Association between hematologic parameters and functional impairment among geriatric inpatients: Data of a prospective cross-sectional multicenter study (“GeriPrävalenz2013”)
Introduction
Anemia is a frequent finding in older patients and association with functional deficits has been described [1], [2]. Data of physical impairment in anemic German geriatric inpatients, however, is scarce [3]. Most of the study groups evaluating association between functionality and anemia in older patients apply Barthel Index (BI) for assessment of physical impairment [4]. “Functional evaluation: the Barthel Index”. Md Med J 14: 61–65. The BI is part of the comprehensive geriatric assessment (CGA) and an established assessment tool, measuring the performance of activity of daily living. Ten performance items are used describing mobility and activity of daily living. Every item is rated and assigned a number of points. A high number of points (maximum 100 points) is associated with more independence in everyday life and less dependence on assistant help [4]. As the original version of BI had shown some weaknesses [5], several modified versions were developed. The Hamburg Classification Manual is a standardized and consensus-based operationalization of the BI and has been developed for application in German geriatric medicine [6]. Assessment of functional impairment in this study is based on the Hamburg Classification Manual for the BI.
As numerous previous studies have revealed significant impairment of overall results of BI score in anemic patients, this study analyses every single item of BI for impairment by anemia associated hematologic parameters. Primary objective of this study was to evaluate the impact of Hb values on impairment of the ten items. Secondary objective of this study was to evaluate impacts of several hematologic variables on impairment of the ten BI items.
Data derives from the cross-sectional multicenter study “GeriAnämie2013”, which has been issued by the German Geriatric Society to evaluate hematologic findings in German geriatric inpatients. It is registered in the German Clinical Trials Register (DRKS, Freiburg) with No. DRKS00004617. The local Ethics Committee of the University Hospital Cologne approved of the study (No. 12-322; 13.2.2013). The study was carried out in accordance with the current version of the Declaration of Helsinki of 2013.
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Patients and methods
Recruitment of patients for “GeriAnämie2013” has been described before [7]: Between June 2013 and December 2014 a number of 598 geriatric inpatients were consecutively recruited on admission in six participating German study centers (5 geriatric centers and 1 general emergency department of a university hospital). Recruitment interval was 4–6 weeks in every study center. Included were patients > 70 years admitted to the geriatric department or – in case of the general emergency department –
Results
Anemia was found in 319 of 579 (53.3%) patients (205 female, 114 male). Anemic patients were between 70 and 97 years old, with a mean age of 81.9 years (standard deviation (SD) 6.23).52.4% of women and 60.6% of men were anemic according to WHO criteria. Anemia was mainly mild and normocytic. BI was evaluated in all 579 patients with a mean value of 51.33 points (SD 26.53). Description of Barthel Index and items as well as the 11 metric and 5 nominal anemia associated hematologic study
Discussion
Aim of this study was to analyse an association between anemia related parameters and functional impairment assessed by BI items among geriatric inpatients. To our knowledge this is the first study to evaluate BI items and anemia related parameters in geriatric inpatients. Our finding of anemic patients having significantly lower BI scores than not-anemic patients is in accordance with previous findings of a Spanish study [2]. In our study multivariable analysis further revealed that reduced
Conclusion
Results of this study underline the idea of a negative impact of anemia and anemia related parameters on ADL and physical performance based on BI items. An impaired total BI should result in an analysis of BI subitems, particularly if anemia related laboratory parameters are deviant.
Contributors
Gabriele Röhrig, contributed to the conception and design of the study, acquisition of data, analysis and interpretation of data and writing the article. Ingrid Becker contributed to the statistical analysis and interpretation of data as well as drafting the article. Ralf-Joachim Schulz, Romana Lenzen-Großimlinghaus, Peter Willschrei, Sybille Gebauer, Mirja Modreke and Martin Jäger contributed to the acquisition of data and drafting the article. Rainer Wirth contributed to the conception and
Conflict of interest
None declared.
Funding
None.
Ethics
The Ethics Committee of the University Hospital Cologne approved of the study (No. 12-322; 13.2.2013) and informed consent was obtained from participants.
Provenance and peer review
This article was peer reviewed.
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