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..
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Mukhopadhyay D, Mohanaruban K. Iron deficiency anaemia in older people: investigation, management and treatment. Age and Ageing 2002;31(2):87–91.
Steensma DP, Tefferi A. Anemia in the elderly: How should we define it, when does it matter, and what can be done? Mayo Clinic Proceedings. 2007;82(8):958–66.
Chaves P. Functional outcomes of anemia in older adults. Semin Hematol 2008; 45(4):255–60.
Maraldi C, Ble A, Zuliani G, Guralnik JM, Mussi C, Fellin R, et al. Association between anemia and physical disability in older patients: role of comorbidity. Aging Clinical and Experimental Research 2006;18(6):485–92.
Chaves PHM, Ashar B, Guralnik JM, Fried LP. Looking at the relationship between hemoglobin concentration and prevalent mobility difficulty in older women. Should the criteria currently used to define anemia in older people be reevaluated? Journal of the American Geriatrics Society 2002;50(7):1257–64.
Patel KV, Harris TB, Faulhaber M, Angleman SB, Connelly S, Bauer DC, et al. Racial variation in the relationship of anemia with mortality and mobility disability among older adults. Blood 2007;109:4663–70.
Peters R, Burch L, Warner J, Beckett N, Poulter R, Bulpitt C. Haemoglobin, anaemia, dementia and cognitive decline in the elderly, a systematic review. BMC Geriatr 2008;8:18.
Terekeci HM, Kucukardali Y, Onem Y, Erikci AA, Kucukardali B, Sahan B, et al. Relationship between anaemia and cognitive functions in elderly people. Eur J Intern Med 2010;21(2):87–90.
Denny SD, Kuchibhatla MN, Cohen HJ. Impact of anemia on mortality, cognition, and function in community-dwelling elderly. Am J Med 2006;119(4):327–34.
Lucca U, Tettamanti M, Mosconi P, Apolone G, Gandini F, Nobili A, et al. Association of mild anemia with cognitive, functional, mood and quality of life outcomes in the elderly: the «Health and Anemia» study. PLoS One 2008;3(4):e1920.
Zakai NA, Katz R, Hirsch C, Shlipak MG, Chaves PHM, Newman AB, et al. A prospective study of anemia status, hemoglobin concentration, and mortality in an elderly cohort- The cardiovascular health study. Archives of Internal Medicine 2005; 165(19):2214–20.
Leng S, Chaves P, Koenig K, Walston J. Serum interleukin-6 and hemoglobin as physiological correlates in the geriatric syndrome of frailty: A pilot study. Journal of the American Geriatrics Society 2002;50(7):1268–71.
Chaves P, Semba R, Leng S, Woodman R, Ferrucci L, Guralnik J, et al. Impact of anemia and cardiovascular disease on frailty status of community-dwelling older women: The Women’s Health and Aging Studies I and II. Journals of Gerontology Series a-Biological Sciences and Medical Sciences 2005;60(6):729–35.
Fried L, Walston J, Ferrucci L. Frailty. In: Halter J, Ouslander J, Tinetti M, Studenski S, High K, Ashtana S, editors. Hazzard´s Geriatric Medicine and Gerontology. 6th ed: McGraw-Hill Medical; 2009. p. 631–46.
Fried LP, Xue QL, Cappola AR, Ferrucci L, Chaves P, Varadhan R, et al. Nonlinear Multisystem Physiological Dysregulation Associated With Frailty in Older Women: Implications for Etiology and Treatment. Journals of Gerontology Series a-Biological Sciences and Medical Sciences 2009;64(10):1049–57.
Andrade FCD, Guevara PE, Lebrao ML, Duarte YAO, Santos JL. Gender differences in life expectancy and disability-free life expectancy among older adults in Sao Paulo, Brazil. Womens Health Issues 2011;21(1):64–70.
Pires Corona L, Drumond Andrade FC, de Oliveira Duarte YA, Lebrao ML. The Association of Hemoglobin Concentration with Disability and Decreased Mobility among Older Brazilians. J Nutr Health Aging 2014;18(3):336–41.
Lebrão ML, Laurenti R. Saúde, bem-estar e envelhecimento: o estudo SABE no Município de São Paulo.. Rev Bras Epidemiol 2005;8:127–41.
WHO. Iron deficiency anaemia. Geneva: 2001.
Fried L, Tangen C, Walston J, Newman A, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56(3):M146–56.
OPAS. XXXVI Reunión del Comité Asesor de Investigaciones en Salud–Encuesta Multicéntrica — Salud Bienestar y Envejecimiento (SABE) en América Latina e el Caribe — Informe preliminar.. Kingston, Jamaica: División de Promoción Y Protección de la Salud. OPAS; 2001.
Icaza MC, Albala C. PROJETO SABE. Minimental State Examination (MMSE) del Studio de dementia en Chile: análisis estatístico. OPAS; 1999. p. 1–18.
Roy C. Anemia in frailty. Clin Geriatr Med 2011;27(1):67–78.
Morley JE. Frailty: diagnosis and management. J Nutr Health Aging 2011;15(8): 667–70.
Xue QL, Bandeen-Roche K, Varadhan R, Zhou J, Fried LP. Initial Manifestations of Frailty Criteria and the Development of Frailty Phenotype in the Women’s Health and Aging Study II. Journals of Gerontology Series a-Biological Sciences and Medical Sciences 2008;63(9):984–90.
Vanasse GJ, Berliner N. Anemia in elderly patients: an emerging problem for the 21st century. Hematology Am Soc Hematol Educ Program 2010;2010:271–5.
Walston J, McBurnie MA, Newman A, Tracy RP, Kop WJ, Hirsch CH, et al. Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities- Results from the Cardiovascular Health Study. Archives of Internal Medicine 2002;162(20):2333–41.
Ershler WB, Keller ET. Age-associated increased interleukin-6 gene expression, late-life diseases, and frailty. Annual Review of Medicine 2000;51:245–70.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pires Corona, L., Drumond Andrade, F.C., de Oliveira Duarte, Y.A. et al. The relationship between anemia, hemoglobin concentration and frailty in Brazilian older adults. J Nutr Health Aging 19, 935–940 (2015). https://doi.org/10.1007/s12603-015-0502-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12603-015-0502-3