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 population, is associated with several negative outcomes. The aim of this study was to investigate the independent prognostic value of anemia in the year after hospital discharge, analyzing its association with disability and mortality in a sample of older hospitalized patients. We evaluated 896 in-hospital older patients enrolled in the CRiteria to Assess Appropriate Medication Use among Elderly Complex Patients (CRIME) study, with assessment of hemoglobin levels at hospital admission and with follow-up data. We analyzed the risk of developing disability (in patients without pre-existing disability in activities of the daily living) and the likelihood of death (in the entire sample) in the 12 months after discharge according to presence and degree of anemia (defined by sex-specific World Health Organization criteria). Mean age of study participants was 81.2±7.4 years, 57.8% had prevalent anemia. In unadjusted analysis, anemia was strongly associated with functional status and survival. Nevertheless, the increased risk of disability and death was influenced by the coexistence of several clinical conditions associated with anemia. Indeed, using multivariate logistic regression analysis adjusted for potential confounders, the association with disability was strongly attenuated [severe anemia odds ratio (OR) 1.86, 95% confidence interval (CI): 0.96-3.58, mild-moderate anemia OR 1.05, 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 hospitalized patients, anemia, despite not influencing mortality, might have a significant disabling effect. Anemia should not be considered as an inevitable epiphenomenon of aging but a condition able to worsen the quality of life.