1
|
Winter A, Schulz SM, Schmitter M, Müller-Richter U, Kübler A, Kasper S, Hartmann S. Comprehensive Geriatric Assessment and Quality of Life Aspects in Patients with Recurrent/Metastatic Head and Neck Squamous Cell Carcinoma (HNSCC). J Clin Med 2023; 12:5738. [PMID: 37685806 PMCID: PMC10488489 DOI: 10.3390/jcm12175738] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
To define frailty in older cancer patients, the aim of this study was to assess the geriatric status and quality of life (QoL) aspects in patients suffering from recurrent/metastatic head and neck squamous cell carcinoma (r/m HNSCC) under palliative treatment. A comprehensive geriatric assessment (CGA) was performed on 21 r/m HNSCC patients at two defined assessments, and the QoL aspects and the impact of descriptive data were evaluated. The Kolmogorov-Smirnov test, Spearman's rho correlation, and two-way mixed ANOVA were used for statistical analysis. All patients were found to be "frail". Pain, fatigue, and the burden of illness were the highest-rated symptoms. Oral function and orofacial appearance were highly impaired. A significant impact of descriptive data on the CGA and QoL results was found (all p ≤ 0.05). Thus, the CGA results revealed high frailty, severe comorbidities, and high impairments in QoL aspects. The CGA and QoL results were negatively affected by the primary HNSCC treatment approach, the need for prosthetic treatment, and worse oral functional capacity. Therefore, frailty in r/m HNSCC patients seems to be multidimensional. The evaluation of the CGA and QoL aspects in r/m HNSCC patients can be recommended to detect special needs, organize aftercare, and improve the support for frail and vulnerable cancer patients to create a multidisciplinary treatment approach.
Collapse
Affiliation(s)
- Anna Winter
- Department of Prosthodontics, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany;
| | - Stefan M. Schulz
- Faculty I, Nursing Science, Department of Behavioural Medicine and Principles of Human Biology for the Health Sciences, Trier University, Universitätsring 15, 54296 Trier, Germany;
| | - Marc Schmitter
- Department of Prosthodontics, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany;
| | - Urs Müller-Richter
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany; (U.M.-R.); (A.K.); (S.K.); (S.H.)
| | - Alexander Kübler
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany; (U.M.-R.); (A.K.); (S.K.); (S.H.)
| | - Sylvia Kasper
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany; (U.M.-R.); (A.K.); (S.K.); (S.H.)
| | - Stefan Hartmann
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany; (U.M.-R.); (A.K.); (S.K.); (S.H.)
| |
Collapse
|
2
|
Costanzo G, Sambugaro G, Mandis G, Vassallo S, Scuteri A. Pancytopenia Secondary to Vitamin B12 Deficiency in Older Subjects. J Clin Med 2023; 12:jcm12052059. [PMID: 36902847 PMCID: PMC10003837 DOI: 10.3390/jcm12052059] [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: 12/19/2022] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Vitamin B12 (cobalamin CBL) is a water-soluble vitamin required to form hematopoietic cells (red blood cells, white blood cells, and platelets). It is involved in the process of synthesizing DNA and myelin sheath. Deficiencies of vitamin B12 and/or folate can cause megaloblastic anemia (macrocytic anemia with other features due to impaired cell division). Pancytopenia is a less frequent exordium of severe vitamin B12 deficiency. Vitamin B12 deficiency can also cause neuropsychiatric findings. In addition to correcting the deficiency, an essential aspect of management is determining the underlying cause because the need for additional testing, the duration of therapy, and the route of administration may differ depending on the underlying cause. METHODS Here, we present a series of four patients hospitalized for megaloblastic anemia (MA) in pancytopenia. All patients diagnosed with MA were studied for a clinic-hematological and etiological profile. RESULTS All the patients presented with pancytopenia and megaloblastic anemia. Vitamin B12 deficiency was documented in 100% of cases. There was no correlation between the severity of anemia and deficiency of the vitamin. Overt clinical neuropathy was present in none of the cases of MA, while subclinical neuropathy was seen in one case. The etiology of vitamin B12 deficiency was pernicious anemia in two cases and low food intake in the remaining cases. CONCLUSION This case study emphasizes the role of vitamin B12 deficiency as a leading cause of pancytopenia among adults.
