Prognostic value of anemia in terms of disability and mortality in hospitalized geriatric patients: results from the CRIME study

Anemia, a common concern in geriatric pop-ulation, is associated with several negativeoutcomes. The aim of this study was to inves-tigate the independent prognostic value ofanemia in the year after hospital discharge,analyzing its association with disability andmortality in a sample of older hospitalizedpatients. We evaluated 896 in-hospital olderpatients enrolled in the CRiteria to AssessAppropriate Medication Use among ElderlyComplex Patients(CRIME) study, with assess-ment of hemoglobin levels at hospital admis-sion and with follow-up data. We analyzed therisk of developing disability (in patients with-out pre-existing disability in activities of thedaily living) and the likelihood of death (in theentire sample) in the 12 months after dis-charge according to presence and degree ofanemia (defined by sex-specific World HealthOrganization criteria). Mean age of study par-ticipants was 81.2±7.4 years, 57.8% had preva-lent anemia. In unadjusted analysis, anemiawas strongly associated with functional statusand survival. Nevertheless, the increased riskof disability and death was influenced by thecoexistence of several clinical conditions asso-ciated with anemia. Indeed, using multivariatelogistic regression analysis adjusted for poten-tial confounders, the association with disabili-ty was strongly attenuated [severe anemiaodds ratio (OR) 1.86, 95% confidence interval(CI): 0.96-3.58, mild-moderate anemia OR1.05, 95% CI: 0.62-1.80] and the relationship with mortality was no longer significant[severe anemia hazard ratio (HR) 1.13, 95%CI: 0.73-1.75, mild-moderate anemia HR 1.14,95% CI: 0.78-1.67]. In older hospitalizedpatients, anemia, despite not influencing mor-tality, might have a significant disabling effect.Anemia should not be considered as aninevitable epiphenomenon of aging but a con-dition able to worsen the quality of life.