Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Geriatrics
Published in: BMC Geriatrics 1/2020

Open Access 01-12-2020 | Anemia | Research article

Hemoglobin concentration; a pathway to frailty

Authors: Zara Steinmeyer, Cyrille Delpierre, Gaelle Soriano, Armand Steinmeyer, Loic Ysebaert, Laurent Balardy, Sandrine Sourdet

Published in: BMC Geriatrics | Issue 1/2020

Login to get access

Abstract

Background

Frailty and hemoglobin concentration, above what would be considered clinical anemia, are two common findings in older patients that lead to an increased risk of negative health outcomes. The objective of this study is to evaluate whether hemoglobin concentration is an independent predictor of frailty and investigate possible causal pathways with a focus on the relationship between inflammation or nutrition and hemoglobin concentration.

Methods

1829 community-dwelling participants aged 65 years or older who visited the Toulouse frailty day hospital during 2011 and 2016 were included in this analysis. Patients underwent a comprehensive geriatric assessment and had a blood sample taken.
A series of multivariate logistic regression models were performed after minimizing potential influence from age, gender, kidney function, inflammation, cognition, nutritional status and certain socio-economic factors.

Results

Hemoglobin concentration and frailty are significantly associated after minimizing potential influence from other covariates (p < 0.005). An increase in one point of hemoglobin concentration is associated with a 14% risk reduction of being frail (OR = 0.86, 95%IC = 0.79–0.94). There was no evidence of a significant causal relationship between inflammation and nutritional status in the relationship between hemoglobin concentration and frailty status (p > 0.005).