Collapse
Affiliation(s)
- Giulia Costanzo
- S.C. di Medicina Interna, Policlinico Universitario Monserrato “Duilio Casula”—AOU di Cagliari, 09123 Cagliari, Italy
| | - Giada Sambugaro
- Scuola Specializzazione Allergologia e Immunologia Clinica, Universita’ di Cagliari, 09124 Cagliari, Italy
| | - Giulia Mandis
- Scuola Specializzazione Medicina Interna, Universita’ di Cagliari, 09124 Cagliari, Italy
| | - Sofia Vassallo
- Scuola Specializzazione Allergologia e Immunologia Clinica, Universita’ di Cagliari, 09124 Cagliari, Italy
| | - Angelo Scuteri
- S.C. di Medicina Interna, Policlinico Universitario Monserrato “Duilio Casula”—AOU di Cagliari, 09123 Cagliari, Italy
- Dipartimento Scienze Mediche e Sanita’ Pubblica, Universita’ di Cagliari, 09124 Cagliari, Italy
- Correspondence:
| |
Collapse
|
3
|
Świątczak M, Młodziński K, Sikorska K, Raczak A, Lipiński P, Daniłowicz-Szymanowicz L. Chronic Fatigue Syndrome in Patients with Deteriorated Iron Metabolism. Diagnostics (Basel) 2022; 12:diagnostics12092057. [PMID: 36140459 PMCID: PMC9498000 DOI: 10.3390/diagnostics12092057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/11/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Fatigue is a common, non-specific symptom that often impairs patients’ quality of life. Even though fatigue may be the first symptom of many serious diseases, it is often underestimated due to its non-specific nature. Iron metabolism disorders are a prominent example of conditions where fatigue is a leading symptom. Whether it is an iron deficiency or overload, tiredness is one of the most common features. Despite significant progress in diagnosing and treating iron pathologies, the approach to chronic fatigue syndrome in such patients is not precisely determined. Our study aims to present the current state of knowledge on fatigue in patients with deteriorated iron metabolism.
Collapse
Affiliation(s)
- Michał Świątczak
- II Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland
| | - Krzysztof Młodziński
- II Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland
| | - Katarzyna Sikorska
- Department of Tropical Medicine and Epidemiology, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland
| | - Alicja Raczak
- Clinical Psychology Department, Faculty of Health Sciences, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Paweł Lipiński
- Department of Molecular Biology, Institute of Genetics and Animal Breeding, Polish Academy of Sciences, Wólka Kosowska, 05-552 Jastrzębiec, Poland
| | - Ludmiła Daniłowicz-Szymanowicz
- II Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland
- Correspondence:
| |
Collapse
|
4
|
Khovasova NO, Vorobyeva NM, Tkacheva ON, Kotovskaya YV, Naumov AV, Selezneva EV, Ovcharova LN. The prevalence of anemia and its associations with other geriatric syndromes in subjects over 65 years old: data of Russian epidemiological study EVKALIPT. TERAPEVT ARKH 2022; 94:24-31. [DOI: 10.26442/00403660.2022.01.201316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/10/2022] [Indexed: 11/22/2022]
Abstract
Background. A low hemoglobin level in older adults impairs cognitive ability and functional status and associates with risk of falls and fractures, sarcopenia, malnutrition, depression, frailty, and decreased autonomy. Epidemiological data on the anemia prevalence in the geriatric population in our country is not available.
Aim. To assess the prevalence of anemia and analyze its associations with geriatric syndromes (GS) in subjects aged 65 years.
Materials and methods. 4308 subjects (30% of men) aged 65107 years, living in 11 regions of the Russian Federation, were examined and divided into age groups (6574 years, 7584 years and 85 years). All the participants underwent a comprehensive geriatric assessment and determined hemoglobin level.
Results. The anemia prevalence in older adults was 23.9%. It has been shown that with an increase in age per 1 year, the risk of anemia detection increases by 4%. The incidence of anemia was higher in males than females (28.1% versus 22.1%; p0.001). In most cases, anemia was mild. The results of a comprehensive geriatric assessment show that patients with anemia had lower hand grip force, Barthel Index, the sum of points on Lawton instrumental activities of daily living scale, Mini Nutritional Assessment scale, the Mini-Cog test and higher the sum of points on the Geriatric Depression Scale (GDS-15) and the Age Is No Barrier scale. Patients with anemia were more likely to use hearing aids, absorbent underwear, and assistive devices during movement. Patients with anemia had a higher incidence of all GS, except for orthostatic hypotension and chronic pain syndrome. The presence of GS is associated with an increased risk of anemia by 1.33.4 times.
