Anemia increases risk of death in the very elderly

Anemia in very elderly people aged 85 and older appears to be associated with an increased risk of death, according to a new study in CMAJ (Canadian Medical Association Journal) http://www.cmaj.ca/press/cmaj090040.pdf (www.cmaj.ca).

The study was part of the Leiden 85-plus study that looked at 562 people aged 85 years in the Netherlands and followed them until age 90. Twenty-seven per cent of participants had anemia at the start of the study (prevalent anemia) and, in the follow up period, incident anemia developed in 24% of the people without anemia at the start of the study.

Anemia in elderly people is generally associated with increased death as well as decreased mobility, cognitive impairment, depression, falls and fractures, hospital admission and diminished quality of life. It can significantly affect health care needs and costs in ageing Western societies.

In the study group, the risk of death was similar among men and women, and among people in long-term care facilities and in the community.

"We found a strong, independent association between prevalent anemia in participants at age 85 years and risk of death," write Ms. Wendy den Elzen of the Leiden University Medical Center and coauthors, confirming results of previous studies of people in the Netherlands and North America. "We found that incident anemia in participants beyond the age of 85 years had an even stronger impact on mortality than prevalent anemia at age 85."

After adjusting for other illnesses, the negative effect of anemia on cognitive ability and physical function was neutralized. The authors conclude that the associated functional decline appears to be mainly attributed to comorbid illnesses.

In a related commentary http://www.cmaj.ca/press/cmaj091199.pdf, Dr. Mark Clarfield of Ben-Gurion University and Dr. Ora Paltiel of Hadassah-Hebrew University in Israel write "for unexplained anemia in elderly patients, we may never be able to disentangle whether the underlying cause or the anemia is responsible for death." They caution that proof is needed that routinely correcting unexplained anemia is more beneficial than harmful.