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von Brackel FN, Oheim R. Iron and bones: effects of iron overload, deficiency and anemia treatments on bone. JBMR Plus 2024; 8:ziae064. [PMID: 38957399 PMCID: PMC11215550 DOI: 10.1093/jbmrpl/ziae064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/24/2024] [Accepted: 05/10/2024] [Indexed: 07/04/2024] Open
Abstract
Iron is a vital trace element and exerts opposing effects on bone in both iron overload and iron deficiency situations. Remarkably, iron supplementation through intravenous infusion in patients with iron deficiency can also have detrimental effects on bone in special cases. The diverse mechanisms underlying these effects and their manifestations contribute to the complexity of this relationship. Iron overload impacts both bone resorption and formation, accelerating bone resorption while reducing bone formation. These effects primarily result from the direct action of reactive oxygen species (ROS), which influence the proliferation, differentiation, and activity of both osteoclasts and osteoblasts differently. This imbalance favors osteoclasts and inhibits the osteoblasts. Simultaneously, multiple pathways, including bone morphogenic proteins, RANK ligand, and others, contribute to these actions, leading to a reduction in bone mass and an increased susceptibility to fractures. In contrast, iron deficiency induces low bone turnover due to energy and co-factor deficiency, both of which require iron. Anemia increases the risk of fractures in both men and women. This effect occurs at various levels, reducing muscular performance and, on the bone-specific level, decreasing bone mineral density. Crucially, anemia increases the synthesis of the phosphaturic hormone iFGF23, which is subsequently inactivated by cleavage under physiological conditions. Thus, iFGF23 levels and phosphate excretion are not increased. However, in specific cases where anemia has to be managed with intravenous iron treatment, constituents-particularly maltoses-of the iron infusion suppress the cleavage of iFGF23. As a result, patients can experience severe phosphate wasting and, consequently, hypophosphatemic osteomalacia. This condition is often overlooked in clinical practice and is often caused by ferric carboxymaltose. Ending iron infusions or changing the agent, along with phosphate and vitamin D supplementation, can be effective in addressing this issue.
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Affiliation(s)
- Felix N von Brackel
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
| | - Ralf Oheim
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
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Yong PSA, Ke Y, Kok EJY, Tan BPY, Kadir HA, Abdullah HR. Preoperative anemia in older individuals undergoing major abdominal surgery is associated with early postoperative morbidity: a prospective observational study. Can J Anaesth 2024; 71:353-366. [PMID: 38182829 DOI: 10.1007/s12630-023-02676-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 01/07/2024] Open
Abstract
PURPOSE Preoperative anemia is associated with poor postoperative outcomes. Older patients have limited physiologic reserves, which renders them vulnerable to the stress of major abdominal surgery. We aimed to determine if the severity of preoperative anemia is associated with early postoperative morbidity among older patients undergoing major abdominal surgery. METHODS Ethics approval was obtained from SingHealth Centralized Institutional Review Board. This is a prospective observational study conducted in the preoperative anesthesia clinic of a tertiary Singapore hospital from 2017 to 2021. Patient demographic data, comorbidities, and intraoperative details were collected. Outcome measures included blood transfusions, complications according to the Postoperative Morbidity Survey, days alive and out of hospital (DaOH), length of hospital stay, and mortality. RESULTS A total of 469 patients were analyzed, 37.5% of whom had preoperative anemia (serum hemoglobin of < 13 g·dL-1 in males and < 12 g·dL-1 in females). Anemia was significantly associated with older age, a higher age-adjusted Comprehensive Complication Index score, a higher incidence of diabetes mellitus, and a higher proportion of patients with an American Society of Anesthesiologists Physical Status of III or IV. The severity of anemia was associated with the presence of early postoperative morbidity at day 5, increased blood transfusions, longer length of hospital stay, and fewer DaOH at 30 days and six months. CONCLUSION Anemia is significantly associated with poorer postoperative outcomes in the older population. The impact of anemia on postoperative outcomes could be further evaluated with quality of life indicators, patient-reported outcome measures, and health economic tools.
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Affiliation(s)
- Phui S Au Yong
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Yuhe Ke
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Eunice J Y Kok
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, Singapore
| | - Brenda P Y Tan
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, Singapore
| | - Hanis Abdul Kadir
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, Singapore
- Health Services Research Unit, Singapore General Hospital, Singapore, Singapore
| | - Hairil R Abdullah
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
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Sutandyo N, Rinaldi I, Sari NK, Winston K. Prevalence of Anemia and Factors Associated With Handgrip Strength in Indonesian Elderly Population. Cureus 2022; 14:e25290. [PMID: 35755554 PMCID: PMC9224904 DOI: 10.7759/cureus.25290] [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] [Accepted: 05/24/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction: Anemia is a common blood disorder in the elderly which is associated with numerous poor medical outcomes. However, there is currently no study that assesses anemia prevalence of the Indonesian elderly population aged ≥60 years old in multiple provinces and analyzes its association with handgrip muscle strength using a large sample size. Aim: We aimed to elucidate the prevalence of anemia and analyze factors associated with handgrip strength in elderly. Method: This was a cross-sectional study using data from the Indonesian Family Life Survey-5 (IFLS-5). All participants aged ≥60 years old were included in this study. Exclusion criteria were: (1) respondents who refused to take health measurements (hemoglobin (Hb) level, handgrip strength, weight, stature, and waist circumference); (2) respondents with incomplete or missing data; (3) respondents with history of stroke; and (4) respondents with history of pain, swelling, inflammation, injury, and surgery on one or both hands within the last 6 months. The dependent variable for this study was handgrip strength. Subjects were classified as weak if the handgrip strength was <28 kg for men and <18 kg for women based on classification from the Asian Working Group for Sarcopenia (AWGS) 2019. The independent variables were Hb level, gender, age, body mass index (BMI), waist circumference, smoking history, comorbidities, and current use of drug therapies. Based on WHO standard, male and female participants with Hb less than 13 g/dL and 12 g/dL, respectively, are defined as anemic. Statistical analyses used included correlation, bivariate logistic regression, and multivariate logistic regression. Result: A total of 3192 individuals were selected for analysis. Overall, 38.8% of participants had anemia, and the prevalence of anemia increases with age. A total of 56.30% of participants aged ≥80 years had anemia. There was a positive correlation between Hb level and handgrip strength in the Indonesian elderly population (r: 0.349; p value: <0.001). Multivariate analysis showed that anemia was significantly associated with weak handgrip strength (OR: 1.557; 95% CI: 1.314-1.846; p value: <0.001). Age ≥ 80 years (OR: 5.234), age 70-79 years (OR: 3.152), low BMI (OR: 1.827), and hypertension (OR: 1.340) were associated with weak handgrip strength in multivariate analysis. Conclusion: The prevalence of anemia in the Indonesian elderly was 38.8% and anemia was associated with weak handgrip strength. The association of anemia with weak handgrip strength is more pronounced in males and the elderly aged ≥80 years.