Conclusion. EVKALIPT study obtained domestic data on the prevalence of anemia in older patients and examined its associations with other GS.
Collapse
|
5
|
What are optimum target levels of hemoglobin in older adults? Aging Clin Exp Res 2021; 33:3173-3181. [PMID: 33913117 DOI: 10.1007/s40520-021-01854-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/02/2021] [Indexed: 10/21/2022]
Abstract
AIM The aim of this study is to identify optimum target levels of hemoglobin (Hgb) in older males and females according to cognitive performance, mood state, nutrition intake, balance-walking functions, muscle strength and performance in daily life activities. METHOD A total of 1942 geriatric patients who had undergone comprehensive geriatric assessment were evaluated. The patient's demographic characteristics, comorbid diseases, number of drugs, cognitive performance, mood and nutritional states, basic and instrumental daily living activity indexes were obtained from hospital files. Hgb levels were analyzed on the same day. Receiver Operating Characteristic analysis was used to detect the optimum level of Hgb according to the best performance of geriatric assessment parameters. RESULTS 1095 participants took part of who 71.9% were female and the mean age was 76.92 ± 7.38 years (65-103 years). There was a significant negative correlation between age, number of drugs used, Geriatric Depression Scale-15, Timed Up and Go test and Hgb in both sexes while a significant positive correlation was found between Barthel and Lawton activities of daily living, Tinetti test, Mini Nutritional Assessment, Mini-Mental State Examination and Hgb (p < 0.05). The optimum Hgb levels were ≥ 13.0 for females and ≥ 13.9 in males. CONCLUSION Findings from the present study in relation to Hgb and key geriatric evaluation parameters suggests that the optimum level of Hgb for older females and males is higher than the level of Hgb in current definitions. Data from this study suggest that the optimum value of the Hgb level is 13.0 for females and 13.9 for males.
Collapse
|
6
|
Neidlein S, Wirth R, Pourhassan M. Iron deficiency, fatigue and muscle strength and function in older hospitalized patients. Eur J Clin Nutr 2021; 75:456-463. [PMID: 32901103 PMCID: PMC7943415 DOI: 10.1038/s41430-020-00742-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 07/31/2020] [Accepted: 08/26/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND/OBJECTIVES Iron deficiency is common in older patients. We investigated whether iron deficiency is an independent risk factor for functional impairment, low muscle function, fatigue, and rehabilitation progress in older hospitalized patients. SUBJECTS/METHODS Two hundred twenty-four patients (age range 65-95 years; 67% females) who were consecutively admitted to a geriatric acute care ward participated in this prospective longitudinal observational study. Ferritin, iron, transferrin in serum, and blood hemoglobin were measured and current iron supplementation was recorded. Fatigue and comorbidity were measured using the fatigue severity scale and Charlson Comorbidity Index, respectively. Barthel Index, handgrip strength, and isometric knee extension strength were conducted at the time of hospital admission and before discharge. RESULTS Ninety-one (41%) patients had iron deficiency in which the majority had functional iron deficiency (78/91, 86%). Absolute iron deficiency with and without anemia was diagnosed in 12 (13%) and one patients, respectively. Barthel Index and handgrip and knee extension strength significantly improved during hospitalization in iron deficiency and non-iron deficiency groups. Knee extension strength showed better improvement in iron-deficient patients receiving iron supplementation and iron supplementation during hospital stay was the main predictor for improvement in knee extension strength. Comorbidity, iron deficiency, and changes in handgrip strength were the major independent risk factors for poor improvement in Barthel Index during hospitalization. There were significant associations between patients' fatigue and iron deficiency, comorbidity, and female gender. CONCLUSION Iron deficiency is an independent risk factor for fatigue and poor functional recovery among older hospitalized patients. Iron supplementation seems to be capable of improving functional performance.
Collapse
Affiliation(s)
- Sophia Neidlein
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Herne, Germany
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Herne, Germany
| | - Maryam Pourhassan
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Herne, Germany.
