Clinical study
Anemia and decline in physical performance among older persons

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Abstract

Purpose

Anemia is prevalent in old age and is potentially modifiable, but its effects on physical function have not been determined. We examined whether anemia in older persons increases the risk of subsequent decline in physical function, as measured by objective performance-based tests.

Methods

Participants in this 4-year prospective cohort study included 1146 participants, aged 71 years or older, living in Iowa and Washington counties, Iowa. Anemia was defined according to World Health Organization (WHO) criteria as a hemoglobin concentration below 12 g/dL in women and below 13 g/dL in men. An assessment of standing balance, a timed 2.4-m walk, and a timed test of five chair rises were used to assess physical performance; these were combined into a 0 (poor) to 12 (excellent) summary scale.

Results

After adjustment for baseline performance score, health status, and demographic characteristics, anemia was associated with greater mean decline in physical performance over 4 years; the adjusted mean decline was 2.3 (95% confidence interval [CI]: 1.7 to 2.8) in subjects with anemia and 1.4 (95% CI: 1.2 to 1.5) in those without anemia (P = 0.003). The association between anemia and greater physical decline was also present in participants who were free of diseases associated with anemia (cancer, infectious disease, and renal failure), and after adjustment for serum cholesterol, iron, and albumin levels. Persons with borderline anemia, a hemoglobin concentration within 1 g/dL above the WHO criteria, also showed greater mean physical decline (1.8; 95% CI: 1.5 to 2.2) than did those with higher hemoglobin concentrations (P = 0.02).

Conclusion

This study suggests that anemia in old age is an independent risk factor for decline in physical performance.

Section snippets

Methods

Data for this study were collected as part of the Established Populations for Epidemiologic Studies of the Elderly (EPESE), a prospective cohort study of older persons. A sample of the eligible population of all persons aged 65 years or older who lived in Iowa and Washington counties, Iowa, was selected (12). Between December 1981 and August 1982, 3673 persons were enrolled in the initial home interview. Follow-up home interviews were conducted annually for 6 years and then again at 10 years.

Results

The mean (± SD) age of the total sample at study baseline was 77 ± 5 years; about 70% were female (Table 1). The mean serum hemoglobin level was 15.0 ± 1.3 g/dL in men and 13.8 ± 1.3 g/dL in women. Twenty-two men and 46 women met criteria for anemia. Anemia was mostly normocytic (79%, n = 54), 10% (n = 7) was microcytic, and 10% (n = 7) was microcytic. A total of 172 subjects (15%; 51 men and 121 women) had borderline anemia (of which 96% [n = 165] were normocytic). Those with anemia were

Discussion

In our community-based study of older persons, anemia defined according to the WHO criteria was associated with a significantly greater decline in physical performance during 4 years. Persons with borderline anemia also had significantly greater physical decline than did those with higher hemoglobin concentrations. These associations were not explained by baseline diseases or by low serum cholesterol, iron, or albumin levels. Anemia was also associated with subsequent physical decline in older

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  • Cited by (0)

    This work was supported through the National Institute on Aging (contract numbers N01-AG-6-2106, N01-AG-6-2102, and N01-AG-6-2103), Bethesda, Maryland, and through support from Ortho Biotech Products, L.P., Bridgewater, New Jersey. The work of Drs. Penninx, Onder, and Pahor is supported by the National Institutes of Health (Claude Pepper Older Americans Independence Center 5P60 AG 10484-07 and contract number N01-AG-1-2112), Bethesda, Maryland.

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