Elsevier

Maturitas

Volume 90, August 2016, Pages 37-41
Maturitas

Association between hematologic parameters and functional impairment among geriatric inpatients: Data of a prospective cross-sectional multicenter study (“GeriPrävalenz2013”)

https://doi.org/10.1016/j.maturitas.2016.04.020Get rights and content

Highlights

Abstract

Objectives

Objective of this study was to analyse the association between impairment of Barthel Index items and hematologic parameters in geriatric inpatients.

Methods

Patient recruitment of the “GeriPrävalenz2013” study has been described before. Inclusion criteria: in-patient aged > = 70 years; exclusion criteria: actual cancer disease or cancer associated treatment. Anemia was defined according to WHO criteria. Physical impairment was assessed by Barthel Index (BI). Association between all 10 items of the BI and hematologic parameters was statistically evaluated.

Results

Anemia prevalence was 55.1% (319/579) with BI impairment in 96.2% patients. T-test revealed significant lower BI in anemic patients (47.9 vs 54.3; p = 0.004). Binary logistic regression revealed that growing age, reduced MCV, reduced iron levels and reduced Hb levels were associated with increased impairment of several items of the Barthel-Index. Interestingly, increased levels of albumin and folic acid (FA) were associated with increased impairment of BI items.

Conclusion

Anemia and lower levels of anemia related parameters showed a negative impact 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. Reasons for the negative impact of elevated FA and albumin levels on BI remain speculative.

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.

Section snippets

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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