| |
Collapse
|
7
|
Son KY, Shin DW, Lee JE, Kim SH, Yun JM, Cho B. Association of anemia with mobility capacity in older adults: a Korean nationwide population-based cross-sectional study. BMC Geriatr 2020; 20:469. [PMID: 33187476 PMCID: PMC7666504 DOI: 10.1186/s12877-020-01879-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 11/09/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Over 10% of adults aged ≥65 years have anemia, as defined by the World Health Organization (WHO). As the timed up and go (TUG) test is one of the most widely used tests of mobility, this study investigated whether anemia was associated with mobility capacity assessed using the TUG test in older adults. METHODS Subjects belonging to the Korean National Health Insurance Service-National Health Screening Cohort of the National Health Information Database were reviewed. Subjects were included if they had completed the TUG test as part of the National Screening Program for Transitional Ages in Korea. An abnormal TUG test result was defined as a time of ≥10 s and anemia was defined according to the WHO criteria as a hemoglobin (Hb) concentration of < 13.0 g/dL in men and < 12.0 g/dL in women. The association between anemia and TUG test results was evaluated using four multiple logistic regression models with different levels of adjustment. Stratified analysis according to risk factors was performed. RESULTS The 81,473 subjects included 41,063 (50.4%) women and 40,410 (49.6%) men. Mean TUG time was 8.44 ± 3.08 s, and abnormal TUG test results were observed in 22,138 (27.2%) subjects. Mean Hb concentration was 13.72 ± 1.41 g/dL, and 10,237 (12.6%) subjects had anemia. U-shaped associations between Hb concentration and TUG test results were observed in both sexes. Subjects with anemia were 19% more likely to have abnormal TUG test results, according to the fully adjusted model (adjusted odds ratio: 1.192, 95% confidence interval: 1.137-1.247). Similar results were observed for both sexes. Stratified analysis showed that subjects with anemia were more likely to have abnormal TUG test results regardless of risk factors. CONCLUSIONS Individuals with anemia are more likely to have abnormal TUG test results, regardless of risk factors, than individuals without anemia. U-shaped relationships between Hb concentrations and TUG test results were observed in both sexes, although the optimal Hb concentration differed between men and women.
Collapse
Affiliation(s)
- Ki Young Son
- Department of Family Medicine, Asan Medical Center, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Dong Wook Shin
- Department of Family Medicine/Supportive Care Center, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
- Center for Clinical Epidemiology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
| | - Ji Eun Lee
- Department of Family Medicine, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, South Korea
| | - Sang Hyuck Kim
- Department of Family Medicine, Bumin Hospital, Seoul, South Korea
| | - Jae Moon Yun
- Health Promotion Center, Seoul National University Hospital, Seoul, South Korea
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Belong Cho
- Health Promotion Center, Seoul National University Hospital, Seoul, South Korea
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea
- Institute on Aging, Seoul National University College of Medicine, Seoul, South Korea
| |
Collapse
|
8
|
[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.
Collapse
|
9
|
[The geriatric syndrome of anemia-Summary of the symposium of the working group anemia during the annual meeting of the German Geriatric Society 2018 in Cologne, Germany]. Z Gerontol Geriatr 2019; 52:370-376. [PMID: 31016373 DOI: 10.1007/s00391-019-01545-z] [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: 01/21/2019] [Revised: 03/15/2019] [Accepted: 03/29/2019] [Indexed: 10/27/2022]
Abstract
This year's symposium of the working group anemia of the German Geriatric Society (DGG) aimed to underline the multicausality of anemia in the aged and to highlight definition parallels with geriatric syndromes. For these reasons, nutritional and malignant causes for anemia were discussed and the influence of oxidative stress on the development of anemia was underlined. The need for ongoing research in the field of anemia in the aged was emphasized by the lack of perioperative transfusion strategies in geriatric patients.
Collapse
|
10
|
Affiliation(s)
- Gabriele Röhrig
- MVZ Medicum Köln Ost, Johann Classen Strasse 68, D-51103, Köln, Deutschland.
| |
Collapse
|
11
|
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.
Collapse
Affiliation(s)
- Gabriele Röhrig
- Zentrum für spezialisierte geriatrische Diagnostik, MVZ Medicum Köln Ost, Johann-Classen-Str. 68, 51103, Köln, Deutschland.