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Esquinas-Requena JL, García-Nogueras I, Hernández-Zegarra P, Atienzar-Núñez P, Sánchez-Jurado PM, Abizanda P. [Anemia and frailty in older adults from Spain. The FRADEA Study]. Rev Esp Geriatr Gerontol 2021; 56:129-135. [PMID: 33771359 DOI: 10.1016/j.regg.2021.01.010] [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: 09/12/2020] [Revised: 12/26/2020] [Accepted: 01/25/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The objective was to examine the prevalence of anemia according to the state of frailty and to analyze the relationship between anemia, hemoglobin concentration and frailty in a cohort of Spanish older adults. MATERIAL AND METHODS Cross-sectional substudy of the FRADEA (Frailty and Dependency in Albacete) cohort, a population-based concurrent cohort study conducted in people older than 69 years of Albacete (Spain). Of the 993 participants included in the first wave, 790 were selected with valid data on anemia and frailty. Anemia was defined according to the criteria of the World Health Organization (hemoglobin less than 13 g/dL in men and 12 g/dL in women). Frailty was assessed using the Fried's phenotype. The association between anemia, hemoglobin concentration and frailty was determined by binary logistic regression adjusted for age, sex, educational level, institutionalization, comorbidity, cognitive status, body mass index, polypharmacy, creatinine, glucose and total white blood cell count. RESULTS The mean age was 79 years. The prevalence of anemia was 19.6%. The prevalence of anemia was significantly higher in frail subjects (29.6%) compared to prefrail (16.6%) and robust ones (6%), p<0.001. The average hemoglobin concentrations were significantly lower in frail (12.7 g/dL), compared to the prefrail (13.5 g/dL) and robust participants (14.4 g/dL), p < 0.001. In the fully adjusted regression model, anemia was associated with frailty (OR 1.95; 95% CI: 1.02-3.73, p<0.05), and similarly, the average hemoglobin concentrations showed a significant association with frailty (OR 0.79; 95% CI: 0.66-0.96, p < 0.05). CONCLUSION Anemia in older adults, defined according to WHO criteria, is independently associated with frailty.
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Affiliation(s)
| | | | - Pablo Hernández-Zegarra
- Servicio de Medicina Interna, Hospital General La Mancha Centro, Alcázar de San Juan, España
| | - Pilar Atienzar-Núñez
- Servicio de Geriatría, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - Pedro Manuel Sánchez-Jurado
- Servicio de Geriatría, Complejo Hospitalario Universitario de Albacete, Albacete, España; CIBERFES, Instituto de Salud Carlos III, Madrid, España
| | - Pedro Abizanda
- Servicio de Geriatría, Complejo Hospitalario Universitario de Albacete, Albacete, España; CIBERFES, Instituto de Salud Carlos III, Madrid, España
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Palapar L, Kerse N, Rolleston A, den Elzen WPJ, Gussekloo J, Blom JW, Robinson L, Martin-Ruiz C, Duncan R, Arai Y, Takayama M, Teh R. Anaemia and physical and mental health in the very old: An individual participant data meta-analysis of four longitudinal studies of ageing. Age Ageing 2021; 50:113-119. [PMID: 32939533 DOI: 10.1093/ageing/afaa178] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To determine the physical and mental health of very old people (aged 80+) with anaemia. METHODS Individual level meta-analysis from five cohorts of octogenarians (n = 2,392): LiLACS NZ Māori, LiLACS NZ non-Māori, Leiden 85-plus Study, Newcastle 85+ Study, and TOOTH. Mixed models of change in functional ability, cognitive function, depressive symptoms, and self-rated health over time were separately fitted for each cohort. We combined individual cohort estimates of differences according to the presence of anaemia at baseline, adjusting for age at entry, sex, and time elapsed. Combined estimates are presented as differences in standard deviation units (i.e. standardised mean differences-SMDs). RESULTS The combined prevalence of anaemia was 30.2%. Throughout follow-up, participants with anaemia, on average, had: worse functional ability (SMD -0.42 of a standard deviation across cohorts; CI -0.59,-0.25); worse cognitive scores (SMD -0.27; CI -0.39,-0.15); worse depression scores (SMD -0.20; CI -0.31,-0.08); and lower ratings of their own health (SMD -0.36; CI -0.47,-0.25). Differential rates of change observed were: larger declines in functional ability for those with anaemia (SMD -0.12 over five years; CI -0.21,-0.03) and smaller mean difference in depression scores over time between those with and without anaemia (SMD 0.18 over five years; CI 0.05,0.30). CONCLUSION Anaemia in the very old is a common condition associated with worse functional ability, cognitive function, depressive symptoms, and self-rated health, and a more rapid decline in functional ability over time. The question remains as to whether anaemia itself contributes to worse outcomes or is simply a marker of chronic diseases and nutrient deficiencies.
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Affiliation(s)
- Leah Palapar
- Department of General Practice and Primary Health Care, School of Population Health, The University of Auckland, New Zealand
| | - Ngaire Kerse
- Department of General Practice and Primary Health Care, School of Population Health, The University of Auckland, New Zealand
| | | | - Wendy P J den Elzen
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
- Department of Internal Medicine, Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeanet W Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Louise Robinson
- Population Health Sciences Institute, Newcastle University, United Kingdom
| | | | - Rachel Duncan
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Yasumichi Arai
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Japan
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Portugal-Nunes C, Castanho TC, Amorim L, Moreira PS, Mariz J, Marques F, Sousa N, Santos NC, Palha JA. Iron Status is Associated with Mood, Cognition, and Functional Ability in Older Adults: A Cross-Sectional Study. Nutrients 2020; 12:E3594. [PMID: 33238615 PMCID: PMC7700455 DOI: 10.3390/nu12113594] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/02/2020] [Accepted: 11/19/2020] [Indexed: 01/04/2023] Open
Abstract
Several conditions are risk factors for iron deficiency (ID), some of which are highly prevalent in older individuals. Despite the amount of evidence pointing for a role of ID in cognition, mood and physical functional ability, the research addressing these associations in older individuals is still scarce. In the present study, 162 older community-dwelling individuals (29.53% classified as ID) were enrolled in a cross-sectional analysis and characterized regarding cognition, mood, functional ability, general nutritional intake and iron status. Assessment of iron status was performed using several blood biomarkers. Storage and erythropoiesis dimensions were positively associated with memory, along with an interaction (moderator effect) between iron storage and nutritional status. A more depressed mood was negatively associated with (iron) transport, transport saturation and erythropoiesis dimensions, and functional tiredness was positively associated with the erythropoiesis dimension. These observations indicate that lower iron status is associated with depressive mood, functional tiredness and poorer memory ability, with the latter moderated by nutritional status. These findings suggest that using iron as a continuous variable may be useful in finding associations with iron homeostasis, eventually missed when iron levels are considered within the usual classification groups.
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Affiliation(s)
- Carlos Portugal-Nunes
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (C.P.-N.); (T.C.C.); (L.A.); (P.S.M.); (J.M.); (F.M.); (N.S.); (N.C.S.)
- ICVS/3B′s, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
- Clinical Academic Center—Braga, 4710-243 Braga, Portugal
| | - Teresa Costa Castanho
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (C.P.-N.); (T.C.C.); (L.A.); (P.S.M.); (J.M.); (F.M.); (N.S.); (N.C.S.)
- ICVS/3B′s, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
- Clinical Academic Center—Braga, 4710-243 Braga, Portugal
| | - Liliana Amorim
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (C.P.-N.); (T.C.C.); (L.A.); (P.S.M.); (J.M.); (F.M.); (N.S.); (N.C.S.)
- ICVS/3B′s, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
- Associação Centro de Medicina P5 (ACMP5), 4710-057 Braga, Portugal
| | - Pedro Silva Moreira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (C.P.-N.); (T.C.C.); (L.A.); (P.S.M.); (J.M.); (F.M.); (N.S.); (N.C.S.)
