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 d iffer between the two groups. Cerebrovascular disease was the main complica tion 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 fo r individuals age 90 to 99 were 25% and 13%, respectively, the survival rat e significantly decreasing, with age in both groups (P < .001). FSR with se vere anemia (Hb less than or equal to8.9g/dl) was 0% in males, and 27% in f emales. 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 contr ols. CONCLUSION: Low hemoglobin concentration predicts early death in nursing ho me residents. Anemia-associated conditions that might be Life-threatening r isks in older people require further investigation.