis. Given the increasing longevity of the global population, it is crucial to investigate the potential benefits of BCAA supplementation and regular exercise as non-pharmacological interventions for improving the overall health of frail older adults. To assess the influence of a 40-week multicomponent exercise intervention (MEP) combined BCCA supplementation on the haematological indicators of frail older adults (83-93 years old) residing in nursing homes. A prospective, naturalistic, controlled clinical trial employing an intervention-washout-intervention was conducted for this purpose. The study included four experimental groups: MEP plus BCAA supplementation (MEP + BCAA, n = 8), MEP only (n = 7), BCAA supplementation only (n = 7), and control group non exercising (CG, n = 13). Fried's physical frailty (PF) protocol was employed to stratify the participants. Additionally, the assessment included the evaluation of nutritional status, comorbidities, and anthropometric measurements. Among the several haematological markers examined, only mean cellular Haemoglobin Concentration (MCH) [F = 4.09; p < 0.03] and Mean Cell haemoglobin Concentration (MCHC) [F = 10, 323; p < 0,0001] showed significant effects of time group. Our findings demonstrate that a long-term intervention with BCAA plus MEP did not lead to significant alterations in the haematological profile. An 8-week withdrawal from interventions did not affect the frailty status in the MEP and MEP + BCAA groups, whereas the control group exhibited an increase in PF status. The findings, demonstrating the potential pro-immune effect and maintenance of MCH and MCHC levels, highlight the relevance of incorporating exercise and nutritional strategies to promote healthy aging. This study contributes to the achievement of the United Nations Sustainable Development Goals 3 (good health and well-being) and 10 (reduced Inequalities) for all.

Effects of Capacitive-Resistive Electric Transfer on Sports Performance in Paralympic Swimmers: A Stopped Randomized Clinical Trial

Throughout history a variety of therapeutic tools have been studied as possible enhancers of sports activities. This study proposes the use of Capacitive-Resistive Electric Transfer (CRET) as a performance booster to paralympic athletes, specifically those belonging to the Spanish Paralympic swimming committee. The study was a randomized, single-blind, and observer-blind, crossover clinical trial. Six athletes were randomly assigned to three groups: one treated with CRET (A); a placebo group (B) and a control group (C). The CRET group attended a twenty-minute session before being subjected to pool trials at distances of 50 and 100 m at maximum performance. Measurements were in two dimensions: time in seconds and the Borg scale for perceived exertion. Comparisons between groups were made with respect to distance and the main variables. In the case of perceived exertion, no significant changes were observed in any of the distances; however, in the case of the time variable, a significant difference was observed between Group A vs. Personal Record at 100 m distance (76.3 ± 6.8 vs. 68.4 ± 3.3). The proposed protocol and level of hyperthermia applied suggest refusal of CRET use for the 100-m distance a few minutes before sports practice. Our analysis suggests the need to modify the presented protocol. ClinicalTrials.gov identifier under NCT number: NCT04336007.

Relationship between Selected Functional Performance Parameters and the Occurrence of Anaemia in Hospitalized Females and Males Aged 80 and More

Anaemia is considered a factor that significantly increases the risk of disability and mortality in the elderly. Among the hospitalized elderly, the incidence of anaemia is higher than in the general population, which necessitates extensive diagnostics for anaemia in this group. The aim was to assess the relationship between the occurrence of anaemia in hospitalized females and males, aged 80 years and more, and selected determinants of motor fitness. The analysis covered 91 females and 57 males aged 80 and more. The study implemented haemoglobin level, handgrip strength, a lower limb strength, mobility and balance measurement. The analysis used the logistic regression model and the cut-off point was determined by ROC curve. A 1 kg increase in muscle strength reduced the risk of anaemia in a group of males by 12%. The value of handgrip strength from which anaemia can be predicted in a group of males is 24.4 kg. In the female group, no statistically significant correlations were found. There is a need to continue research in this area with the participation of a larger group of respondents to look for potential factors that may be related to anaemia, in order to find non-invasive diagnostic tools useful for elderly people.

Red cell distribution width, anemia, and lower-extremity physical function among rural-dwelling older adults

BACKGROUND

Elevated red cell distribution width (RDW) has been associated with degenerative conditions in aging.

AIMS

We aimed to evaluate the associations of RDW and anemia with lower-extremity physical function among rural-dwelling older adults.

