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Schuchart DM, Becker I, Harbeck B, Röhrig G. Association between anemia and vitamin D deficiency in German seniors : A retrospective data analysis. Z Gerontol Geriatr 2024:10.1007/s00391-024-02322-3. [PMID: 38967671 DOI: 10.1007/s00391-024-02322-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/22/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Anemia and deficiency of vitamin D (VDD) are frequently seen in seniors and an association is suspected. Approximately one third of the German population is affected by VDD, with a rising prevalence among seniors. AIM To analyze the association between anemia and VDD among German seniors aged ≥ 60 years. METHODS Retrospective cross-sectional data analysis (n = 4008) in a nationwide working laboratory medical center (January-December 2019). Study parameters included amongst others: hemoglobin (Hb), calcifediol (25D) and calcitriol (1.25D), glomerular filtration rate (GFR) to assess the kidney disease outcomes quality initiative (KDOQI) state. The inclusion criteria were age ≥ 60 years, normal C‑reactive protein (CRP) and leucocyte levels. RESULTS The 25D was estimated in 4008 patients and 1.25D only in 411 patients. Mean age 75 years (± 8.61 years; 60-99 years) with 30.6% males; mean GFR 62 ml/min/1.73 m3 (± 22.74); 20% of patients were anemic, 35% were deficient for 25D (< 50 nmol/l), with men > women (p = 0.014). Linear regression analysis revealed a significant effect of 25D values < 30 nmol/l on hemoglobin in males of KDOQI I-III and females of KDOQI I-IV (R2 = 0.052; p = 0.005; and R2 = 0.124; p < 0.001, respectively). For 1.25D a weak but significant effect on hemoglobin independent of KDOQI was only seen in women (R2 = 0.200; p = 0.005). CONCLUSION In this cohort deficiency of 25D and 1.25D was significantly associated with hemoglobin independent of renal function only in women but not in men.
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Affiliation(s)
| | - Ingrid Becker
- Institute of Medical Statistics and Computational Biology, University Cologne, Cologne, Germany
| | - Birgit Harbeck
- Germany and III. Department of Medicine, University Medical Center Hamburg-Eppendorf, amedes medical specialist center of endocrinology and osteology, Hamburg, Germany
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriele Röhrig
- European University of Applied Sciences (EUFH), Neusser Straße 99, 50670, Cologne, Germany.
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Röhrig G, Pia S, Bussmann M, Kunter H, Noack MJ, Barbe AG. Do subjectively and objectively impaired oral health parameters influence geriatric assessment results in hospitalized geriatric patients? Eur Geriatr Med 2020; 11:465-474. [PMID: 32297265 DOI: 10.1007/s41999-020-00306-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/28/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Impaired oral health affects oral health-related quality of life (OHrQoL) in orthogeriatric hospitalized patients, and both might be associated with potential risk factors for functional impairment, based on the comprehensive geriatric assessment (CGA) and related blood laboratory values. As data on this field are scarce, we investigated possible associations between oral health, items of the geriatric oral health assessment instrument (GOHAI), CGA assessment tools, and relevant laboratory values. METHODS Explorative cross-sectional pilot study investigating oral and general health, OHrQoL, and functionality based on objective oral health, GOHAI, CGA, and routinely assessed laboratory parameters of orthogeriatric patients. Correlations (Spearman's rho and Pearson's) and regression analysis were performed for the dependent variables functionality, cognition, Mini-Nutritional Assessment, Falls Efficacy Scale (FES), and the 15-item geriatric depression scale (GDS). RESULTS Among all participants (N = 40), several GOHAI single items (GOHAI 1,4,5,7,10,11) correlated with certain CGA assessment results (fear of falling, Barthel index, handgrip power). Reduced subjective oral health (GOHAI, xerostomia) and objective oral health (oral hygiene index, root caries index, unstimulated salivation rate) correlated with reduced general health and CGA results (polypharmacy, handgrip power, FES, GDS). Anemia was seen in all participants, but no associations between reduced oral health and laboratory blood values were detected. CONCLUSION Our results demonstrate the association between impaired subjective and objective oral health, OHrQoL, and physical functional impairment among orthogeriatric patients. Impaired GOHAI item results at the dentist, and the association between GOHAI values and CGA results that implies an association between physical and oral health, should encourage a geriatric check based on CGA, and vice versa. Results encourage interdisciplinary cooperation between geriatricians and dentists, but also indicate the need for further research in this field. TRIAL REGISTRATION DRKS00013230.
