Association of Mild Anemia with Cognitive, Functional, Mood and Quality of Life Outcomes in the Elderly: The “Health and Anemia” Study

Asociacion de anemia leve con calidad de vida en ancianos. Estudio “Health and Anemia”.

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Ugo Lucca1*, Mauro Tettamanti1, Paola Mosconi2, Giovanni Apolone3, Francesca Gandini1, Alessandro Nobili1, Maria Vittoria Tallone4, Paolo Detoma4, Adriano Giacomin5, Mario Clerico6, Patrizia Tempia6, Adriano Guala7, Gilberto Fasolo8, Emma Riva1

1 Laboratory of Geriatric Neuropsychiatry, Istituto di Ricerche Farmacologiche “Mario Negri”, Milano, Italy2 Laboratory for Medical Research & Consumer Involvement, Istituto di Ricerche Farmacologiche “Mario Negri”, Milano, Italy3 Laboratory of Translational and Outcome Research in Oncology, Istituto di Ricerche Farmacologiche “Mario Negri”, Milano, Italy4 Laboratory of Analysis, Ospedale degli Infermi, Biella, Italy5 County Cancer Registry, Local Health Authority, ASL12, Biella, Italy6 Department of Oncology, Ospedale degli Infermi, Biella, Italy7 Department of Medicine & Geriatrics, Ospedale degli Infermi, Biella, Italy8 Community Medicine, Local Health Authority, ASL12, Biella, Italy



In the elderly persons, hemoglobin concentrations slightly below the lower limit of normal are common, but scant evidence is available on their relationship with significant health indicators. The objective of the present study was to cross-sectionally investigate the association of mild grade anemia with cognitive, functional, mood, and quality of life (QoL) variables in community-dwelling elderly persons.


Among the 4,068 eligible individuals aged 65–84 years, all persons with mild anemia (n = 170) and a randomly selected sample of non-anemic controls (n = 547) were included in the study. Anemia was defined according to World Health Organization (WHO) criteria and mild grade anemia was defined as a hemoglobin concentration between 10.0 and 11.9 g/dL in women and between 10.0 and 12.9 g/dL in men. Cognition and functional status were assessed using measures of selective attention, episodic memory, cognitive flexibility and instrumental and basic activities of daily living. Mood and QoL were evaluated by means of the Geriatric Depression Scale-10, the Short-Form health survey (SF-12), and the Functional Assessment of Cancer Therapy-Anemia.


In univariate analyses, mild anemic elderly persons had significantly worse results on almost all cognitive, functional, mood, and QoL measures. In multivariable logistic regressions, after adjustment for a large number of demographic and clinical confounders, mild anemia remained significantly associated with measures of selective attention and disease-specific QoL (all fully adjusted p<.046). When the lower limit of normal hemoglobin concentration according to WHO criteria was raised to define anemia (+0.2 g/dL), differences between mild anemic and non anemic elderly persons tended to increase on almost every variable.


Cross-sectionally, mild grade anemia was independently associated with worse selective attention performance and disease-specific QoL ratings.


Mean blood concentrations of hemoglobin progressively decline with aging [1]. In the elderly persons, hemoglobin concentrations slightly below the lower limit of normal are common and are usually viewed by the physician as having no clinical significance or as a chronic disease marker with no independent effect on health. In recent years however, anemia has been increasingly shown to be associated with a number of health indicators. Fatigue and weakness are common consequences of anemia. Several cross-sectional studies in the elderly persons have reported the association of anemia with functional disability and poorer physical performance [2], decreased muscular strength [3], fall injury events at home [4], and increased frailty risk [5]. Two longitudinal studies suggested that elderly persons with anemia are at increased risk of physical decline and recurrent falls [6], [7]. Anemia can thus have a relevant effect on healthcare needs and, with the increasing rate of growth of the elderly population, become a significant healthcare burden [8], [9].

The hypoxic condition caused by anemia may not only negatively affect physical function but also the cognitive performance, mood, and quality of life (QoL) of the elderly person. Very few studies in community-dwelling elderly persons have explored the relationship of anemia with cognitive performance or mood, and none with QoL. Moreover, those few studies did not exclude moderate to severe anemic individuals from the analyses whose scores likely affected the results.

The main aim of the study was to investigate the association of mild grade anemia with significant health-related variables such as cognitive performance, functional status, mood, and QoL in a sample of community-dwelling elderly persons.