| |
Collapse
|
12
|
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]
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Zaninetti C, Klersy C, Scavariello C, Bastia R, Balduini CL, Invernizzi R. Prevalence of anemia in hospitalized internal medicine patients: Correlations with comorbidities and length of hospital stay. Eur J Intern Med 2018; 51:11-17. [PMID: 29153343 DOI: 10.1016/j.ejim.2017.11.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/24/2017] [Accepted: 11/03/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Several studies have documented a linear growth of the prevalence of anemia with aging. Especially in hospitalized elderly patients, anemia can aggravate the course of chronic disorders, and ultimately get worse the clinical outcomes. METHODS To evaluate the distribution, the main causes, and the possible correlations of anemia with comorbidities and length of hospitalization in a population of internal medicine inpatients, we carried out an observational study on a cohort of 923 consecutive admissions relative to 856 subjects. RESULTS Anemia was observed in 58.4% of patients, with an increase of the prevalence with increasing age regardless gender difference. In more than one-half of anemic patients, anemia was mild. Chronic inflammation and chronic renal failure were the most frequent causes of anemia in our population, and in >35% of patients a multifactorial anemia was diagnosed. Age, chronic renal failure, chronic liver disease, hematological malignancies, solid tumors, and antiplatelet therapy showed a significantly independent association with the presence of anemia. Hemoglobin levels were influenced by the presence of chronic lung disease, chronic renal failure, hematological malignancies, solid tumors, and antiplatelet therapy. The presence and the degree of anemia also correlated with a significantly longer hospital stay. CONCLUSIONS Our data confirm the high prevalence of anemia in patients hospitalized in an Internal Medicine Department, with a remarkable burden of mild forms, and of chronic inflammation's pathogenic mechanism. Correlations with comorbidities and duration of hospital stay highlight the crucial part played by anemia in determining the clinical complexity of such patients.
Collapse
Affiliation(s)
- Carlo Zaninetti
- Department of Internal Medicine, University of Pavia, and IRCCS Policlinico San Matteo Foundation, Pavia, Italy; PhD program in Experimental Medicine, University of Pavia, Pavia, Italy.
| | - Catherine Klersy
- Service of Biometry and Clinical Epidemiology, Scientific Direction, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Concetta Scavariello
- Department of Internal Medicine, University of Pavia, and IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Raffaella Bastia
- Department of Internal Medicine, University of Pavia, and IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Carlo L Balduini
- Department of Internal Medicine, University of Pavia, and IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Rosangela Invernizzi
- Department of Internal Medicine, University of Pavia, and IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| |
Collapse
|
15
|
Cecchi F, Pancani S, Vannetti F, Boni R, Castagnoli C, Paperini A, Pasquini G, Sofi F, Molino-Lova R, Macchi C. Hemoglobin concentration is associated with self-reported disability and reduced physical performance in a community dwelling population of nonagenarians: the Mugello Study. Intern Emerg Med 2017; 12:1167-1173. [PMID: 29071662 PMCID: PMC5691100 DOI: 10.1007/s11739-017-1762-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/14/2017] [Indexed: 02/06/2023]
Abstract
People aged 90 and older represent a fast-growing population segment who deserve specific attention and research. Aging is associated with a progressive decrease in hemoglobin concentration, which predicts adverse outcome, such as mortality, morbidity, frailty and disability. Whether this association is independent from increased prevalence of comorbidity, causing both anemia and reduced physical function is yet under debate. The aim of this study is to explore the relationship between hemoglobin concentration and self-reported disability and reduced physical performance in a community dwelling population of nonagenarians. Data presented were collected in the framework of the Mugello Study, a clinical epidemiologic survey of nonagenarians living in the Mugello area (Tuscany, Italy). 251 persons (177 women, age 93.2 ± 3.3 years; 74 men, age 92.2 ± 2.5 years) underwent a blood draw. Along with hemoglobin concentration, self-reported disability (basic and instrumental activities of daily living), physical performance (Short Physical Performance Battery), self-reported physical activity and muscular strength (handgrip measurement) were assessed. Covariates, inherent sociodemographic and health indicators and comorbidities were also included in the analysis. This study confirms that anemia is very common in the oldest old, with a significantly higher prevalence in males (50% in men vs 24% in women). Multiple linear regression analysis, including all the comorbid conditions as confounding factors, shows that hemoglobin concentration is independently associated with handgrip strength, self-reported physical activity and disability in dressing, and taking a shower/bath. In conclusion, results from this study confirm that in the oldest old, low hemoglobin concentration is strongly associated with self-reported disability and decline of physical performance independent of comorbidity.
Collapse
Affiliation(s)
- Francesca Cecchi
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Silvia Pancani
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy.
| | - Federica Vannetti
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Roberta Boni
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Chiara Castagnoli
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Anita Paperini
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Guido Pasquini
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Francesco Sofi
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Raffaele Molino-Lova
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Claudio Macchi
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| |
Collapse
|
16
|
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.
Collapse
Affiliation(s)
- Abdulmaged M Traish
- Department of Urology, Boston University School of Medicine, Boson, MA, USA.
| |
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
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]
|