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Affiliation(s)
- Gabriele Röhrig
- Zentrum für Spezialisierte Geriatrische Diagnostik, MVZ Medicum Köln Ost, Johann Classen Strasse 68, 51103, Cologne, Germany.
| | - Schmidt Pia
- Department of Operative Dentistry and Periodontology, Center of Dental Medicine, University of Cologne, Kerpener Str. 32, 50931, Cologne, Germany
| | - Michael Bussmann
- Department of Orthogeriatrics, Evangelisches Krankenhaus Köln Kalk, Buchforststrasse 2, 51103, Cologne, Germany
| | - Henning Kunter
- Department of Orthogeriatrics, Evangelisches Krankenhaus Köln Kalk, Buchforststrasse 2, 51103, Cologne, Germany
| | - Michael Johannes Noack
- Department of Operative Dentistry and Periodontology, Center of Dental Medicine, University of Cologne, Kerpener Str. 32, 50931, Cologne, Germany
| | - Anna Greta Barbe
- Department of Operative Dentistry and Periodontology, Center of Dental Medicine, University of Cologne, Kerpener Str. 32, 50931, Cologne, Germany
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[Perioperative patient blood management in the aged-more than only transfusion? : Review of the 4th symposium of the working group on anemia on the occasion of the annual meeting of the German Geriatric Society in Frankfurt 2019]. Z Gerontol Geriatr 2020; 53:233-238. [PMID: 32065249 DOI: 10.1007/s00391-020-01708-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 02/03/2020] [Indexed: 10/25/2022]
Abstract
Anemia is frequent in older people with one in two geriatric inpatients being affected. Therefore, in elective surgery, such as endoprosthetic treatment it is very likely that anemia is already present in a preoperative setting. So far there are no particular guidelines about perioperative management of anemia in geriatric patients. The existing recommendations of the Patient Blood Management (PBM) network cooperation and the current Association of the Scientific Medical Societies in Germany (AWMF) S3 guidelines on preoperative anemia refer to all patients aged >18 years but without particular consideration of the growing number of oldest old orthogeriatric patients. This is more problematic as anemia in the aged has been shown to be different from anemia in younger patients in terms of diagnostics and treatment. Based on several interdisciplinary lectures, this year the symposium of the working group on anemia of the German Geriatric Society (DGG) focused on the problems of perioperative PBM in orthogeriatric patients and encouraged the discussion about developing PBM treatment recommendations for this patient group.
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Affiliation(s)
- Gabriele Röhrig
- MVZ Medicum Köln Ost, Johann Classen Strasse 68, D-51103, Köln, Deutschland.
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Röhrig G. [Anemia in the aged]. Z Gerontol Geriatr 2018; 51:935-946. [PMID: 30498858 DOI: 10.1007/s00391-018-01479-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/05/2018] [Accepted: 10/31/2018] [Indexed: 10/27/2022]
Abstract
Anemia in the aged is still often an underestimated clinical problem; however, in recent years increasing research on this topic has permitted deeper insights, allowing a differentiated approach to anemia in the aged. Meanwhile, multicausality and a negative impact on functional outcome have become characteristics of anemia in older people. This has led to a scientific discussion on the question of accepting anemia as a geriatric syndrome. The present article gives a concise overview of the current state of research on this clinically relevant subject.
