Five-year survival of older people with anemia: Variation with hemoglobin concentration

OBJECTIVES: To investigate the significance of low hemoglobin concentration and longevity in older people. DESIGN: Randomized prospective study. SETTING: Nursing home and geriatric hospital ward in a metropolitan welfare center. PARTICIPANTS: Apparently stable older residents from 1990 to 1996. MEASUREMENTS: Survival rates were estimated by statistical analysis. Sixty-three older subjects with low hemoglobin (Hb < 11g/dl) and age/sex-matched normal controls (Hb greater than or equal to 11g/dl) were observed for, 60 months. Scores of activities of daily living (ADLs) did not significantly differ between the two groups. Cerebrovascular disease was the main complication in both, and malignant neoplasms were not apparent initially. RESULTS: After 60 months, the 5-year survival rate (FSR) of normal controls was significantly higher than, that of cases with anemia (P = .0078). FSR was 67% in normal controls and 48% in anemic individuals age 70 to 79. The figures for individuals age 80 to 89 were 62% and 41%, respectively, and for individuals age 90 to 99 were 25% and 13%, respectively, the survival rate significantly decreasing, with age in both groups (P < .001). FSR with severe anemia (Hb less than or equal to8.9g/dl) was 0% in males, and 27% in females. Values for moderate anemia (9.0g/dl to 10.9g/dl) were 25% and 51%, respectively, for normal hemoglobin (11.0g/dl to 12.9g/dl) were 44% and 61%, respectively, and for high hemoglobin (13.0g/dl less than or equal to Hb) were 50% and 70%, respectively. Advanced carcinomas were often detected at autopsy in anemic individuals. No death by cancer occurred in normal controls. CONCLUSION: Low hemoglobin concentration predicts early death in nursing home residents. Anemia-associated conditions that might be Life-threatening risks in older people require further investigation.