Hemoglobin decline, function, and mortality in the elderly: the cardiovascular health study

Area of Science:

• Gerontology
• Hematology
• Epidemiology

Background:

• Anemia in the elderly is linked to poor outcomes.
• The impact of hemoglobin decline without anemia is less understood.
• Identifying at-risk elderly individuals is vital for timely intervention.

Purpose of the Study:

• To evaluate the determinants and consequences of hemoglobin decline in non-anemic elderly individuals.
• To compare hemoglobin decline and anemia development as predictors of adverse outcomes.
• To assess the utility of hemoglobin decrease for identifying at-risk elderly individuals.

Main Methods:

• Prospective cohort study of 3,758 community-dwelling elderly (≥65 years).
• Hemoglobin measured at baseline and 3 years later; anemia defined by World Health Organization (WHO) criteria.
• Modeled hemoglobin decline per 1 g/dL decrease and development of anemia; assessed subsequent cognitive function and mortality.

Main Results:

• Hemoglobin decreased by 0.4 g/dL over 3 years; 9% developed anemia.
• Predictors of hemoglobin decline included age, female sex, diabetes, and kidney disease.
• Hemoglobin decline predicted worse cognitive function in men; anemia predicted worse cognitive function in women.
• Both anemia development and hemoglobin decline predicted subsequent mortality.
• Hemoglobin decrease identified individuals missed by WHO anemia criteria.

Conclusions:

• Hemoglobin decline is a significant risk factor for adverse outcomes in the elderly, independent of anemia.
• Monitoring hemoglobin levels can identify a broader group of at-risk elderly individuals.
• Early intervention based on hemoglobin decrease may improve quality and quantity of life in the elderly.