METHODS

This population-based cross-sectional study included 5093 rural residents (age ≥ 60 years, 57.3% women) who participated in the MIND-China Study in Shandong. Data were collected via face-to-face interviews, clinical examinations, and laboratory tests. RDW was categorized according to quartiles and the lower-extremity physical function was assessed using the Short Physical Performance Battery (SPPB), RESULTS: Multiple linear regression analyses suggested that the fourth quartile of RDW (vs. first quartile) was associated with lower SPPB summary score (β-coefficient - 0.38; 95% CI - 0.58 to - 0.18) and lower scores in balance test (- 0.09; - 0.17 to - 0.01), chair stand test (- 0.17; - 0.27 to - 0.07), and walking speed test (- 0.12; - 0.19 to - 0.05). Anemia was associated with a multiple-adjusted β-coefficient of - 0.34 (- 0.52 to - 0.16) for SPPB summary score. Stratified analysis by anemia showed that there was a linear association between RDW and SPPB in individuals without anemia but a J-shaped association in individuals with anemia.

DISCUSSION

This large-scale population-based study revealed the associations of high RDW and anemia with poor lower-extremity physical function among rural-dwelling Chinese older adults. These findings suggest that an elevated RDW might be a biochemical marker for poor lower-extremity physical function among older adults.

CONCLUSIONS

Anemia and an elevated RDW are associated with poor performance in lower-extremity physical function among rural-dwelling Chinese older adults.

The clinical implications and importance of anemia in older women

OBJECTIVES

The objective of this study was to investigate associations between anemia with geriatric syndromes and comprehensive geriatric assessment (CGA) parameters in older women.

METHODS

886 older outpatient women were included. Anemia was defined as a hemoglobin concentration below 12 g/dL. patients were divided into two groups as anemic and non-anemic. The relationships between anemia and CGA parameters/geriatric syndromes were determined.

RESULTS

The mean age of the participants was 76.00 ± 8.91. The prevalence of patients with anemia was 15.35%. There was a significant difference between anemic and non-anemic groups in terms of age, Charlson Comorbidity Index, body mass index, the number of drugs used, and the presence of chronic renal failure (p < 0.05). After adjustment for these covariates, anemia was associated with Timed Up and Go test (OR: 1.10, 95% CI: 1.02-1.18), muscle strength (OR: 0.99, 95% CI: 0.83-0.99), dynapenia (OR: 1.92, 95% CI: 1.06-3.47), Mini Nutritional Assessment scores (OR: 0.88, 95% CI: 0.83-0.94), poor nutritional status (OR: 1.97, 95% CI: 1.10-3.48), Fried scores (OR: 1.42, 95% CI: 1.24-1.68), frailty (OR: 2.58, 95% CI: 1.42-4.69), falls (OR: 1.78, 95% CI: 1.10-2.92) and polypharmacy (OR: 2.31, 95% CI: 1.38-3.86).

CONCLUSION

In the present study anemia was associated with frailty, polypharmacy, poor nutritional status, falls, and decreased muscle strength. Therefore, anemia may be a sign of poor health status in older women. When anemia is detected in an older woman, CGA should be strongly considered if not routinely performed.

Total Hemoglobin Trajectories from Pregnancy to Postpartum in Rural Northeast Brazil: Differences between Adolescent and Adult Women

This study examines total hemoglobin (THB) trajectories during pregnancy and postpartum and associated factors among adolescents and adults from a low-income community. This is an observational, longitudinal study, part of the Adolescence and Motherhood Research (AMOR) project, performed between 2017 and 2019 in the Trairi region of Rio Grande do Norte state, Brazil. The THB levels of 100 primigravida adolescents and adults were monitored up to 16 weeks of gestation, in the third trimester, and 4–6 weeks postpartum, along with socioeconomic characteristics, anthropometrics, and health-related variables. Mixed-effect linear models evaluated the trajectories of THB and the associated factors. THB levels decreased between first and second assessments and increased between the second and postpartum assessments. For the adolescent cohort, the rebound in THB concentration between the third trimester and postpartum was not enough to make up for the initial losses, as occurred in the adult cohort. For the adult group, higher THB levels were associated with pregnancy planning and good self-rated health. Race was marginally associated to THB levels, with black/brown women presenting higher concentrations in the adolescent and lower concentration in the adult group. Special attention to prenatal care among pregnant adolescents should consider their higher risk of anemia and its negative effects.

Biomarkers shared by frailty and sarcopenia in older adults: A systematic review and meta-analysis

BACKGROUND

Physical frailty and sarcopenia show extensive clinical similarities. Whether biomarkers exist that are shared by the two conditions is presently unclear.

