Prevalence of anemia among elderly patients in an emergency room setting

PurposeAnemia is highly prevalent in geriatric patients and associated with increased morbidity, functional and cognitive decline. German prevalence data are rare and no treatment guidelines exist for the elderly. Anemia often remains unconsidered in this population. This study evaluates prevalence of anemia among geriatric patients in an emergency room (ER) setting and the performed diagnostic and therapeutic steps.SubjectsData of 1045 elderly patients > 70 years admitted to the ER at our university hospital between January and August 2010 were retrospectively analyzed (384 female and 474 male in-patients, 92 female and 95 male out-patients). Anemia definition: hemoglobin < 12 g/dL (female) and < 13 g/dL (male). Diagnostic and therapeutic steps, medication and hemoglobin (hb) characteristics at transfer from ER to other departments were evaluated.ResultsAmong in-patients anemia was found in 54.2%, among out-patients in 36.4% (P < 0.001). Hb was significantly lower in anemic in-patient men (P = 0.007) compared to anemic out-patient men. No such difference was found among women. Anemic patients’ age did not influence the hb level. There were department specific differences in hb level as well as diagnostics and therapy of anemia. Only 12% of all evaluable anemic in-patients received a non-drug anemia treatment, mostly consisting of transfusions.Discussion/ConclusionMore than 50% of all elderly patients suffered from anemia; less than one fifth received either anti-anemic medication or non-drug treatment; insufficiency of medical care in this study group can be assumed; close intersdisciplinary cooperation with geriatrician in ER is necessary with development of diagnostic and therapeutic guidelines for anemic elderly.     

老年维持性血液透析患者炎症氧化应激状态与贫血的关系

目的 评价老年维持性血液透析（MHD）患者炎症、氧化应激与贫血的关系.方法 选取2013年3月在我院治疗的MHD患者79例,其中包括年龄≥65岁老年患者48例及＜65岁的非老年MHD患者31例,透析龄均超过3个月,透析当日上机前空腹采血测定血红蛋白（Hb）、甲状旁腺激素（I-PTH）、高敏C反应蛋白（hs-CRP）、丙二醛（MDA）、超氧化物歧化酶（SOD）、血清白蛋白（Alb）水平及透析前后血尿素氮（BUN）,并根据透析时间、脱水量、干体重计算KT/V及尿素氮清除率（URR）,同时记录每周促红细胞生成素（EPO）、铁剂用量、透析时间.结果 老年组MHD患者贫血达标率为45.8％,明显低于非老年组的70.9％,维持相同血红蛋白水平需要皮下注射更大剂量重组人促红细胞生成素剂量（rHuEPO）（P＜0.05）;老年组MHD患者hs-CRP、MDA明显升高,SOD、Alb明显降低（P＜0.05）;老年贫血患者hs-CRP、MDA明显升高,SOD、Alb明显降低（P＜0.05）.结论 老年患者贫血达标率低,氧化应激状态是其贫血发生的主要原因,hs-CRP、SOD、MDA、Alb是反映老年MHD患者氧化应激的敏感指标.     

增龄及肾小球滤过率下降对合肥市老年体检人群贫血患病率的影响

目的 探讨增龄及肾功能下降对合肥市老年体检人群贫血患病率的影响.方法 回顾性分析2005年1月-2007年12月在安徽省立医院体检中心体检的所有年龄大于60周岁的人群,进行贫血患病率调查,分析增龄、估算的肾小球滤过率(eGFR)下降与贫血患病率之间的关系.结果 在资料完整的4547例老年体检者中,贫血患病率为4.40%(95%CI:3.83%～5.05%),其中男性为4.04%(95%CI:3.37%～4.84%),女性为5.04%(95%CI:4.05%～6.24%).贫血患病率随年龄增加、eGFR降低而升高,差异均有统计学意义(P<0.001).多因素logistic回归分析发现,增龄、女性、eGFR降低的OR分别为2.507、1.758和1.741.结论 在合肥市老年体检人群中,贫血患病率为4.40%;增龄及肾小球滤过率下降是贫血患病率增加的独立危险因素. 在资料完整的4547例老年体检者中,贫血患病率为4.40%(95%CI:3.83%～5.05%),其中男性为4.04%(95%CI:3.37%～4.84%),女性为5.04%(95%CI:4.05%~6.24%).贫血患病率随年龄增加、eGFR降低而 高,差异均有统计学意义(P<0.001).多因素logistic回归分析发现,增龄、女性、eGFR降低的OR分别为2.507、1.758和1.741.结论 在合肥市老年体检人群中,贫血患病率为4.4     