Conclusions

Hemoglobin concentration is strongly associated with frailty in older adults. These results can have potentially important implications for prevention policies targeting frailty by identifying potential patients with high risk of adverse outcomes and functional outcomes.
Literature
1.
Rockwood K, Howlett SE, MacKnight C, Beattie BL, Bergman H, Hébert R, et al. Prevalence, attributes, and outcomes of fitness and frailty in community-dwelling older adults: report from the Canadian study of health and aging. J Gerontol A Biol Sci Med Sci. 2004;59(12):1310–7.PubMedCrossRef
2.
Lang P-O, Michel J-P, Zekry D. Frailty syndrome: a transitional state in a dynamic process. Gerontology. 2009;55(5):539–49.PubMedCrossRef
3.
Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol Ser A. 2004;59(3):M255–63.CrossRef
4.
Fried LP, Tangen CM, Walston J, Newman AB, 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.CrossRefPubMed
5.
Fielding RA. A summary of the biological basis of frailty. Nestle Nutr Inst Workshop Ser. 2015;83:41–4.PubMedCrossRef
6.
Juárez-Cedillo T, Basurto-Acevedo L, Vega-García S, Manuel-Apolinar L, Cruz-Tesoro E, Rodríguez-Pérez JM, et al. Prevalence of anemia and its impact on the state of frailty in elderly people living in the community: SADEM study. Ann Hematol. 2014;93(12):2057–62.PubMedCrossRef
7.
Chaves PHM, Semba RD, Leng SX, Woodman RC, Ferrucci L, Guralnik JM, 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. J Gerontol A Biol Sci Med Sci. 2005;60(6):729–35.PubMedCrossRef
8.
Palmer K, Vetrano DL, Marengoni A, Tummolo AM, Villani ER, Acampora N, et al. The relationship between Anaemia and frailty: a systematic review and meta-analysis of observational studies. J Nutr Health Aging. 2018;22(8):965–74.PubMedCrossRef
9.
Mindell J, Moody A, Ali A, Hirani V. Using longitudinal data from the health survey for England to resolve discrepancies in thresholds for haemoglobin in older adults. Br J Haematol. 2013;160(3):368–76.PubMedCrossRef
10.
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. Arch Intern Med. 2005;165(19):2214–20.PubMedCrossRef
11.
Cecchi F, Pancani S, Vannetti F, Boni R, Castagnoli C, Paperini A, et al. Hemoglobin concentration is associated with self-reported disability and reduced physical performance in a community dwelling population of nonagenarians: the Mugello study. Intern Emerg Med. 2017;12(8):1167–73.PubMedPubMedCentralCrossRef
12.
Landi F, Russo A, Danese P, Liperoti R, Barillaro C, Bernabei R, et al. Anemia status, hemoglobin concentration, and mortality in nursing home older residents. J Am Med Dir Assoc. 2007;8(5):322–7.PubMedCrossRef
13.
Pires Corona L, Drumond Andrade FC, de Oliveira Duarte YA, Lebrao ML. The relationship between Anemia, hemoglobin concentration and frailty in Brazilian older adults. J Nutr Health Aging. 2015;19(9):935–40.PubMedCrossRef
14.
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. J Am Geriatr Soc. 2002;50(7):1268–71.PubMedCrossRef
15.
16.
Guralnik JM, Eisenstaedt RS, Ferrucci L, Klein HG, Woodman RC. Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. Blood. 2004;104(8):2263–8.PubMedCrossRef
17.
18.
Vellas B, Balardy L, Gillette-Guyonnet S, Abellan Van Kan G, Ghisolfi-Marque A, Subra J, et al. Looking for frailty in community-dwelling older persons: the Gérontopôle frailty screening tool (GFST). J Nutr Health Aging. 2013;17(7):629–31.PubMedCrossRef
19.
Patel KV, Coppin AK, Manini TM, Lauretani F, Bandinelli S, Ferrucci L, et al. Midlife physical activity and mobility in older age. Am J Prev Med. 2006;31(3):217–24.PubMedPubMedCentralCrossRef
20.
21.
Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.CrossRef
22.
Ng TP, Feng L, Nyunt MSZ, Larbi A, Yap KB. Frailty in older persons: multisystem risk factors and the frailty risk index (FRI). J Am Med Dir Assoc. 2014;15(9):635–42.PubMedCrossRef
23.
Palosuo T, Husman T, Koistinen J, Aho K. C-reactive protein in population samples. Acta Med Scand. 1986;220(2):175–9.PubMedCrossRef
24.
Young B, Gleeson M, Cripps AW. C-reactive protein: a critical review. Pathology (Phila). 1991;23(2):118–24.
25.
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–12.PubMedPubMedCentralCrossRef
26.
Stevens PE, Levin A. Kidney disease: improving global outcomes chronic kidney disease guideline development work group members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 2013;158(11):825–30.PubMedCrossRef
27.
Vellas B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S, et al. The mini nutritional assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutr Burbank Los Angel Cty Calif. 1999;15(2):116–22.CrossRef
28.
Folstein MF, Folstein SE, McHugh PR. ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.PubMedCrossRef
29.
Tombaugh TN, McIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc. 1992;40(9):922–35.PubMedCrossRef
30.
Perneczky R, Wagenpfeil S, Komossa K, Grimmer T, Diehl J, Kurz A. Mapping scores onto stages: mini-mental state examination and clinical dementia rating. Am J Geriatr Psychiatry Off J Am Assoc Geriatr Psychiatry. 2006;14(2):139–44.CrossRef
31.
Unesco. International Standard Classification of Education (ISCED) 2011. 2012.
32.
Katz S. Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc. 1983;31(12):721–7.PubMedCrossRef
33.
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? J Am Geriatr Soc. 2002;50(7):1257–64.PubMedCrossRef
34.
Beghé C, Wilson A, Ershler WB. Prevalence and outcomes of anemia in geriatrics: a systematic review of the literature. Am J Med. 2004;116(Suppl 7A):3S–10S.PubMedCrossRef
35.
Penninx BWJH, Pahor M, Cesari M, Corsi AM, Woodman RC, Bandinelli S, et al. Anemia is associated with disability and decreased physical performance and muscle strength in the elderly. J Am Geriatr Soc. 2004;52(5):719–24.PubMedCrossRef
36.
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. Arch Intern Med. 2002;162(20):2333–41.PubMedCrossRef
37.
Soysal P, Stubbs B, Lucato P, Luchini C, Solmi M, Peluso R, et al. Inflammation and frailty in the elderly: a systematic review and meta-analysis. Ageing Res Rev. 2016;31:1–8.PubMedCrossRef
38.
Baylis D, Bartlett DB, Patel HP, Roberts HC. Understanding how we age: insights into inflammaging. Longev Heal. 2013;2:8.CrossRef
39.
Leng SX, Xue Q-L, Tian J, Huang Y, Yeh S-H, Fried LP. Associations of neutrophil and monocyte counts with frailty in community-dwelling disabled older women: results from the Women’s health and aging studies I. Exp Gerontol. 2009;44(8):511–6.PubMedCrossRef
40.
Araújo DA, Noronha MB, Cunha NA, Abrunhosa SF, Rocha AN, Amaral TF. Low serum levels of vitamin B12 in older adults with normal nutritional status by mini nutritional assessment. Eur J Clin Nutr. 2016;70(7):859–62.PubMedCrossRef
41.
Bharadwaj S, Ginoya S, Tandon P, Gohel TD, Guirguis J, Vallabh H, et al. Malnutrition: laboratory markers vs nutritional assessment. Gastroenterol Rep. 2016;4(4):272–80.
Metadata
Title
Hemoglobin concentration; a pathway to frailty
Authors
Zara Steinmeyer
Cyrille Delpierre
Gaelle Soriano
Armand Steinmeyer
Loic Ysebaert
Laurent Balardy
Sandrine Sourdet
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Anemia
Published in
BMC Geriatrics / Issue 1/2020
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-020-01597-6

Other articles of this Issue 1/2020

BMC Geriatrics 1/2020 Go to the issue

Research article

Physical activity in people with dementia attending farm-based dementia day care – a comparative actigraphy study

Research article

Prevalence of medication-related falls in 200 consecutive elderly patients with hip fractures: a cross-sectional study

Research article

Exercise interveNtion outdoor proJect in the cOmmunitY for older people – results from the ENJOY Seniors Exercise Park project translation research in the community

Research article

The social and economic burden on family caregivers for older adults in the Czech Republic

Research article

Translating facilitated multimodal online learning into effective person-centred practice for the person living with dementia among health care staff in Australia: an observational study

Research article

Is adiposity associated with objectively measured physical activity and sedentary behaviors in older adults?
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits