title: Anemia status, hemoglobin concentration, and mortality in nursing home older residents.
abstract: BACKGROUND
  Anemia status is a typical feature of the "frailty syndrome" of elderly subjects. Increasing evidences suggest that low hemoglobin concentration is common in elderly subjects and adversely affects morbidity and mortality.
  
  
  OBJECTIVE
  In the present study, we evaluate the impact of hemoglobin concentration on the risk of all-cause mortality in a large population of frail and old subjects living in a nursing home.
  
  
  METHODS
  There were 372 residents admitted to the teaching nursing home of Catholic University of Rome aged 65 years and older from January 2002 to November 2004 who were enrolled. For the present study we selected all the subjects with a full MDS-NH assessment within 14 days after admission. The main outcome measure was the relative hazard ratio of death after 2 years of follow-up for different levels of hemoglobin concentration.
  
  
  RESULTS
  Based on the WHO criteria for anemia, 235 participants were anemic at enrollment (63.1% of the cohort). A total of 130 deaths (44 men and 86 women) occurred during 2-years of follow-up. Death rates for those with and without anemia based on the WHO criteria were 38% and 28%, respectively (P = .03). The age- and sex-adjusted hazard ratio for mortality was 1.56 (95% CI, 1.07-2.28) for persons with anemia. Compared with the lower tertile, the age- and sex-adjusted hazard ratios of mortality for hemoglobin in the second and third tertiles were 0.40 (95% CI, 0.26-0.61), and 0.39 (95% CI, 0.24-0.58), respectively. Adjusting for potential confounders, including markers of frailty, cognitive impairment, creatinine levels, cancer, stroke, body mass index, and pressure ulcer, somewhat reduced the strength of the association between hemoglobin level and mortality, but it remained statistically significant.
  
  
  CONCLUSIONS
  Our results obtained from a representative sample of very old and frail elderly subjects living in a nursing home expand the knowledge that high levels of hemoglobin are associated with better survival. Anemia should be actively sought, appropriate diagnostic strategies should be implemented to search for potentially correctable causes, and aggressive interventions may be warranted to reduce mortality and improve functional status.
authors.affiliation: Department of Gerontology and Geriatrics, Catholic University of Sacred Heart, Roma, Italy. francesco_landi@rm.unicatt.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Landi
authors.forename: Andrea
authors.initials: A
authors.lastname: Russo
authors.forename: Paola
authors.initials: P
authors.lastname: Danese
authors.forename: Rosa
authors.initials: R
authors.lastname: Liperoti
authors.forename: Christian
authors.initials: C
authors.lastname: Barillaro
authors.forename: Roberto
authors.initials: R
authors.lastname: Bernabei
authors.forename: Graziano
authors.initials: G
authors.lastname: Onder
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood* / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006454:Hemoglobins / Q000378:metabolism*; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D009735:Nursing Homes / Q000706:statistics & numerical data*; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D006454:Hemoglobins