- ICVS/3B′s, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
- Clinical Academic Center—Braga, 4710-243 Braga, Portugal
| | - José Mariz
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (C.P.-N.); (T.C.C.); (L.A.); (P.S.M.); (J.M.); (F.M.); (N.S.); (N.C.S.)
- ICVS/3B′s, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
- Clinical Academic Center—Braga, 4710-243 Braga, Portugal
- Emergency Department, Intermediate Care Unit (EDIMCU), Hospital de Braga, 4710-243 Braga, Portugal
| | - Fernanda Marques
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (C.P.-N.); (T.C.C.); (L.A.); (P.S.M.); (J.M.); (F.M.); (N.S.); (N.C.S.)
- ICVS/3B′s, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (C.P.-N.); (T.C.C.); (L.A.); (P.S.M.); (J.M.); (F.M.); (N.S.); (N.C.S.)
- ICVS/3B′s, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
- Clinical Academic Center—Braga, 4710-243 Braga, Portugal
| | - Nadine Correia Santos
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (C.P.-N.); (T.C.C.); (L.A.); (P.S.M.); (J.M.); (F.M.); (N.S.); (N.C.S.)
- ICVS/3B′s, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
- Associação Centro de Medicina P5 (ACMP5), 4710-057 Braga, Portugal
| | - Joana Almeida Palha
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (C.P.-N.); (T.C.C.); (L.A.); (P.S.M.); (J.M.); (F.M.); (N.S.); (N.C.S.)
- ICVS/3B′s, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
- Clinical Academic Center—Braga, 4710-243 Braga, Portugal
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Esquinas-Requena JL, Lozoya-Moreno S, García-Nogueras I, Atienzar-Núñez P, Sánchez-Jurado PM, Abizanda P. [Anemia increases mortality risk associated with frailty or disability in older adults. The FRADEA Study]. Aten Primaria 2020; 52:452-461. [PMID: 31506204 PMCID: PMC8054287 DOI: 10.1016/j.aprim.2019.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/17/2019] [Accepted: 07/09/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To analyze if anemia increases 10-year mortality risk associated to frailty and disability in older adults. DESIGN Substudy of the FRADEA population-based concurrent cohort study (Frailty and dependence in Albacete), with a 10-year follow-up (2007-2017) in people older than 69years. SETTING Albacete city, Spain. PARTICIPANTS Of the 993 participants included in the first wave, 790 were selected with valid data on function (frailty and disability), anemia and vital status at 10years. MAIN MEASUREMENTS Anemia was defined according to the criteria of the World Health Organization (hemoglobin <13g/dL in men and <12g/dL in women). A functional classification variable was created, including frailty and disability, identifying four progressive functional levels: robust, prefrail, frail and disabled in basic activities of daily life, using frailty phenotype and Barthel index respectively. A new eight categories variable was constructed combining the four functional groups with the presence or absence of anemia. The association with mortality was determined by Kaplan-Meier and Cox proportional hazards analysis adjusted for age, sex, comorbidity, polypharmacy, institutionalization and creatinine. RESULTS Mean age was 79years and 59.6% were women. 393 participants (49.7%) died during the follow-up period. The median survival was 98.4months (interquartile range 61). The risk of mortality increased from the levels with better functionality to those with worse functionality, and for each subgroup it was higher in the participants with anemia. Prefrail without anemia HR [hazard ratio] 1.59 (95%CI 1.07-2.36) and with anemia HR 2.37 (95%CI 1.38-4.05). Frail without anemia HR 3.18 (95%CI 1.68-6.02) and with anemia HR 4.42 (95%CI 1.99-9.84). Disabled without anemia HR 3.81 (95%CI 2.45-5.84) and with anemia HR 5.48 (95%CI 3.43-8.76). CONCLUSION Anemia increases the risk of mortality associated with frailty and disability in older adults.
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Affiliation(s)
| | - Silvia Lozoya-Moreno
- Servicio de Geriatría, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | | | - Pilar Atienzar-Núñez
- Servicio de Geriatría, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - Pedro Manuel Sánchez-Jurado
- Servicio de Geriatría, Complejo Hospitalario Universitario de Albacete, Albacete, España; CIBERFES, Instituto de Salud Carlos III, Madrid, España
| | - Pedro Abizanda
- Servicio de Geriatría, Complejo Hospitalario Universitario de Albacete, Albacete, España; CIBERFES, Instituto de Salud Carlos III, Madrid, España.
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de Araújo Amaral C, Amaral TLM, Monteiro GTR, de Vasconcellos MTL, Portela MC. Factors associated with low handgrip strength in older people: data of the Study of Chronic Diseases (Edoc-I). BMC Public Health 2020; 20:395. [PMID: 32216788 PMCID: PMC7098144 DOI: 10.1186/s12889-020-08504-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/11/2020] [Indexed: 12/16/2022] Open
Abstract
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.
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Affiliation(s)
| | | | - Gina Torres Rego Monteiro
- Department of Epidemiological and Quantitative Methods in Health, National School of Public Health Sergio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, RJ Brazil
| | | | - Margareth Crisóstomo Portela
- Department of Health Administration and Planning, National School of Public Health Sergio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, RJ Brazil
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Boureau AS, de Decker L. Blood transfusion in older patients. Transfus Clin Biol 2019; 26:160-163. [DOI: 10.1016/j.tracli.2019.06.190] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 06/12/2019] [Indexed: 12/16/2022]
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Bastida JM, López-Godino O, Vicente-Sánchez A, Bonanad-Boix S, Xicoy-Cirici B, Hernández-Sánchez JM, Such E, Cervera J, Caballero-Berrocal JC, López-Cadenas F, Arnao-Herráiz M, Rodríguez I, Llopis-Calatayud I, Jiménez MJ, Del Cañizo-Roldán MC, Díez-Campelo M. Hidden myelodysplastic syndrome (MDS): A prospective study to confirm or exclude MDS in patients with anemia of uncertain etiology. Int J Lab Hematol 2018; 41:109-117. [PMID: 30290085 DOI: 10.1111/ijlh.12933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/30/2018] [Accepted: 09/07/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Diagnosis of myelodysplastic syndromes (MDSs) when anemia is the only abnormality can be complicated. The aim of our study was to investigate the primary causes of anemia and/or macrocytosis of uncertain etiology. METHODS We conducted a multicenter, prospective study over 4 months in three hematology laboratories. In step 1, we used an automated informatics system to screen 137 453 hemograms for cases of anemia and/or macrocytosis (n = 2702). In step 2, we excluded all patients whose anemia appeared to be due to a known cause. This left 290 patients had anemia of uncertain etiology. In step 3, we conducted further investigations, including a peripheral blood smear, and analysis of iron, vitamin B12, folate, and thyroid hormone levels. RESULTS A differential diagnosis was obtained in 139 patients (48%). The primary causes of anemia were iron deficiency (n = 59) and megaloblastic anemia (n = 39). In total, 25 hematologic disorders were diagnosed, including 14 patients with MDS (56%). The median age of MDS patients was 80 years, 12 had anemia as an isolated cytopenia, and most (n = 10) had lower-risk disease (IPSS-R ≤ 3.5). SF3B1 mutations were most frequent (n = 6) and correlated with the presence of ring sideroblasts (100%) and associated with better prognosis (P = 0.001). CONCLUSIONS Our prospective, four-step approach is an efficient and logical strategy to facilitate the diagnosis of MDS on the basis of unexplained anemia and/or macrocytosis, and may allow the early diagnosis of the most serious causes of anemia. Molecular analysis of genes related to MDS could be a promising diagnostic and prognostic approach.