METHODS

We conducted a systematic review and meta-analysis of cross-sectional and longitudinal studies that investigated the association of frailty and/or sarcopenia with biomarkers as a primary or secondary outcome in adults aged 60 years and older. Only studies published in English that defined frailty using a validated scale and/or questionnaire and diagnosed sarcopenia according to the presence of muscle atrophy plus dynapenia or low physical function were included. Studies were identified from a systematic search of MEDLINE and SCOPUS databases from inception through August 2020. The quality of reporting of each study was assessed by using the Quality Assessment Tool for Observational Cohort, Cross-Sectional and Case-Control studies of the National Institute of Health. A meta-analysis was conducted when at least three studies investigated the same biomarker in both frailty and sarcopenia. Pooled effect size was calculated based on standard mean differences and random-effect models. Sensitivity analysis was performed based on age and the setting where the study was conducted.

RESULTS

Eighty studies (58 on frailty and 22 on sarcopenia) met the inclusion criteria and were included in the qualitative analysis. Studies on frailty included 33,160 community-dwellers, hospitalized, or institutionalized older adults (60-88 years) from 21 countries. Studies on sarcopenia involved 4904 community-living and institutionalized older adults (68-87.6 years) from 9 countries. Several metabolic, inflammatory, and hematologic markers were found to be shared between the two conditions. Albumin and hemoglobin were negatively associated with both frailty and sarcopenia. Interleukin 6 was associated with frailty and sarcopenia only in people aged < 75. Community-dwelling older adults with frailty and sarcopenia had higher levels of tumor necrosis factor alpha compared with their robust and non-sarcopenic counterparts.

CONCLUSIONS

A set of metabolic, hematologic, and inflammatory biomarkers was found to be shared by frailty and sarcopenia. These findings fill a knowledge gap in the quest of biomarkers for these conditions and provide a rationale for biomarker selection in studies on frailty and sarcopenia.

The Association with Dietary Patterns and Risk of Anemia in Japanese Elderly

Anemia is a risk factor for frailty. Although various factors can reduce the risk of anemia, information on dietary contributions is limited. This study aimed to evaluate the association between anemia and eating patterns in Japanese elderly. Our study included 6,864 elderly individuals, aged ≥65 y, whose data were obtained from the 2010-2015 National Health and Nutritional Survey, Japan. Anemia was defined as whole blood hemoglobin concentrations <13 g/dL in men, and <12 g/dL in women. We classified eating patterns into 33 food groups, using food items obtained from dietary records, and identified three dietary patterns using principal component analysis method. Participants were assigned and divided into quartiles according to pattern-specific factor scores. We calculated adjusted odds ratios (ORs) for anemia using multivariate logistic regression, and assigned the first quartile (minimum) as the reference. The overall prevalence of anemia was 17.1%. The meats and vegetables eating pattern was characterized by red meat and other vegetables, the Japanese eating pattern by rice and salted or pickled vegetables, and the fruits and vegetables eating pattern by fruits and green-yellow vegetables. Participants in the highest meats and vegetables eating pattern quartile had a 20% lower risk of anemia than those in the lowest quartile (OR 0.81; 95% confidence interval (CI) 0.66-1.00); the Japanese eating pattern participants had a 20% higher risk of anemia (OR 1.28; 95% CI 1.06-1.53). The fruits and vegetables eating pattern participants had no significant change in their risk of anemia. This study may indicate that consuming a high red meat diet prevents anemia in elderly Japanese individuals.

Hemoglobin Improvement is Positively Associated with Functional Outcomes in Stroke Patients with Anemia

OBJECTIVES

The aim of this study was to evaluate the associations between hemoglobin improvement and functional outcomes in anemic patients after stroke.

METHODS

This retrospective cohort study included consecutive hospitalized post-stroke patients with anemia. Data on serum hemoglobin level were extracted from medical records. The "change in hemoglobin levels" was defined as the pre-discharge hemoglobin level minus the baseline hemoglobin level. Study outcomes included the Functional Independence Measure-motor (FIM-motor) efficacy, and length of stay. Multivariate analyses were used to determine whether the change in hemoglobin levels was independently associated with study outcomes, after adjusting for potential confounders.

RESULTS

Of the 637 patients admitted, 194 stroke patients (mean age 75.4 years; 53.6% women) presented anemia at baseline and were included in the analysis. The mean (SD) baseline hemoglobin level was 11.2 (0.9) g/dL and the median (IQR) change was 0.4 (0.1-1.1) g/dL. In multivariate analyses, the change in hemoglobin levels was positively associated with the FIM-motor efficacy (β = 0.114, p = 0.031), and negatively associated with length of stay (β = -0.059, p = 0.039). Moreover, the baseline hemoglobin level was independently associated with the FIM-motor efficacy (β = 0.267, p = 0.001).

CONCLUSIONS

A lower baseline hemoglobin level is negatively associated with functional recovery, and hemoglobin improvement is positively associated with functional recovery and shorter hospital stay in stroke patients with anemia. Anemia should be assessed at baseline as a prognostic indicator and, if treatable, treated appropriately to maximize outcomes in these patients.

Low Hemoglobin Levels are Associated with Sarcopenia, Dysphagia, and Adverse Rehabilitation Outcomes After Stroke

OBJECTIVE

The aim of our study was to evaluate the associations between baseline hemoglobin (Hb) levels and sarcopenia and outcomes in patients undergoing rehabilitation after stroke.

METHODS

This retrospective cohort study included consecutive hospitalized post-stroke patients. Data on serum Hb level were extracted from medical records on tests performed within 24 h of admission. Primary outcome was the presence of sarcopenia at admission, diagnosed based on both low skeletal muscle mass and strength criteria per recently updated Asian Working Group for Sarcopenia 2019 guidelines. Other outcomes included the Functional Independence Measure-motor (FIM-motor) score at discharge and its change from baseline, and the Food Intake Level Scale (FILS) score (measure of dysphagia, FILS score < 7) at discharge. Multivariate analyses were used to determine the association between Hb levels at admission and outcomes of interest, adjusted for potential confounders.

RESULTS

Data from 598 patients (mean age 72.1 years; 52.7% men) were included in the analysis. The mean Hb level at admission was 13.2 g/dL, and 86 (27.3%) men and 102 (36.0%) women had low Hb levels, i.e., 13.0 g/dL and 12.0 g/dL, respectively. In multivariate analyses, the baseline Hb level was independently associated with sarcopenia (odds ratio [OR]: 0.794, 95% confidence interval [CI]: 0.677-0.930, p = 0.004), FIM-motor score (β = 0.096, p = 0.045) at discharge and its change from baseline (β = 0.191, p = 0.018), and dysphagia (OR: 0.762, 95% CI: 0.595-0.961, p = 0.041) at discharge.

CONCLUSION

Baseline low Hb levels were associated with sarcopenia, poorer recovery of physical function, and dysphagia in patients undergoing rehabilitation after stroke.

Hemoglobin concentration; a pathway to frailty

BACKGROUND

Frailty and hemoglobin concentration, above what would be considered clinical anemia, are two common findings in older patients that lead to an increased risk of negative health outcomes. The objective of this study is to evaluate whether hemoglobin concentration is an independent predictor of frailty and investigate possible causal pathways with a focus on the relationship between inflammation or nutrition and hemoglobin concentration.

METHODS

1829 community-dwelling participants aged 65 years or older who visited the Toulouse frailty day hospital during 2011 and 2016 were included in this analysis. Patients underwent a comprehensive geriatric assessment and had a blood sample taken. A series of multivariate logistic regression models were performed after minimizing potential influence from age, gender, kidney function, inflammation, cognition, nutritional status and certain socio-economic factors.

RESULTS

Hemoglobin concentration and frailty are significantly associated after minimizing potential influence from other covariates (p < 0.005). An increase in one point of hemoglobin concentration is associated with a 14% risk reduction of being frail (OR = 0.86, 95%IC = 0.79-0.94). There was no evidence of a significant causal relationship between inflammation and nutritional status in the relationship between hemoglobin concentration and frailty status (p > 0.005).

CONCLUSIONS

Hemoglobin concentration is strongly associated with frailty in older adults. These results can have potentially important implications for prevention policies targeting frailty by identifying potential patients with high risk of adverse outcomes and functional outcomes.

Factors associated with low handgrip strength in older people: data of the Study of Chronic Diseases (Edoc-I)

BACKGROUND

Handgrip strength (HGS) is an important health biomarker whose low scores have been shown to be associated with the morbimortality. This study aimed to analyze the factors associated with low HGS in older people in Rio Branco, Acre, Brazil.

METHODS

The study was carried out with data from the Study of Chronic Diseases (EDOC-I) - Older People, a cross-sectional household PAPI probability sample survey performed with 1016 people aged over 60 residing in Rio Branco in 2014. The low HGS was defined by the 20th percentile of the maximum HGS by sex and age group. Associations between variables of health status (psychological and physical) and low HGS, by sex, were estimated using logistic regression, expressed by adjusted ORs (aOR).

RESULTS

Older individuals had lower median HGS than younger individuals (- 6.0 kg among men and - 2.6 kg among women). Women aged over 80 had, on average, the lower quintile of HGS compared to women of the previous age groups. Factors independently associated with low HGS in men and women, respectively, were low weigh in body mass index [(aOR = 2.80; 95%CI: 1.19, 6.61) and (aOR = 2.61; 95%CI: 1.46, 4.66)], anemia [(aOR = 4.15; 95%CI: 2.09, 8.21) and (aOR = 1.80; 95%CI: 1.06, 3.06)] and diabetes as a risk factor in men (aOR 1.95; 95%CI: 1.00, 3.81). There was a higher chance of low HGS in men with partners (aOR = 2.44; 95%CI: 1.32, 4.51), smokers or former smokers (aOR = 3.25; 95%CI: 1.25, 8.44), with current self-assessment of health worse than the 12 previous months (aOR = 2.21; 95%CI: 1.14, 4.30) and dependence in activities of daily living (aOR = 2.92; 95%CI: 1.35, 6.30). Only among women, there was an increased chance of low HGS associated with altered waist-to-hip ratio (aOR = 1.79; 95%CI: 1.02, 3.12), insomnia (aOR = 1.83; 95%CI: 1.10, 3.03) and physical activity from displacement/occupation (aOR = 1.75; 95%CI: 1.08, 2.84).

CONCLUSION

Factors associated with low HGS are not the same between sexes, and the inclusion of HGS as a component of health assessment seems to be a promising strategy for disease prevention and health promotion.

Association of Anemia with Activities of Daily Living in Chinese Female Centenarian

OBJECTIVES

Although anemia and activities of daily living (ADL) disability in female elderly are common conditions and are more likely to occur as people age, little is known about the association of anemia with ADL in female centenarians. The objective of this study was to examine the relationship between anemia and ADL disability in Chinese female centenarians.

DESIGN, SETTING AND PARTICIPANTS

We conducted a population-based cross-sectional study of a sample of 822 Chinese female centenarians from 2014 to 2016.

MEASUREMENTS

Blood analysis, home interview, and physical examination were performed following standard procedures. ADL disability was defined as a Barthel Index total score≤60.

RESULTS

The prevalence of anemia and ADL disability were 66.8% and 29.7% respectively in Chinese female centenarians. Multiple logistic regression analyses revealed that inflammation (OR = 2.280, 95% CI, 1.524-3.410), underweight (OR = 1.653, 95% CI, 1.186-2.303), anemia (OR = 1.775, 95% CI, 1.250-2.521), and living with family (OR = 0.518, 95% CI, 0.302-0.888) were significant factors related to ADL disability. Centenarians with severe anemia had an approximately fourfold greater likelihood of ADL disability than those without anemia (OR =3.747; 95% CI 1.525-9.206). An apparent dose-response relationship was found between anemia and ADL disability.

CONCLUSION

These findings may provide some insights into targeted intervention for maintaining ADL independence in female centenarians, especially encouraging the interventions of anemia to improve ADL.

Independent Functioning in Nonagenarians Living in a Rural Italian Community: The Mugello Study

Nonagenarians are a fast-growing population deserving specific research. We explored the prevalence and characteristics of functionally independent nonagenarians from a rural community-dwelling Italian population. Data were collected in the Mugello Study; 475 persons aged ≥90 years (median age, 92) underwent a home-based clinical and functional assessment, including psychosocial, clinical, functional, and lifestyle history and status and physical and instrumental examinations. Sixty-eight (15%) persons reported no need for help in basic and instrumental daily living activities. Among variables significantly associated with independent functionality after age- and gender-adjusted cross-sectional analysis, lower body mass index (BMI; p = .034) and depressive symptoms (p = .028), higher current physical activity (p < .001), better cognitive status (p = .033), and lower medication intake (p = .048) were associated with reporting no disability in the logistic regression analysis. Disability was mainly associated with current lifestyle-related potentially modifiable factors. Thus, lifestyle-oriented multidimensional interventions, should be developed and evaluated for their potential effects on functionality, even in the oldest old.

Anemia in the Elderly

Anemia affects a substantial fraction of the elderly population, representing a public health problem that is predicted to further increase in coming years because of the demographic drive. Being typically mild, it is falsely perceived as a minor problem, particularly in the elderly with multimorbidity, so that it often remains unrecognized and untreated. Indeed, mounting evidence indicates that anemia in the elderly (AE) is independently associated with disability and other major negative outcomes, including mortality. AE is generally multifactorial, but initial studies suggested that etiology remains unexplained in near one-third of cases. This proportion is consistently declining due to recent advances highlighting the role of several conditions including clonal hematopoiesis, "inflammaging," correctable androgen deficiency in men, and under-recognized iron deficiency. Starting from a real-world case vignette illustrating a paradigmatic example of anemia in an elderly patient with multimorbidity, we review the main clinical and pathophysiological aspect of AE, giving some practical insights into how to manage similar cases.