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Affiliation(s)
- Gabriele Röhrig
- Zentrum für spezialisierte geriatrische Diagnostik, MVZ Medicum Köln Ost, Johann-Classen-Str. 68, 51103, Köln, Deutschland.
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Anämie im Alter – ein geriatrisches Syndrom? Z Gerontol Geriatr 2018; 51:921-923. [DOI: 10.1007/s00391-018-1457-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 09/05/2018] [Accepted: 09/20/2018] [Indexed: 01/28/2023]
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Röhrig G, Gütgemann I, Kolb G, Leischker A. Klinisch-hämatologisches Bild des Vitamin-B12-Mangels im Alter. Z Gerontol Geriatr 2018; 51:446-452. [DOI: 10.1007/s00391-018-1410-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/25/2018] [Accepted: 05/02/2018] [Indexed: 11/30/2022]
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Röhrig G, Gütgemann I, Kolb G, Leischker A. Anemia in the aged is not ageing related: position paper on anemia in the aged by the "working group anemia" of the German Geriatric Society (DGG). Eur Geriatr Med 2018; 9:395-397. [PMID: 34654237 DOI: 10.1007/s41999-018-0048-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 03/20/2018] [Indexed: 11/30/2022]
Abstract
Anemia in the aged is a frequent but still under-estimated problem in geriatric patients. However, in recent years increasing research on anemia in the aged has improved awareness and interest in this clinically relevant problem. Guidelines for diagnostic and therapeutic steps are now required to improve the treatment of anemic aged patients. For encouraging the development of diagnostic and therapeutic recommendations, the "working group anemia" of the German Geriatric Society (DGG) has issued a position paper on anemia in the aged, based on the current literature. The statements are (1) that anemia has to be considered a highly prevalent but not a physiologic finding in aged persons; (2) that reference values for hemoglobin concentration are independent of age, indicating that WHO reference values for anemia definition are valid for aged persons; (3) that anemia in the aged is associated with functional and cognitive impairment based on comprehensive geriatric assessment (CGA), requiring diagnosis and treatment.
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Affiliation(s)
- Gabriele Röhrig
- Geriatric Diagnostic Center, MVZ Medicum Köln Ost, Johann Classen Strasse 68, 51103, Cologne, Germany.
| | - Ines Gütgemann
- Institute of Pathology, University Hospital Bonn, Bonn, Germany
| | - Gerald Kolb
- Medizinische Klinik FB Geriatrie, Bonifatius Hospital Lingen (Ems), Lingen, Germany
| | - Andreas Leischker
- Klinik für Geriatrie, Alexianer Krefeld GmbH und Klinik für Geriatrische Rehabilitation, Alexianer Tönisvorst GmbH, Tönisvorst, Germany
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Traish AM. Benefits and Health Implications of Testosterone Therapy in Men With Testosterone Deficiency. Sex Med Rev 2017; 6:86-105. [PMID: 29128268 DOI: 10.1016/j.sxmr.2017.10.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/06/2017] [Accepted: 10/06/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Testosterone (T) deficiency (TD; hypogonadism) has deleterious effects on men's health; negatively affects glycometabolic and cardiometabolic functions, body composition, and bone mineral density; contributes to anemia and sexual dysfunction; and lowers quality of life. T therapy (TTh) has been used for the past 8 decades to treat TD, with positive effects on signs and symptoms of TD. AIM To summarize the health benefits of TTh in men with TD. METHODS A comprehensive literature search was carried out using PubMed, articles relevant to TTh were accessed and evaluated, and a comprehensive summary was synthesized. MAIN OUTCOME MEASURES Improvements in signs and symptoms of TD reported in observational studies, registries, clinical trials, and meta-analyses were reviewed and summarized. RESULTS A large body of evidence provides significant valuable information pertaining to the therapeutic value of TTh in men with TD. TTh in men with TD provides real health benefits for bone mineral density, anemia, sexual function, glycometabolic and cardiometabolic function, and improvements in body composition, anthropometric parameters, and quality of life. CONCLUSION TTh in the physiologic range for men with TD is a safe and effective therapeutic modality and imparts great benefits on men's health and quality of life. Traish AM. Benefits and Health Implications of Testosterone Therapy in Men With Testosterone Deficiency. Sex Med Rev 2018;6:86-105.