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Affiliation(s)
| | | | | | | | - Blanca Xicoy-Cirici
- Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Badalona, Spain
| | - Jesus M Hernández-Sánchez
- Instituto de Investigacion Biomedica de Salamanca, IBMCC, Centro de Investigacion del Cancer, Universidad de Salamanca-CSIC, Salamanca, Spain
| | - Esperanza Such
- Hematology, Laboratorio de Citogenética y Biología Molecular, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Jose Cervera
- Hematology, Laboratorio de Citogenética y Biología Molecular, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | | | | | - Inés Rodríguez
- Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Badalona, Spain
| | | | - María J Jiménez
- Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Badalona, Spain
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12
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Burden and Determinants of Anemia in a Rural Population in South India: A Cross-Sectional Study. Anemia 2018; 2018:7123976. [PMID: 30112198 PMCID: PMC6077670 DOI: 10.1155/2018/7123976] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/22/2018] [Accepted: 06/14/2018] [Indexed: 12/03/2022] Open
Abstract
Background/Objectives To determine the prevalence and determinants of blood haemoglobin level and mild, moderate, and severe anemia in a sample of adults from rural Tamil Nadu, India. Subjects/Methods We recruited a sample of men and nonpregnant women aged 20 years and older. Clinical health measures included blood haemoglobin concentration and body mass index. We assessed associations between anemia outcomes and sociodemographic and dietary factors using linear and logistic regression modeling. Results A total of 753 individuals (412 women and 341 men) participated in this study. The prevalence of anemia was 57.2% among women and 39.3% among men (P<0.001). Prevalence of anemia increased with age among men (P<0.001) but not women (P>0.05). Iron intake was low; 11.7% women and 24.1% of men reported iron intakes above recommended dietary allowances (P<0.001). Factors (OR (95% CI)) associated with mild or moderate anemia among women included television ownership (0.27 (0.13, 0.58)), livestock ownership (0.46 (0.28, 0.75)), refined grain consumption (1.32 (1.02, 1.72)), meat consumption (0.84 (0.71, 0.99)), and commercial agriculture production (mild: 4.6 (1.1, 18.8); moderate: 6.8 (1.98, 23.1)). Factors associated with mild, moderate, or severe anemia among men included rurality (0.50 (0.25, 0.99)), sugar consumption (1.04 (1.01, 1.06)), egg consumption (0.80 (0.65, 0.99)), and high caste (7.3 (1.02, 52.3)). Conclusion Both women and men in this region may be particularly vulnerable to anemia, and future research must expand beyond dietary risk factors to examine the impacts of sociodemographic and environmental factors.
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13
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Abdullah HR, Sim YE, Sim YTM, Lamoureux E. Preoperative ANemiA among the elderly undergoing major abdominal surgery (PANAMA) study: Protocol for a single-center observational cohort study of preoperative anemia management and the impact on healthcare outcomes. Medicine (Baltimore) 2018; 97:e10838. [PMID: 29794778 PMCID: PMC6392554 DOI: 10.1097/md.0000000000010838] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/03/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Preoperative anemia and old age are independent risk factors for perioperative morbidity and mortality. However, despite the high prevalence of anemia in elderly surgical patients, there is limited understanding of the impact of anemia on postoperative complications and postdischarge quality of life in the elderly. This study aims to investigate how anemia impacts elderly patients undergoing major abdominal surgery in terms of perioperative morbidity, mortality and quality of life for 6 months postoperatively. METHODS AND ANALYSIS We will conduct a prospective observational study over 12 months of 382 consecutive patients above 65 years old, who are undergoing elective major abdominal surgery in Singapore General Hospital (SGH), a tertiary public hospital. Baseline clinical assessment including full blood count and iron studies will be done within 1 month before surgery. Our primary outcome is presence of morbidity at fifth postoperative day (POD) as defined by the postoperative morbidity survey (POMS). Secondary outcomes will include 30-day trend of POMS complications, morbidity defined by Clavien Dindo Classification system (CDC) and Comprehensive Complication Index (CCI), 6-month mortality, blood transfusion requirements, days alive out of hospital (DaOH), length of index hospital stay, 6-month readmission rates and Health Related Quality of Life (HRQoL). HRQoL will be assessed using EuroQol five-dimensional instrument (EQ-5D) scores at preoperative consult and at 1, 3, and 6 months. ETHICS AND DISSEMINATION The SingHealth Centralised Institutional Review Board (CIRB Ref: 2017/2640) approved this study and consent will be obtained from all participants. This study is funded by the National Medical Research Council, Singapore (HNIG16Dec003) and the findings will be published in peer-reviewed journals and presented at academic conferences. Deidentified data will be made available from Dryad Repository upon publication of the results.
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Affiliation(s)
- Hairil Rizal Abdullah
- Department of Anaesthesiology, Singapore General Hospital
- DukeNUS Medical School, Singapore, Singapore
| | | | | | - Ecosse Lamoureux
- Academic Medicine Research Institute (AMRI), DukeNUS Medical School, Singapore, Singapore
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14
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Payne CF, Davies JI, Gomez-Olive FX, Hands KJ, Kahn K, Kobayashi LC, Tipping B, Tollman SM, Wade A, Witham MD. Cross-sectional relationship between haemoglobin concentration and measures of physical and cognitive function in an older rural South African population. J Epidemiol Community Health 2018; 72:796-802. [PMID: 29680801 PMCID: PMC6109255 DOI: 10.1136/jech-2018-210449] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/02/2018] [Accepted: 04/10/2018] [Indexed: 12/18/2022]
Abstract
Background Age cohort differences in haemoglobin concentrations and associations with physical and cognitive performance among populations of lower income and middle-income countries have not previously been described. We examined the association between these factors among older men and women in rural South Africa. Methods We analysed cross-sectional data from a population-based study of rural South African men and women aged 40 and over (n=4499), with data drawn from questionnaire responses, a cognitive battery, objective physical function tests and blood tests. Anaemia was defined as a haemoglobin concentration <12 g/dL for women and <13 g/dL for men. We related haemoglobin concentrations to each of age, grip strength, walk speed and a latent cognitive function z-score for men and women separately. We used unadjusted correlations and linear models to adjust for comorbidities and inflammation. Results In total, 1042 (43.0%) women and 833 (40.1%) men were anaemic. Haemoglobin concentrations were inversely correlated with age for men but not for women; in adjusted analyses, haemoglobin was 0.3 g/dL lower per decade older for men (95% CI 0.2 to 0.4 g/dL). In adjusted analyses, haemoglobin concentration was independently associated with grip strength in women (B=0.391, 95% CI 0.177 to 0.605), but this did not reach significance in men (B=0.266, 95% CI −0.019 to 0.552); no associations were observed between haemoglobin levels and walk speed or cognitive score. Conclusions Anaemia was prevalent in this study population of middle-aged and older, rural South African adults, but in contrast to high-income countries, it was not associated with poor physical or cognitive function. Our findings need to be replicated in other populations.
