Impact of anemia and cardiovascular disease on frailty status of community-dwelling older women: the Women's Health and Aging Studies I and II.
BACKGROUND
The physiological basis of the geriatric syndrome of frailty, a clinical state of increased vulnerability to adverse outcomes such as disability and mortality, remains to be better characterized. We examined the cross-sectional relationship between hemoglobin (Hb) and a recently-validated measure of frailty in community-dwelling older women, and whether this relationship was modified by cardiovascular disease (CVD) status.


METHODS
Data were pooled from women 70-80 years old participating in the Women's Health and Aging Studies I and II (Baltimore, MD, 1992-1996) with known frailty status and Hb > or = 10 g/dL (n = 670). Logistic regression was used to model the relationship between frailty and Hb, adjusting for demographics, major chronic diseases, and physiologic and functional impairments.


RESULTS
Prevalence of frailty was 14%. Frailty risk was highest at the lowest Hb levels, and lowest at mid-normal Hb levels (e.g., 13-14 g/dL). Mildly low and low-normal Hb concentrations were independently associated with frailty. Compared to an Hb concentration equal to 13.5 g/dL, the adjusted odds of being frail were 1.9 (95% confidence interval: 1.1-3.4) and 1.5 (95% confidence interval: 1.0-2.1) times higher for Hb concentrations equal to 11.5 g/dL and 12 g/dL, respectively. A statistically significant (p <.05) multiplicative interaction between Hb level and CVD status with respect to frailty risk was observed.


CONCLUSIONS
In community-dwelling older women, mildly low and low-normal Hb levels were independently associated with increased frailty risk. This risk was synergistically modified by the presence of CVD. These results suggest that mild anemia, and even low-normal Hb levels are independent, potentially modifiable risk factors for frailty in community-dwelling older adults.
The Johns Hopkins Center on Aging and Health, 2024 East Monument Street, Suite 2-700, Baltimore, MD 21205, USA. pchaves@jhsph.edu
Paulo H M
PH
Chaves
Richard D
RD
Semba
Sean X
SX
Leng
Richard C
RC
Woodman
Luigi
L
Ferrucci
Jack M
JM
Guralnik
Linda P
LP
Fried
D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications*; D002318:Cardiovascular Diseases / Q000150:complications*; D005260:Female; D016330:Frail Elderly; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D012044:Regression Analysis
D006454:Hemoglobins