Association between physical function and the load pattern during stepping-up motion in community-dwelling elderly women

ObjectiveStepping-up motion is challenging task for elderly people in daily life. The present study investigated the relationship between the load pattern during stepping-up motion at maximum speed and physical function in elderly women.MethodsThe subjects comprised 109 community-dwelling elderly women (age 72.5 ± 5.3 years). The load pattern (maximum load, rate of load production, and stepping-up time) during ascending a 30 cm step at maximum speed was measured, using a step up platform that measures the load at the lower and upper level. Physical function, including hip and knee extensor strength and performance on the vertical jump test, one-legged stance test, timed “Up & Go” (TUG) test, and stepping test were measured.ResultsPearson’s correlation analysis showed that stepping-up time was correlated with the maximum load at the lower level (r = −0.51), but not with the maximum load at the upper level. A multiple regression analysis showed that hip extensor strength and performance on the vertical jump, TUG, and stepping tests were significant determinants of the load pattern during stepping-up motion in the elderly women.ConclusionsOur study revealed that rapid stepping-up ability was more closely related to the maximum load during push-off at the lower level rather than that during weight loading on the upper level, and that the load pattern during stepping-up motion in elderly women was associated with various physical functions such as the hip extensor strength, leg muscle power, dynamic balance function, and agility.     

Prevalence and correlates of fear of falling in Korean community-dwelling elderly subjects

Purpose

This study was conducted to investigate the factors related to fear of falling in elderly subjects, with a view to developing interventions to prevent falls.

Methods

Data from 9033 elderly subjects aged ≥ 65 years were analyzed from the 2008 National Elderly Survey of the Korea Ministry of Health & Welfare.

Results

In total, 76.6% of elderly Korean subjects had fear of falling. Factors associated with an increased risk of fear of falling in elderly subjects were, in order from highest to lowest, previous experience of falling (odds ratio [OR] = 6.41, p < 0.001), experience of body pain (OR = 2.45, p < 0.001), lower perceived health status (OR = 1.89, p < 0.001), presence of depression (OR = 1.82, p < 0.001), receipt of more doses of drugs per day for those receiving 1–2 (OR = 1.72, p < 0.001) or ≥ 3 doses of drugs per day (OR = 1.67, p = 0.001), older age (OR = 1.68, p < 0.001), female gender (OR = 1.64, p < 0.001), dependence for instrumental activities of daily living (OR = 1.55, p < 0.001), dependence for activities of daily living (OR = 1.44, p = 0.017), and lower education level (OR = 1.18, p = 0.016).

Conclusion

The fear of falling can be attenuated by providing interventions to reduce the impact of modifiable risk factors that were identified in this study.     

Executive function, more than global cognition, predicts functional decline and mortality in elderly women

BACKGROUND: Functional impairment in community-dwelling older adults is common and is associated with poor outcomes. Our goal was to compare the contribution of impairment in executive function or global cognitive function to predicting functional decline and mortality. METHODS: We studied 7717 elderly women enrolled in a prospective study (mean age 73.3 years) and identified women with poor baseline executive function (score > 1 standard deviation [SD] below the mean on the Trail Making Test B (Trails B; n = 957, 12.4%), poor global cognitive function (score > 1 SD below the mean on a modified Mini-Mental State Examination [mMMSE], n = 387, 5.0%), impairment in both (n = 249, 3.2%), or no impairment (n = 6124, 79.4%). We compared level of functional difficulty (Activities of Daily Living [ADLs] and Instrumental ADLs [IADLs]) at baseline and at 6-year follow-up and survival at follow-up. We also determined if the association was independent of age, education, depression, medical comorbidities, and baseline functional ability. RESULTS: At baseline, women with Trails B impairment only or impairment on both tests reported the highest proportion of ADL and IADL dependence compared to the other groups. At the 6-year follow-up after adjusting for age, education, medical comorbidities, depression, and baseline ADL or IADL, women with only Trails B impairment were 1.3 times more likely to develop an incident ADL dependence (adjusted odds ratio [OR] = 1.34; 95% confidence interval [CI], 1.07-1.69) and 1.5 times more likely to develop a worsening of ADL dependence (adjusted OR = 1.48; 95% CI, 1.16-1.89) when compared to women with no impairment on either test. In addition, women with only Trails B impairment had a 1.5-fold increased risk of mortality (adjusted hazard ratio [HR] = 1.48; 95% CI, 1.21-1.81). In contrast, women with impairment on only mMMSE were not at increased risk to develop incident ADL or IADL dependence, a worsening of ADL or IADL dependence, or mortality. CONCLUSION: Compared to women with no impairment, women with executive function impairment had significantly worse ADL and IADL function cross-sectionally and over 6 years. Individuals with executive dysfunction also had increased risk of mortality. These results suggest that screening of executive function can help to identify women who are at risk for functional decline and decreased survival.     

Perspectives on the relation of blood pressure and cognition in the elderly

The relationship of blood pressure to cognition in the elderly is a poorly understood topic. Many questions exist such as does treatment of hypertension prevent cognitive decline, the optimal timing of intervention and selecting the appropriate agent. In this review we will explore recent epidemiologic data and clinical trials addressing hypertension and cognition, review pathophysiology of chronic hypertension and effects of brain function, discuss the timing of intervention and finally review opportunities for future research.     

Erythropoietin in anemia of unknown etiology: A systematic review and meta-analysis

Introduction: We conducted a systematic review and meta-analysis of observational studies in order to explore the relationship between erythropoietin (EPO) and hemoglobin in elderly individuals with anemia of unknown etiology (AUE) and other forms of anemia.

Methods: We searched Medline, EMBASE, Web of Science, Biosis Previews, Dissertations, and Theses in addition to meeting abstracts of the European Hematology Association and American Society of Hematology for relevant studies. The meta-analysis was conducted using pooled ratio of means (ROM) through the generic inverse variance method.

Results: Six studies were included in the meta-analysis, which confirmed that EPO levels were significantly lower in AUE as compared to iron deficiency anemia (ROM 0.7210; random 95% CI 0.7052 to 0.7372; P-value?<?0.00001) and anemia of chronic disease (ROM 0.8995; random 95% CI 0.8362 to 0.9677; P?=?0.004). EPO levels in AUE were slightly higher than levels in anemia of chronic kidney disease (ROM 1.0940; random 95% CI 1.0557, 1.1337; P?<?0.00001). The heterogeneity (I2) of all analyses was 100%.

Conclusion: Our findings suggest that erythropoietin levels in AUE, although elevated, remain inappropriately low, particularly when compared with other forms of anemia. This suggests a relative erythropoietin deficiency or a blunted erythroid cell response.     

Physical fitness and 6.5-year mortality in an 85-year-old community-dwelling population

Although poor physical fitness is known to be associated with increased mortality in adult and elderly populations, this association is not conclusive in very elderly. The purpose of the present study was to evaluate the association for a very old community-dwelling population. The participants (90 males, 117 females) were 85-year-old individuals residing in Fukuoka, Japan. Baseline examinations including muscle strength of the handgrip and leg extension, one-leg standing, leg stepping rate, and walking were performed in 2003 and these subjects were followed for 6.5 years. During the follow-up period, 81 individuals (49 males and 32 females) died. Handgrip strength and leg extension strength at age 85 were stronger in surviving men than in non-survivors. Total mortality adjusted for both gender and serum level of total cholesterol fell 5-6% with a 1-kg increase in the handgrip strength of a single hand or both hands. Total mortality also decreased 2% with a 1 kg increase in the leg extension strength of both legs. With adjustment for gender and total cholesterol, mortality fell by 57% in participants of the walking test and fell by 45% in participants of the stepping-rate test compared to mortality in nonparticipants. No association was found between mortality and participation in the handgrip strength test, leg extension strength test, or one-leg standing time test. In conclusion, not only poor muscle strength in handgrip or leg extension, but also nonparticipation in walking test or leg-stepping test were independent predictors of total mortality in a very elderly population.     

增龄对老年高血压病患者动态血压的影响

目的：观察增龄对老年高血压病患动态血压（ABP）的影响。方法：比较478例高血压患（分为3个年龄组）和229例血压正常的ABP资料。结果：60－岁组高血压患的收缩压（SBP）和日／夜（N／D）血压比值低于70－岁和＞80岁组的；而舒张压（DBP）则前高于后两组（P＜0.05)，各组脉压（PP）值均呈现随年龄增大而增高之趋势（P＜0.05)；60－岁组的血压波动曲线类似于灼型，而后两组均为非杓型。结论：PP随年龄增大而增高可能与大动脉硬化加重有关，而血压昼夜节律的消失可能为增龄所致的自主神经功能紊乱及白天、夜间活动变化的表现。     

Cu to Zn ratio, physical function, disability, and mortality risk in older elderly (ilSIRENTE study)

Associations between copper to zinc ratio (CZr) and mortality have suggested CZr as a biomarker of aging. Nevertheless, very limited data exist on the association between serum CZr and physical or functional status of very old people. We examined the relationship between serum CZr and physical performance, muscle strength, functional status, and survival from the ilSIRENTE Study: a longitudinal study of persons aged 80 years or older (n = 346). An adjusted linear regression model was subsequently performed to calculate the regression coefficients of the associations between baseline physical and functional measures (dependent variable) with CZr or “Cu and Zn” alone taking also into account the influence of other relevant factors, including hematological (albumin, cholesterol, and urea) and inflammatory biomarkers (IL-6 and CRP) that were significantly different across CZr tertiles. CZr showed significant and stronger relationships than Cu or Zn alone with all baseline physical and functional measures in models that did not include adjustments for inflammatory parameters. CZr was also associated with physical decline, measured as “SPPB% decline” at 2 years of follow-up and mortality at 4 years of follow-up. Subjects in the high CZr tertile had a higher risk of death with an adjusted hazard ratio of 1.92 (95% CI, 1.12–3.29; p = 0.02). In conclusion, we have confirmed the role of CZr as a predictor of mortality, whereas the role of CZr as a biomarker or predictor of physical or functional performance seems to be the consequence of its strict relationships with inflammatory parameters. In this context, further investigations need to be carried out.     

老年维持性血液透析患者临床分析

目的了解上海交通大学医学院附属瑞金医院老年维持性血液透析（MHD）患者的临床特点。方法收集上海交通大学医学院附属瑞金医院血液透析中心目前存活的老年（≥60岁）MHD患者资料共111例。对其人口学资料、血压、实验室指标、透析相关参数、透析充分性进行分析。并根据其血红蛋白水平,按照高血红蛋白组（Hb≥110g／L）及低血红蛋白组（Hb〈110g／L）进行比较探讨。结果（1）111例老年MHD患者平均年龄为（69．4±6．8）岁,男性占64．0％（71／111）,中位透析龄为3年,原发性肾小球。肾病占54．1％（60／111）、糖尿病肾病患者占13．5％（15／111）。（2）111例患者透前血压为（142．3±16．2／77．7±8．2）mmHg,达标率为39．6％（44／111）;血红蛋白水平为（107．9±17．2）g／L;钙磷乘积为（4．1±1．7）mmol^2／L^2;iPTH水平为266．1±259．2pg／mL,达标率为27．9％（31／111）;白蛋白为（34．5±4．9）g／L;spKt／v达标率为72．1％（80／111）。（3）低血红蛋白组与高血红蛋白组比较,其糖尿病。肾病患者比例较高、血肌酐水平较低、透析时血流量较慢,P值〈0．05;其他实验室指标如铁蛋白、钙磷、iPTH、白蛋白及血压水平、年龄、性别比等无统计学差异。（4）尽管高血红蛋白组患者血肌酐水平较高,但其干体重、超滤量、透析充分性等指标与低血红蛋白组无统计学差异,前白蛋白水平略高。结论（1）老年MHD患者以男性为主,原发性。肾小球肾病仍是主要原发病,但应重视糖尿病肾病患者增多带来的挑战。（2）老年MHD患者透析充分性相对较为满意,但对CKD并发症的控制有待加强。（3）提高老年MHD患者的营养水平、鼓励蛋白质摄入可能有助于贫血的纠正,需要进一步的临床观察予以验证。     

重组人生长激素对老年心力衰竭合并贫血患者肾功能及氨基末端B型利钠肽前体的影响

目的观察重组人生长激素（rhGH）对老年慢性心力衰竭（CHF）合并贫血患者心功能、肾功能、血红蛋白的影响。方法将87例心功能Ⅱ～Ⅳ级（NYHA）的慢性心力衰竭患者随机分为治疗组（44例）及对照组（43例）。在慢性心力衰竭常规治疗基础上,对照组给予口服铁剂,治疗组给予口服铁剂加皮下注射重组人生长激素。治疗4周后,观察两组血红蛋白、血肌酐、肌酐清除率、心功能、氨基末端B型利钠肽前体（NT-proBNP）变化。结果与治疗前相比,治疗后治疗组血红蛋白明显升高[（111．2±3．3）g／L比（99．3＋4-3）g／L,P〈0．05],血清肌酐水平明显降低[（161．4±39．7）μmol／L比（198．2±41．7）μmol／L,P〈0．05],肌酐清除率增加[（43．8±7．1）ml／min比（39．0±8．8）ml／L,P〈0．05],心功能分级明显改善[（3．1±0．7）比（2．3±0．5）],血浆biT—proBNP显著下降[（11236．1＋430．7）ng／L比（2215．3±950．2）ng／L,P〈0．05]。对照组上述参数均有所改善,但差异无统计学意义。结论老年慢性心力衰竭合并贫血患者应用rhGH和口服铁剂治疗,在改善心功能的基础上,可进一步纠正贫血,改善肾功能,降低血浆NT—proBNP水平。     

Cognitive function and health-related quality of life in elderly patients with hypertension--baseline data from the study on cognition and prognosis in the elderly (SCOPE)

The Study on COgnition and Prognosis in the Elderly (SCOPE) study is a multi-centre, prospective, randomized, double-blind, and parallel-group study aiming at comparing the effects of candesartan cilexetil and placebo on cardiovascular events and cognitive function in elderly patients with hypertension. The aim of this sub-analysis was to present data on cognitive function and health-related quality of life (HRQL) at baseline (randomization), and to investigate whether cognitive function was related to HRQL. More specifically, the main aim was to investigate the possible relationship between the Mini-Mental State Examination on one hand, and the Psychological General Well-Being (PGWB) index, the Subjective Symptom Assessment (SSA-P) Profile and the EuroQoL Health Utility Index (EQ-5D) on the other. All the instruments are extensively validated. A general finding was that cognitive function was positively associated with higher well-being (PGWB total score and self-control) and higher utility value (EQ-5D current health) but was unrelated to the occurrence of subjective adverse symptoms (SSA-P). Age and the use of psychotropic drugs, but not gender and education level, influenced this relationship significantly.     

Influenza vaccination in community-dwelling elderly: impact on mortality and influenza-associated morbidity

BACKGROUND: Influenza-related morbidity and mortality have been extensively studied with hospital and reimbursement data. However, little is known about the effectiveness of the annual vaccination programs in generally healthy community-dwelling elderly. The objective of our study was to investigate the effectiveness of influenza vaccination in community-dwelling elderly during the 1996 to 1997 influenza epidemic. METHODS: We performed a population-based cohort study using the computerized Integrated Primary Care Information database in the Netherlands. Subjects who were 65 years and older in 1996 with a permanent status in a practice in the source population were considered eligible for study participation. Two cohorts were defined on the basis of vaccination status. We estimated and compared all-cause mortality, pneumonia, and clinical influenza infection rates between the cohorts. RESULTS: Influenza vaccination was associated with a significant reduction of morbidity and mortality in vaccinated elderly (relative risk [RR], 0.72; 95% confidence interval [CI], 0.60-0.87). Influenza infections decreased significantly in the vaccinated population (RR, 0.48; 95% CI, 0.26-0.91). Mortality was reduced significantly in elderly with comorbidity (RR, 0.67; 95% CI, 0.48-0.94). The risk reduction for pneumonia was nonsignificant (RR, 0.77; 95% CI, 0.55-1.07) but was temporally related to the peak influenza activity. CONCLUSIONS: In this study, influenza vaccination was associated with decreased mortality and influenza infections in community-dwelling elderly. Our results indicate that, in a season of mild influenza activity and good antigenic match between vaccine strains and circulating strains, influenza vaccination reduced mortality in the vaccinated population. Our data support an annual vaccination strategy for all community-dwelling elderly.     

蛋白尿对老年慢性心力衰竭患者心功能影响的研究

目的探讨蛋白尿对中国老年慢性心力衰竭（CHF）患者心功能的影响。方法人组老年CHF患者457例,根据尿常规定性结果或24h尿蛋白定量结果（≥30mg／24h）分为尿蛋白阳性组和阴性组,同时在所有患者中将214名患者根据24h尿蛋白定量结果进行亚组分析,测定尿微量白蛋白（UMA）、尿白蛋白比肌酐比率（UACR）、N-氨基酸末端脑利钠肽前体（NT-proBNP）、高敏C反应蛋白（hsCRP）、血肌酐（sCr）和二维超声心动图。结果本研究中伴有蛋白尿的患者共278例（60．83％）。相比阴性组患者,阳性组患者纽约心脏病学会（NYHA）心功能分级更差（P〈0．05）,且随着蛋白尿的增加而加重（P〈0．05）。蛋白尿阳性组患者具有较高的HF、心源性再住院率及住院天数伊均〈0．05）,亚组分析提示再住院发生率和住院天数随着蛋白尿水平增加而增加。阳性组患者的UMA、UACR、血肌酐（sCr）均增高（P均〈0．001）,蛋白尿对NT—proBNP、hsCRP也存在影响（P〈0．05）。平均随访1年后,伴随阳性组患者尿蛋白水平下降,部分心脏结构指标和心功能指标均有所改善（P〈0．05）。结论蛋白尿在老年CHF患者中的发生率较高,蛋白尿水平较高者心功能较差,是心源性再住院的独立预测因子,蛋白尿的降低能明显改善CHF的进展及预后。     

老年人肾功能、贫血和促红细胞生成素的相关性

目的 通过分析老年人肾小球滤过率（ GFR）和血清促红细胞生成素（EPO）水平对老年贫血患病率的影响,探讨老年贫血发生的相关因素及其与老年人肾功能水平的关系.方法 选取200例年龄≥60岁的老年患者作为观察对象,既往无慢性疾病的健康体检者30人作为正常对照组.采用Cockcroft-Gault方程计算eGFR;根据eGFR分为A组[eGFR＞ 50ml/（ min·1.73m2）,62例]、B组[30ml/（ min· 1.73m2）≤eGFR≤50ml/（ min·1.73m2）,114例]和C组[eGFR＜ 30ml/（ min· 1.73m2）,24例];66例老年贫血患者再根据GFR估算值（eGFR）分为AA组、AB组和AC组（分组标准同上）.测定血红蛋白（Hb）、血肌酐（Scr）、EPO水平.结果 伴随着肾功能水平的降低,老年人贫血患病率呈升高趋势,并且A,B,C3组之间比较均有显著性差异（P＜0.05）;正常对照组Log EPO与Hb呈负相关（r2=0.219,P=0.009）;A组Log EPO与Hb成负相关（r2=0.065,P=0.045）,B组Log EPO与Hb之间无相关关系,C组Log EPO与Hb为正相关（r2=0.294,P=0.006）;老年贫血患者随着肾功能水平的降低,EPO呈现下降趋势,AA组和AC组比较有显著性差异（P=0.042）.结论 老年人肾功能水平中度减退时贫血患病率即显著增加;随着年龄的增长,老年人EPO的分泌代偿性增加,但随着eGFR的不断下降,这种代偿机制逐渐减弱;当肾功能水平严重降低时,EPO分泌的减少是老年贫血发生的主要原因.