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Affiliation(s)
- Collin F Payne
- Center for Population and Development Studies, Harvard University, Boston, Massachusetts, USA
| | - Justine I Davies
- School of Population Sciences and Health Services Research, Faculty of Life Sciences and Medicine, Centre for Global Health, King's College London, London, UK.,Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - F Xavier Gomez-Olive
- Center for Population and Development Studies, Harvard University, Boston, Massachusetts, USA.,Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Katherine J Hands
- Scottish National Blood Transfusion Service, Ninewells Hospital, Dundee, South Africa
| | - Kathleen Kahn
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umea, Sweden.,INDEPTH Network, Accra, Ghana
| | - Lindsay C Kobayashi
- Center for Population and Development Studies, Harvard University, Boston, Massachusetts, USA.,Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA
| | - Brent Tipping
- Division of Geriatric Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen M Tollman
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,INDEPTH Network, Accra, Ghana.,Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umea, Sweden
| | - Alisha Wade
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Miles D Witham
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Ageing and Health, School of Medicine, University of Dundee, Dundee, UK
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15
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Anpalahan M, Savvas S, Lo KY, Ng HY, Gibson S. Chronic idiopathic normocytic anaemia in older people: the risk factors and the role of age-associated renal impairment. Aging Clin Exp Res 2017; 29:147-155. [PMID: 27038455 DOI: 10.1007/s40520-016-0563-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 03/16/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To characterise the risk factors for chronic idiopathic normocytic anaemia (CINA) in older people, particularly the role of age-associated renal impairment. METHODS Patients aged ≥65 years admitted to a medical unit over 12 months were assessed. Those with secondary causes of anaemia including chronic kidney disease (CKD) were excluded. CINA was defined as a haemoglobin <130 g/l for men and <120 g/l for women for at least 6 months without any apparent cause. Renal function was determined by estimating creatinine clearance (CrCl) using Cockcroft-Gault formula, and glomerular filtration rate (GFR) using modification of diet in renal disease (MDRD) and chronic kidney disease epidemiology collaboration (CKD-EPI) formulas. RESULTS 116 had CINA. Controls were 572. The mean estimates of renal function were significantly lower in cases as compared with controls (P < 0.001). The risk of CINA increased by 12.6, 10.4 and 12 %, respectively, for each unit decrease in CrCl, MDRD-eGFR and CKD-EPI-eGFR, independent of age and other covariates. The adjusted odds ratios for CINA in those with CrCl, MDRD or CKD-EPI eGFR <60 ml/min/1.73 m2 were 2.68 (CI 1.53-4.70); 2.70 (CI 1.57-4.62) and 2.12 (CI 1.46-3.74), respectively. Other covariates in the model that were independently associated with CINA included advanced age, diabetes mellitus (DM), use of angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB), history of dementia and living in a residential care facility. CONCLUSIONS Age-associated renal impairment independently contributes to CINA. Other potential risk factors for CINA include advanced age, DM and ACEI or ARB use.
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Affiliation(s)
- Mahesan Anpalahan
- Department of General Medicine, Western Health, Melbourne, Australia.
- Department of Medicine, North West Academic Centre, The University of Melbourne, Melbourne, Australia.
- Department of General Internal Medicine, Eastern Health, Albert Street, Melbourne, VIC, 3156, Australia.
| | - Steven Savvas
- National Ageing Research Institute (NARI), Melbourne, Australia
| | - Kar Yan Lo
- Department of General Medicine, Western Health, Melbourne, Australia
| | - Hui Yi Ng
- Department of General Internal Medicine, Eastern Health, Albert Street, Melbourne, VIC, 3156, Australia
| | - Stephen Gibson
- National Ageing Research Institute (NARI), Melbourne, Australia
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16
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Abrahamsen JF, Monsen ALB, Landi F, Haugland C, Nilsen RM, Ranhoff AH. Readmission and mortality one year after acute hospitalization in older patients with explained and unexplained anemia - a prospective observational cohort study. BMC Geriatr 2016; 16:109. [PMID: 27221100 PMCID: PMC4879736 DOI: 10.1186/s12877-016-0284-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/16/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Few studies have examined whether specific subtypes of anemia in older persons are more related to adverse outcomes such as hospital readmissions and death after acute hospitalization and post-acute care. METHODS An observational prospective cohort study was conducted between 2011 and 2014. A total of 884 community-dwelling patients, ≥70 years of age were transferred from acute medical and orthopaedic hospital departments to a skilled nursing home where they were examined by comprehensive geriatric assessment and had laboratory tests taken for the investigation of anemia. They were divided into three major groups and compared; 1) no anemia (reference group), 2) explained anemia (renal insufficiency, iron deficiency, vitaminB12/folate deficiency or multifactorial anemia) and 3) unexplained anemia. The groups were compared, and association of anemia with hospital readmission and death was estimated by logistic regression analyses. RESULTS Compared to the patients with unexplained anemia (n=135), patients with explained anemia (n=275) had more often died (22 % vs. 14 %, p=0.05) and had more frequenlty been readmitted to hospital (39 % vs. 27 %, p=0.03). Compared to the patients without anemia (n=474), the patients with explained anemia had increased odds of hospital readmissions (OR = 1.54 (95 % CI: 1.05-2.25), p=0.03), while patients with unexplained anemia, (n=135), had neither increased odds of hospital readmissions, (OR=0.83, 95 % CI: 0.51-1.34, p=0.44) nor death (OR = 0.74, 95 % CI: 0.41-1.31, p=0.30), in adjusted regression analysis. CONCLUSION Since no increased risk of hospital readmissions or death was seen in older patients with unexplained anemia in the first year after acute hospitalization, no further invasive investigations might be necessary to investigate the cause of anemia in these patients. A close clinical follow up might be the best way to care for older patients with a mild and unexplained anemia.
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Affiliation(s)
- Jenny Foss Abrahamsen
- Kavli Research Centre for Geriatrics and Dementia, Haraldsplass Deaconess Hospital, Ulriksdal 8, Bergen, 5009, Norway. .,Department of Nursing Home Medicine, Municipality of Bergen, Norway.
| | | | - Francesco Landi
- Facoltà di Medicina e chirurgia, Universita Cattoloca del Sacro Cuore, Rome, Italy
| | | | - Roy Miodini Nilsen
- Centre for Clinical Research, Haukeland -University Hospital, Bergen, Norway
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17
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Perdomo-Ramírez B, Socorro-García A, Baztán-Cortés JJ. [Anaemia and mortality after admission to an acute geriatric unit]. Rev Esp Geriatr Gerontol 2015; 50:298-299. [PMID: 26186984 DOI: 10.1016/j.regg.2015.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 06/11/2015] [Indexed: 06/04/2023]
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18
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Pires Corona L, Drumond Andrade FC, de Oliveira Duarte YA, Lebrao ML. The Relationship between Anemia, Hemoglobin Concentration and Frailty in Brazilian Older Adults. J Nutr Health Aging 2015; 19:935-40. [PMID: 26482696 DOI: 10.1007/s12603-015-0502-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE to explore the relationship between anemia, hemoglobin concentration and frailty syndrome in older adults. RESEARCH METHODS AND PROCEDURES This was a cross-sectional population-based study, with adults ≥60 years (n=1,256) from the third wave of the SABE Cohort Study (Health, Well-being and Aging) conducted in 2010 in São Paulo, Brazil. Frailty syndrome was evaluated according to Fried´s phenotype. Anemia was defined using the WHO criteria (hemoglobin concentration <12 g/dL for women and <13 g/dL for men). Four approaches were used to verify the associations between anemia, hemoglobin concentration and frailty status or number of frailty criteria. We used logistic regression and Poisson regression in the analyses, and they were adjusted in three hierarchical models using three blocks of variables: basic characteristics; clinical characteristics; cognitive status. RESULTS Mean hemoglobin concentration was significantly lower in frail elderly (13.3g/dL, versus 14.3g/dL in non-frail; p<0.001). Prevalence of anemia was also significantly higher in frail when compared to non-frail elderly (24.2% and 3.8%; p<0.001). Anemia was significantly associated to low physical activity, weakness and slowness. In the fully adjusted regression models, anemia was strongly associated to frailty (OR=3.27, 95%IC=1.89,5.65; p<0.001), and lower levels of hemoglobin were associated to higher number of frailty criteria. CONCLUSIONS We found important associations between anemia, hemoglobin concentration and frailty; anemic older adults were more likely to be frail, and lower levels of hemoglobin were associated to higher number of frailty criteria showing a clear dose-response effect.
