Anemia Associated with Disability and Poorer Physical Performance

May 1, 2004

WINSTON-SALEM, N.C. – Older adults with anemia have more disabilities and score lower on physical performance and strength tests than those without anemia, report researchers from Wake Forest University Baptist Medical Center and colleagues in the current issue of the Journal of the American Geriatrics Society.

“Our results suggest that anemia is a risk factor for disability, poor physical function and low muscle strength – all which can threaten the independence of older adults,” said Brenda Penninx, Ph.D., lead researcher. “Physicians should be aware of their older patients’ anemia status, even if there is no apparent disease.”

Anemia, which is a reduced level of oxygen-carrying red blood cells, affects about 13 percent of people over age 70. It has a variety of causes, from iron or vitamin B-12 deficiencies to chronic diseases such as cancer or liver disease. In older adults, about 20 percent of 30 percent of cases have no known cause.

The researchers used data from the InCHIANTI Study, a study of 1,156 older adults living in the Chianti area of Italy that was conducted by the Italian National Research Council of Aging. The research measured physical performance using tests of standing balance, walking speed and ability to rise from a chair. Previous studies illustrated that these tests can predict the likelihood of hospitalization and later disability, nursing home admission, mortality. Handgrip and knee muscle strength were also measured.

Disability was assessed by asking participants whether they needed help with six basic activities of daily living (eating, bathing, dressing, transferring from bed to chair, using the toilet and walking across a small room), and eight other activities, including shopping, doing light housework, and preparing meals.

“Participants with anemia reported an average of 1.7 disabilities, compared to an average of 1.0 for the non-anemic subjects,” said Penninx, who was an associate professor at Wake Forest Baptist at the time the research was conducted. She is currently at the Vrije University in the Netherlands.

On the performance tests, the participants with anemia scored an average of one point lower on a 12-point scale. They also had significantly lower strength in their hand and knee muscles.

“Research has shown that one point on the performance battery is quite large and is associated with considerable increased risk of disability, hospitalization and mortality,” said Marco Pahor, M.D., professor of geriatrics at Wake Forest Baptist.

The researchers adjusted for factors that could have influenced the results, including age, body mass index, diseases such as diabetes, cancer or stroke, the presence of inflammatory markers in the blood, and whether the participant had been hospitalized in the past year. They found that anemia was still linked with increased disability and poorer scores on physical performance and strength tests.

Penninx and colleagues had previously reported than anemia in older adults is associated with a significantly higher risk of death and hospitalization and with a doubled risk for a decline in physical performance.

“Our research suggests that anemia deserves more attention,” said Penninx. “We need to learn whether treatment can help restore physical function or prevent a physical decline.”

The researchers said that because higher levels of hemoglobin are associated with less disability and better strength, the hemoglobin levels used to diagnose anemia in the elderly should be reevaluated.

Other researchers involved in the project were Marco Pahor, M.D., and Matteo Cesari, M.D., with Wake Forest Baptist; Anna Maria Corsi, Ph.D., and Stephania Bandinelli, M.D., from the National Research Institute, Florence, Italy, Richard Woodman, M.D., with Ortho Biotech Products, L.P., and Luigi Ferrucci, M.D., and Jack M. Guralnik, M.D., Ph.D., with the National Institute on Aging. Data analyses were supported through Ortho Biotech Products, L.P.

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Contacts: Karen Richardson,; Shannon Koontz,; at 336-716-4587.

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