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.

Figure 1

Comparison of individual Short Form 36 Health Survey (SF-36) scores by anemia status. White bars represent mean SF-36 domain scores for subjects with anemia, filled-in bars represent mean the SF-36 domain scores for subjects without anemia. Physical functioning (PF), role limitations due to physical health problems (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role limitations due to emotional problems (RE), and mental health (MH) domains are shown. Lines above bars represent one positive standard deviation. Statistical significance (P values) based on t-tests are shown above each domain comparison (NS = not significant).

Figure 2

Comparison of Short Form 36 Health Survey (SF-36) summary scores, Functional Assessment of Chronic Illness Therapy – Anemia (FACIT-An) scores and handgrip strength by anemia status. White bars represent SF-36, FACIT-An scores and handgrip strength for subjects with anemia, filled-in bars represent SF-36, FACIT-An scores and handgrip strength for subjects without anemia. The SF-36 physical component (PCS) and mental health component (MCS) scores are shown. FACIT fatigue and non-fatigue scores are shown. The overall FACIT-An score is the sum of the fatigue and non-fatigue scores. Mean values are shown in the bars. Lines above bars represent one positive standard deviation. Statistical significance (P values) based on t-tests are shown above each comparison between anemia and no anemia groups.