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Affiliation(s)
- L Pires Corona
- Ligiana Pires Corona, University of Campinas, Nutrition, R. Pedro Zaccaria, 1300, Limeira, Sao Paulo 13484-35, 0, Brazil,
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19
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Abstract
Aging occurs as a series of small steps, first causing cellular damage and then affecting tissues and organs. This is also true in the brain. Frailty, a state of increased risk due to accelerated deficit accumulation, is robustly a risk factor for cognitive impairment. Community-based autopsy studies show that frail individuals have brains that show multiple deficits without necessarily demonstrating cognitive impairment. These facts cast a new light on the growing number of risk factors for cognitive impairment, suggesting that, on a population basis, most health deficits can be associated with late-life cognitive impairment. The systems mechanism by which things that are bad for the body are likely to be bad for the brain can be understood like this: the burden of health deficits anywhere indicates impaired ability to withstand or repair endogenous and environmental damage. This in turn makes additional damage more likely. If true, this suggests that a life course approach to preventing cognitive impairment is desirable. Furthermore, conducting studies in highly selected, younger, healthier individuals to provide ‘proof of concept’ information is now common. This strategy might exclude the very circumstances that are required for disease expression in the people in whom dementia chiefly occurs (that is, older adults who are often in poor health).
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Affiliation(s)
- Samuel D Searle
- Department of Medicine, Dalhousie University, 1421-5955 Veterans' Memorial Lane, Halifax, NS B3H 2E1 Canada ; Capital District Health Authority, 1421-5955 Veterans' Memorial Lane, Halifax, NS B3H 2E1 Canada
| | - Kenneth Rockwood
- Department of Medicine, Dalhousie University, 1421-5955 Veterans' Memorial Lane, Halifax, NS B3H 2E1 Canada ; Centre for Health Care of Elderly, Division of Geriatric Medicine QEII Health Sciences Centre, Capital District Health Authority, 1421-5955 Veterans' Memorial Lane, Halifax, NS B3H 2E1 Canada
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20
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Looker AC. Hemoglobin and hip fracture risk in older non-Hispanic white adults. Osteoporos Int 2014; 25:2389-98. [PMID: 24938506 PMCID: PMC4759638 DOI: 10.1007/s00198-014-2769-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 06/05/2014] [Indexed: 10/25/2022]
Abstract
SUMMARY The relationship between hemoglobin and hip fracture was examined in older non-Hispanic white adults from the third National Health and Nutrition Examination Survey (NHANES III). Both low and high hemoglobin values were associated with increased hip fracture risk before and after adjusting for selected risk factors. INTRODUCTION The few studies to date that have examined the relationship between hemoglobin and fracture risk have focused on low hemoglobin values. The present study examined hip fracture risk across the hemoglobin distribution in older non-Hispanic white adults from the third National Health and Nutrition Examination Survey (NHANES III, 1988-1994). METHODS Hemoglobin was measured using a Coulter S-plus Jr.® (Coulter Electronics, Hialeah, FL) in 2,122 non-Hispanic whites age 65 years and older. Hip fracture cases were identified using linked Medicare and mortality records obtained through 2007. Cox proportional hazards models were used to assess the best-fitting model and to estimate the hazards ratio (HR) for hip fracture by hemoglobin decile before and after adjusting for selected confounders. RESULTS There were 239 hip fracture cases in the analytic sample. The best fitting model was quadratic. When compared to values in the middle of the distribution, those with hemoglobin in the lowest and highest deciles had increased hip fracture risk (HRlowest decile = 2.96, 95 % confidence interval (CI) 1.44-6.08; HRhighest decile = 2.06, 95 % CI 1.09-3.92) after adjusting for age and sex. Both HRs remained significant after adjusting for additional confounders (HRlowest decile = 2.24, 95 % CI 1.09-3.92; HRhighest decile = 2.37, 95 % CI 1.35-4.16). CONCLUSIONS Both low and high hemoglobin values were associated with increased hip fracture risk. The mechanism underlying the relationship is not clear, but there were some suggestions that it may differ for low versus high hemoglobin.
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Affiliation(s)
- A C Looker
- National Center for Health Statistics, Centers for Disease Control and Prevention, Room 4310, 3311 Toledo Rd, Hyattsville, MD, 2078, USA,
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Jonassaint CR, Varma VR, Chuang YF, Harris GC, Yasar S, Polinder-Bos H, Carlson MC. Lower hemoglobin is associated with poorer cognitive performance and smaller brain volume in older adults. J Am Geriatr Soc 2014; 62:972-3. [PMID: 24828925 DOI: 10.1111/jgs.12810] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Naeim A, Aapro M, Subbarao R, Balducci L. Supportive care considerations for older adults with cancer. J Clin Oncol 2014; 32:2627-34. [PMID: 25071112 DOI: 10.1200/jco.2014.55.3065] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The treatment of cancer presents specific concerns that are unique to the growing demographic of elderly patients. Because the incidence of cancer is strongly correlated with aging, the expansion of supportive care and other age-appropriate therapies will be of great importance as the population of elderly patients with cancer increases in the coming years. Elderly patients are especially likely to experience febrile neutropenia, complications from chemotherapy-induced nausea, anemia, osteoporosis (especially in patients diagnosed with breast or prostate cancer), depression, insomnia, and fatigue. These issues are often complicated by other chronic conditions related to age, such as diabetes and cardiac disease. For many patients, symptoms may be addressed both through lifestyle management and pharmaceutical approaches. Therefore, the key to improving quality of life for the elderly patient with cancer is an awareness of their specific needs and a familiarity with emergent treatment options.