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Affiliation(s)
- Abdulmaged M Traish
- Department of Urology, Boston University School of Medicine, Boson, MA, USA.
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Röhrig G, Becker I, Pappas K, Polidori MC, Schulz RJ. Analysis of cytopenia in geriatric inpatients. Z Gerontol Geriatr 2017; 51:231-236. [PMID: 28660533 DOI: 10.1007/s00391-017-1280-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 06/09/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Peripheral blood dyscrasias in older patients are repeatedly seen in geriatric clinical practice; however, there is substantial lack of data about the epidemiology, possible causes and treatment options in this patient group. Proton pump inhibitors (PPI) are extensively used in older patients and associated with leukopenia. The primary objective of this study was the assessment of encoded cytopenia prevalence in a geriatric patient cohort and the secondary objective was the assessment of putative causes and the analysis of PPI administration in patients with cytopenia. METHODS Retrospective evaluation of patients admitted to the geriatric department of a German urban hospital between 2010 and 2012. Electronic patient data were screened for encoded diagnosis of cytopenia according to the International Classification of Diseases (ICD) 10. Inclusion criteria were ICD code D69.0-9 and/or D70.0-7, age ≥60 years and exclusion criteria were no ICD code D69.0-9 and/or D70.0-7 and age <60 years. Out of 9328 screened inpatients 54 patients remained for analysis. Study parameters included hemoglobin (Hb), red blood cell count (RBC), leucocytes, platelets, mean cell volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW), presence of leukopenia (<4000/µl), presence of thrombocytopenia (<140,000/µl) and presence of anemia according to the World Health Organization (WHO). Substitution of blood products, medication with PPI and potential causes for dyscrasias were evaluated based on electronic patient records. RESULTS The mean age was 78.3 ± 6.5 years (27 females, 27 males), anemia was seen in 78%, leukopenia was encoded in13% and thrombocytopenia in 44.4%. In most of the patients no substitution of blood products was documented. In most of the patients (20.4%) cytopenia was attributed to either heparin-induced thrombocytopenia (HIT) or hemato-oncologic (20.4%) diseases, followed by drug association in 18.5%. In 70.8% of the study patients PPIs were administered but the indication for PPI administration remained unclear in 20.4%. CONCLUSION The results encourage accurate assessment of blood dyscrasias and appropriate documentation as well as indication check for PPI treatment in geriatric inpatients.
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Affiliation(s)
- G Röhrig
- Ageing Clinical Research, Department II Internal Medicine, University Hospital Cologne, Cologne, Germany. .,Geriatric Department, St. Marien-Hospital, Kunibertskloster 11-13, 50668, Cologne, Germany.
| | - I Becker
- Institute for Medical Statistics, Informatics and Epidemiology, University Hospital Cologne, Cologne, Germany
| | - K Pappas
- Ageing Clinical Research, Department II Internal Medicine, University Hospital Cologne, Cologne, Germany.,Geriatric Department, St. Marien-Hospital, Kunibertskloster 11-13, 50668, Cologne, Germany
| | - M C Polidori
- Ageing Clinical Research, Department II Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - R J Schulz
- Geriatric Department, St. Marien-Hospital, Kunibertskloster 11-13, 50668, Cologne, Germany
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Aktuelle Einblicke in die Anämie im Alter. Z Gerontol Geriatr 2017; 51:343-348. [DOI: 10.1007/s00391-017-1212-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/16/2017] [Indexed: 12/19/2022]
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Godaert L, Saint-Albin L, Bousquet L, Fanon JL, Dramé M. Macrocytic isolated anaemia as an unusual adverse effect of divalproex sodium in the elderly. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2016.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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