title: Diminished quality of life and physical function in community-dwelling elderly with anemia.
abstract: The occurrence of anemia in older adults has been associated with adverse outcomes including functional decline, disability, morbidity, and mortality. It is not clear to what extent these outcomes are the result of the anemia or concurrent illness. We performed a cross-sectional, observational study to determine whether lower hemoglobin concentrations in older adults are associated with reduced health-related quality of life, functional status, depression, disability, and physical strength, independent of chronic disease. Three sites participated in this research: an academic geriatric practice, a hospital-based geriatric outpatient unit, and a community-based multispecialty internal medicine group. Health-related quality of life and functional status were measured using the Short Form-36 Health Survey (SF-36) and the Functional Assessment of Chronic Illness Therapy-Anemia (FACIT-An). Disability and depression were assessed using the Instrumental Activities of Daily Living (IADL) and the Geriatric Depression Scale (GDS) questionnaires, respectively. Handgrip strength was used as a physical performance measure. Anemia was defined as hemoglobin <13 g/dL for men or <12 g/dL for women. The mean SF-36 physical health component summary scores were 38.9 (with anemia) and 44.1 (without anemia) (p<0.001). Anemia was associated with greater fatigue (p < 0.001), lower handgrip strength (p = 0.014), increased number of disabilities (p=0.005), and more depressive symptoms (p = 0.002). Multivariate regression analysis, adjusted for demographic and clinical characteristics, demonstrated strong associations for reduced hemoglobin, even within the "normal" range, and poorer health-related quality of life across multiple domains. Thus, anemia was independently associated with clinically significant impairments in multiple domains of health-related quality of life, especially in measures of functional limitation. Mildly low hemoglobin levels, even when above the World Health Organization (WHO) anemia threshold, were associated with significant declines in quality of life among the elderly.
authors.affiliation: From the Institute for Advanced Studies in Aging and Geriatric Medicine (MT, WBE, ASA, JT), Washington, DC; Clinical Research Branch (WBE), National Institute on Aging, Baltimore, Maryland; University of Chicago Hospitals (ASA), Chicago, Illinois; Sarasota Hospital (BER), University of South Florida, Sarasota, Florida; University of Utah School of Medicine (GR), Salt Lake City, Utah; and Amgen Inc. (AL, IGC, ZJL, SR), Thousand Oaks, California.
authors.forename: Mya
authors.initials: M
authors.lastname: Thein
authors.forename: William B
authors.initials: WB
authors.lastname: Ershler
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Artz
authors.forename: Josephine
authors.initials: J
authors.lastname: Tecson
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Robinson
authors.forename: Gerald
authors.initials: G
authors.lastname: Rothstein
authors.forename: Alexander
authors.initials: A
authors.lastname: Liede
authors.forename: Ina
authors.initials: I
authors.lastname: Gylys-Colwell
authors.forename: Z John
authors.initials: ZJ
authors.lastname: Lu
authors.forename: Sean
authors.initials: S
authors.lastname: Robbins
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D004185:Disability Evaluation; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D018737:Hand Strength / Q000502:physiology; D006454:Hemoglobins / Q000032:analysis; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008603:Mental Health; D015999:Multivariate Analysis; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
chemical_list: D006454:Hemoglobins