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Affiliation(s)
- Arash Naeim
- Arash Naeim, Rashmi Subbarao, University of California Los Angeles, Los Angeles CA; Lodovico Balducci, Moffitt Cancer Center, Tampa FL; Matti Aapro, The Multidisciplinary Oncology Institute of Clinique de Genolier, Genolier, Switzerland.
| | - Matti Aapro
- Arash Naeim, Rashmi Subbarao, University of California Los Angeles, Los Angeles CA; Lodovico Balducci, Moffitt Cancer Center, Tampa FL; Matti Aapro, The Multidisciplinary Oncology Institute of Clinique de Genolier, Genolier, Switzerland
| | - Rashmi Subbarao
- Arash Naeim, Rashmi Subbarao, University of California Los Angeles, Los Angeles CA; Lodovico Balducci, Moffitt Cancer Center, Tampa FL; Matti Aapro, The Multidisciplinary Oncology Institute of Clinique de Genolier, Genolier, Switzerland
| | - Lodovico Balducci
- Arash Naeim, Rashmi Subbarao, University of California Los Angeles, Los Angeles CA; Lodovico Balducci, Moffitt Cancer Center, Tampa FL; Matti Aapro, The Multidisciplinary Oncology Institute of Clinique de Genolier, Genolier, Switzerland
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Prevalence of anemia among elderly inpatients and its association with multidimensional loss of function. Ann Hematol 2014; 93:1645-54. [DOI: 10.1007/s00277-014-2110-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 05/09/2014] [Indexed: 01/08/2023]
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Ascenzi P, Gustincich S, Marino M. Mammalian nerve globins in search of functions. IUBMB Life 2014; 66:268-76. [DOI: 10.1002/iub.1267] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 04/02/2014] [Indexed: 12/24/2022]
Affiliation(s)
- Paolo Ascenzi
- Interdepartmental Laboratory of Electron Microscopy; University Roma Tre; Roma Italy
| | | | - Maria Marino
- Department of Science; University Roma Tre; Roma Italy
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Corona LP, Andrade FCD, Duarte YADO, Lebrao ML. The association of hemoglobin concentration with disability and decreased mobility among older Brazilians. J Nutr Health Aging 2014; 18:336-41. [PMID: 24626764 DOI: 10.1007/s12603-013-0389-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To examine the association between hemoglobin concentration and disability and mobility difficulty among older adults living in São Paulo, Brazil. DESIGN Cross-sectional study. SETTING Population-based study conducted in São Paulo, Brazil. PARTICIPANTS Adults age 60 and over (n=1,256) from the third data collection wave of the SABE Study (Health, Well-being, and Aging) conducted in 2010. MEASUREMENTS Two outcome measures were included in the analyses: 1) a difficulty to perform at least one of the instrumental activities of daily living (IADL) and 2) mobility difficulty, which was assessed using the Short Physical Performance Battery (SPPB). Logistic regression models assessed the association between hemoglobin and each of the outcome measures. All analyses were adjusted for sociodemographic and health characteristics. RESULTS The prevalence of IADL disability was 26.8% and 10.7% of participants had mobility difficulty. The mean hemoglobin concentration was significantly lower in older adults who already presented disability (13.7g/dL versus 14.4g/dL among independent elderly) or decreased mobility (13.4g/dL versus 14.3g/dL among elderly with preserved mobility). Higher values of hemoglobin concentration were associated with lower the risk of IADL disability (OR=0.88; p=0.04) and mobility difficulty (OR=0.81; p=0.02). Hemoglobin concentrations showed a dose-response effect in the probability of each outcome. CONCLUSIONS Lower hemoglobin concentration was associated with a higher probability of IADL disability and mobility difficulty, showing a clear dose-response effect.
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Affiliation(s)
- L Pires Corona
- Ligiana Pires Corona, MS, Faculty of Public Health, Sao Paulo, Sao Paulo Brazil,
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Manu P, Grudnikoff E, Khan S, Kremen NJ, Greenwald BS, Kane JM, Correll CU. Medical outcome of patients with dementia in a free-standing psychiatric hospital. J Geriatr Psychiatry Neurol 2013; 26:29-33. [PMID: 23407398 DOI: 10.1177/0891988712473799] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The hospital outcome of patients with dementia is significantly worse than that of cognitively intact persons of the same age admitted to medical or surgical units but has not been investigated in psychiatric settings. AIM OF STUDY To determine the medical outcome of patients with dementia admitted for behavioral disturbance to a free-standing psychiatric hospital. METHODS Emergency transfers from the psychiatric setting to a general hospital were used as proxies for medical deteriorations occurring among the 71 patients with dementia (age 78.4 ± 10.4 years; 40.1% males) and 71 age- and gender-matched nondementia control patients. The patients were identified in a cohort of 1000 patients consecutively admitted to a free-standing mental health institution. Logistic regression was used to determine the clinical and laboratory variables independently associated with medical deteriorations. RESULTS A total of 30 patients with dementia and 25 nondementia patients were transferred to a general hospital after an acute medical deterioration (42.3% vs 35.2%, P = .38). Febrile illnesses and falls with head trauma were the most common reasons for transfers in the dementia group, in which they constituted more than half of medical deteriorations, a proportion significantly higher than in the control group (P = .011). Admission hemoglobin levels were the only independent predictor of medical deterioration in this geriatric sample. CONCLUSIONS Although nearly 50% of patients with dementia admitted for behavioral disturbance to a free-standing psychiatric institution required transfer to a general hospital, their rate of medical deteriorations was similar to age-matched nondementia control patients.
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Affiliation(s)
- Peter Manu
- The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY 11004, USA
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Silva CLÁD, Lima-Costa MF, Firmo JOA, Peixoto SV. Nível de hemoglobina entre idosos e sua associação com indicadores do estado nutricional e uso de serviços de saúde: Projeto Bambuí. CAD SAUDE PUBLICA 2012; 28:2085-94. [DOI: 10.1590/s0102-311x2012001100008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 08/17/2012] [Indexed: 01/23/2023] Open
Abstract
O objetivo deste estudo foi descrever a prevalência de anemia e avaliar a associação de nível de hemoglobina (Hb) com indicadores do estado nutricional e uso de serviços de saúde em uma população idosa (≥ 60 anos). Dos 1.742 idosos participantes da linha de base da coorte de Bambuí, Minas Gerais, Brasil, foram incluídos 1.441 (82,7%). A variável dependente foi o nível de Hb e as independentes foram número de hospitalizações e visitas ao médico nos 12 meses precedentes à entrevista, índice de massa corporal (IMC) e albumina sérica. Foi realizada regressão linear multivariada estratificada por sexo e ajustada por fatores de confusão. A prevalência de anemia foi baixa na população (4,5%), sem diferenças entre sexos e significativamente maior em idosos mais velhos (10,2%). Baixos níveis de Hb foram associados ao maior número de consultas médicas e a menores valores de albumina sérica e IMC em ambos os sexos. O estudo sugere um ciclo complexo entre baixos níveis de Hb, desnutrição e atendimento médico, o que deve ser considerado na estruturação de programas de saúde para idosos.
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Abstract
Developed countries, such as the United Kingdom, are experiencing a change in demographics resulting in the largest proportion of adults over 65 years of age that our health systems have ever experienced. As such, haematologists must be prepared to evaluate and treat anaemia in a more complicated patient population, but sufficient evidence-based guidelines are lacking. Critical next steps that must be taken to ensure the best care of this population include the determination of appropriate haemoglobin concentrations for older adults in light of age, gender, race, and comorbidities; the development of interventional trials that address physical performance outcomes in addition to haemoglobin targets; and translational studies which address the molecular pathogenesis of anaemia in older adults with the most advanced scientific approaches.
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Affiliation(s)
- Akil A. Merchant
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Cindy N. Roy
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Eaton CB, Hochberg MC, Assaf A, Cryer BL, Lu B, Sands G, Rodriguez B, LaCroix A, Lessin L, Limacher MC, Fugate Woods N, Connelly S, Chen Z. The cross-sectional relationship of hemoglobin levels and functional outcomes in women with self-reported osteoarthritis: results from the Women's Health Initiative. Semin Arthritis Rheum 2011; 41:406-14. [PMID: 21723591 PMCID: PMC5369766 DOI: 10.1016/j.semarthrit.2011.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 03/11/2011] [Accepted: 04/13/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Gastrointestinal blood loss is a recognized complication of the use of nonsteroidal anti-inflammatory drugs (NSAIDS) in patients with arthritis. We examined the cross-sectional relationship of patient-reported outcomes of overall health, physical function, vitality, and quality of life to hemoglobin (hgb) levels in postmenopausal women with self-reported osteoarthritis to determine whether hgb levels as potential markers of chronic blood loss were associated with these functional outcomes. METHODS Postmenopausal women (N = 64,850) with self-reported osteoarthritis (srOA) at baseline in the Women's Health Initiative study, excluding participants with chronic or hemolytic diseases associated with anemia, had hgb levels measured and completed Short-Form Health Surveys. General linear models analysis adjusting for potential confounders was performed. RESULTS A nonlinear plateauing relationship between hgb levels and functional outcomes was found. Participants with srOA had statistically significantly worse overall health, physical function, and vitality, but not quality of life, for each gram of hgb below 14 g/dL, compared with those with hgb 14 g/dL (P < 0.001). Participants with srOA taking NSAIDS had worse functional outcomes for each level of hgb compared with those not reporting NSAIDS use. CONCLUSIONS In cross-sectional analyses of postmenopausal women with srOA, differences in hgb levels are related to differences in functional outcomes of overall health, physical function, and vitality at clinically important levels. Prospective studies evaluating whether changes in hgb levels result in changes in functional outcomes in participants with osteoarthritis are needed to confirm of our findings and before any changes in therapeutics based on hemoglogin levels are considered in the care of patients with osteoarthritis.
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Affiliation(s)
- Charles B Eaton
- Alpert Medical School of Brown University, Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, RI 02860, USA.
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Maggio M, Ceda GP, Lauretani F, Bandinelli S, Metter EJ, Guralnik JM, Basaria S, Cattabiani C, Luci M, Dall'Aglio E, Vignali A, Volpi R, Valenti G, Ferrucci L. Gonadal status and physical performance in older men. Aging Male 2011; 14:42-7. [PMID: 20937007 PMCID: PMC3142745 DOI: 10.3109/13685538.2010.518179] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To test the relationship between gonadal status and objective measures and determinants of physical performance in older men and their determinants. METHODS The study included 455 ≥ 65 year older men of InCHIANTI study, Italy, with complete data on testosterone levels, hand grip strength, cross-sectional muscle area (CSMA), short physical performance battery (SPPB). Linear models were used to test the relationship between gonadal status and determinants of physical performance. RESULTS Three different groups of older men were created: (1) severely hypogonadal (N=23), total testosterone levels ≤ 230 ng /dl; (2) moderately hypogonadal (N=88), total testosterone >230 and < 350 ng/dl) and (3) eugonadal (N=344), testosterone levels ≥ 350 ng/dl. With increased severity of hypogonadal status, participants were significantly older while their BMI was substantially similar. In the age and BMI adjusted analysis, there was a significant difference in haemoglobin levels, hand grip strength and SPPB score (p for trend < 0.001) among three groups, with severely hypogonadal men having lower values of haemoglobin, muscle strength and physical performance. We found no association between testosterone group assignment and calf muscle mass and 4 m walking speed. In the multivariate analysis grip strength (p for trend = 0.004) and haemoglobin (p for trend < 0.0001) but not SPPB and other determinants of physical performance were significantly different between the three groups. CONCLUSIONS In older men, gonadal status is independently associated with some determinants (haemoglobin and muscle strength) of physical performance.
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Affiliation(s)
- Marcello Maggio
- Department of Internal Medicine and Biomedical Sciences, Section of Geriatrics, University of Parma, Italy.
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Strand V, Cryer B, Luo X, Bushmakin AG, Cappelleri JC, Cuffel B, Sands G, Assaf AR. Effect of Blood Loss on Physical Function in Arthritis Patients: A Pooled Analysis. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.ehrm.2010.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Urrutia A, Sacanella E, Mascaro J, Formiga F. [Anemia in the elderly]. Rev Esp Geriatr Gerontol 2010; 45:291-7. [PMID: 20692732 DOI: 10.1016/j.regg.2010.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 06/10/2010] [Accepted: 06/10/2010] [Indexed: 10/19/2022]
Abstract
Anemia is a common disorder in the elderly and is associated with increased morbidity and mortality. In elderly subjects, in whom anemia is highly prevalent, there are several aspects, such as a hemoglobin at a level which should concern us limit, or identifying its causes, that are not easy to establish. This review focuses on knowing what is considered to be normal hemoglobin levels in adults and the common causes and potential consequences of anemia in elderly patients. It provides a diagnostic algorithm and an approach to treatment that addresses new treatments such as parenteral iron drugs and erythropoiesis-stimulating agents.
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Affiliation(s)
- Agustín Urrutia
- Servicio de Medicina Interna, Unidad de Geriatría de Agudos, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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Chaves PH, Deal JA, Carlson MC. RESPONSE LETTER TO DR. FINUCANE. J Am Geriatr Soc 2010. [DOI: 10.1111/j.1532-5415.2010.02830.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ria R, Moschetta M, Reale A, Mangialardi G, Castrovilli A, Vacca A, Dammacco F. Managing myelodysplastic symptoms in elderly patients. Clin Interv Aging 2009; 4:413-23. [PMID: 19966910 PMCID: PMC2785865 DOI: 10.2147/cia.s5203] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Indexed: 11/23/2022] Open
Abstract
Most patients with myelodysplastic syndromes (MDS) are elderly (median age range 65 to 70 years); as a consequence, the incidence and prevalence of these diseases are rising as the population ages. Physicians are often uncertain about how to identify patients who may benefit from specific treatment strategies. The International Prognostic Scoring System is a widely used tool to assess the risk of transformation to leukemia and to guide treatment decisions, but it fails to take into account many aspects of treating elderly patients, including comorbid illnesses, secondary causes of MDS, prior therapy for MDS, and other age-related health, functional, cognitive, and social problems that affect the outcome and managing of myelodysplastic symptoms. Patients with low-risk disease traditionally have been given only best supportive care, but evidence is increasing that treatment with novel non-conventional drugs such as lenalidomide or methyltransferase inhibitors may influence the natural history of the disease and should be used in conjunction with supportive-care measures. Supportive care of these patients could also be improved in order to enhance their quality of life and functional performance. Elderly patients commonly have multiple medical problems and use medications to deal with these. In addition, they are more likely to have more than one health care provider. These factors all increase the risk of drug interactions and the consequent treatment of toxicities. Manifestations of common toxicities or illnesses may be more subtle in the elderly, owing to age-associated functional deficits in multiple organ systems. Particularly important to the elderly MDS patient is the age-related decline in normal bone marrow function, including the diminished capacity of response to stressors such as infection or myelosuppressive treatments. Through the integration of geriatric and oncological strategies, a personalized approach toward this unique population may be applied. As with many diseases in the elderly, reliance on family members or friends to maintain the prescribed treatments, including travel to and from appointments, may place additional stressors on the patient and his/her support network. Careful evaluation and knowledge of functional status, ability to tolerate treatments, effect of disease progression, and general overall health conditions can provide the best opportunity to support these patients. Immediate assessment of daily living activities may detect deficiencies or deficits that often require early interventions.
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Affiliation(s)
- R Ria
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Medical School, Bari, Italy.
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Affiliation(s)
- Kushang V Patel
- Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, NIH, Bethesda, MD, USA.
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