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Frail Older Adults and Palliative Care

Frail Older Adults and Palliative Care To the Editor: Many symptoms and consequences of anemia, especially late-life anemia, are similar to those characterizing frailty (fatigue, weakness, and impaired physical and cognitive performance).1 In Table 1 of their discussion of palliative care for frail older adults, Drs Boockvar and Meier2 summarized operational definitions, assessment, and treatment methods for common symptoms of frailty. Anemia was listed as a remediable cause of fatigue but not as an underlying cause of falls. Although the association between anemia and increased risk of falls among elderly individuals has been recognized,3,4 anemia associated with long-term conditions other than renal disease may not be treated aggressively or considered in risk assessments for falls.5 The accepted definition of anemia (hemoglobin <12 g/dL in women; <13 g/dL in men) may no longer be clinically valid for elderly individuals.6 Symptoms of nonanemic iron depletion (serum ferritin ≤50 ng/mL [≤112 pmol/L]) also may be misinterpreted as age-related frailty and remain untreated. Although the causes of frailty and falls among elderly individuals are numerous and complex, it is important for clinicians to recognize that the physical and cognitive effects of anemia or low iron stores, even when hemoglobin and hematocrit values are normal or near normal, can be devastating to older persons. Ferritin levels and other underlying causes of anemia should be investigated whenever inexplicable symptoms of frailty develop. Back to top Article Information Financial Disclosures: None reported. References 1. Eisenstaedt R, Penninx BW, Woodman RC. Anemia in the elderly: current understanding and emerging concepts. Blood Rev. 2006;20:213-22616472893Google ScholarCrossref 2. Boockvar KS, Meier DE. Palliative care for frail older adults: “there are things I can't do anymore that I wish I could . . . ” JAMA. 2006;296:2245-225317090771Google ScholarCrossref 3. Penninx BW, Pluijm SM, Lips P. et al. Late-life anemia is associated with increased risk of recurrent falls. J Am Geriatr Soc. 2005;53:2106-211116398894Google ScholarCrossref 4. Dharmarajan TS, Avula S, Norkus EP. Anemia increases risk for falls in hospitalized older adults: an evaluation of falls in 362 hospitalized, ambulatory, long-term care, and community patients. J Am Med Dir Assoc. 2006;7:287-29316765864Google ScholarCrossref 5. Steinberg KE. Anemia and falls. J Am Med Dir Assoc. 2006;7:32716765871Google ScholarCrossref 6. Zakai NA, Katz R, Hirsch C. et al. A prospective study of anemia status, hemoglobin concentration, and mortality in an elderly cohort: the Cardiovascular Health Study. Arch Intern Med. 2005;165:2214-222016246985Google ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Frail Older Adults and Palliative Care

JAMA , Volume 297 (11) – Mar 21, 2007

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References (6)

Publisher
American Medical Association
Copyright
Copyright © 2007 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.297.11.1194-a
Publisher site
See Article on Publisher Site

Abstract

To the Editor: Many symptoms and consequences of anemia, especially late-life anemia, are similar to those characterizing frailty (fatigue, weakness, and impaired physical and cognitive performance).1 In Table 1 of their discussion of palliative care for frail older adults, Drs Boockvar and Meier2 summarized operational definitions, assessment, and treatment methods for common symptoms of frailty. Anemia was listed as a remediable cause of fatigue but not as an underlying cause of falls. Although the association between anemia and increased risk of falls among elderly individuals has been recognized,3,4 anemia associated with long-term conditions other than renal disease may not be treated aggressively or considered in risk assessments for falls.5 The accepted definition of anemia (hemoglobin <12 g/dL in women; <13 g/dL in men) may no longer be clinically valid for elderly individuals.6 Symptoms of nonanemic iron depletion (serum ferritin ≤50 ng/mL [≤112 pmol/L]) also may be misinterpreted as age-related frailty and remain untreated. Although the causes of frailty and falls among elderly individuals are numerous and complex, it is important for clinicians to recognize that the physical and cognitive effects of anemia or low iron stores, even when hemoglobin and hematocrit values are normal or near normal, can be devastating to older persons. Ferritin levels and other underlying causes of anemia should be investigated whenever inexplicable symptoms of frailty develop. Back to top Article Information Financial Disclosures: None reported. References 1. Eisenstaedt R, Penninx BW, Woodman RC. Anemia in the elderly: current understanding and emerging concepts. Blood Rev. 2006;20:213-22616472893Google ScholarCrossref 2. Boockvar KS, Meier DE. Palliative care for frail older adults: “there are things I can't do anymore that I wish I could . . . ” JAMA. 2006;296:2245-225317090771Google ScholarCrossref 3. Penninx BW, Pluijm SM, Lips P. et al. Late-life anemia is associated with increased risk of recurrent falls. J Am Geriatr Soc. 2005;53:2106-211116398894Google ScholarCrossref 4. Dharmarajan TS, Avula S, Norkus EP. Anemia increases risk for falls in hospitalized older adults: an evaluation of falls in 362 hospitalized, ambulatory, long-term care, and community patients. J Am Med Dir Assoc. 2006;7:287-29316765864Google ScholarCrossref 5. Steinberg KE. Anemia and falls. J Am Med Dir Assoc. 2006;7:32716765871Google ScholarCrossref 6. Zakai NA, Katz R, Hirsch C. et al. A prospective study of anemia status, hemoglobin concentration, and mortality in an elderly cohort: the Cardiovascular Health Study. Arch Intern Med. 2005;165:2214-222016246985Google ScholarCrossref

Journal

JAMAAmerican Medical Association

Published: Mar 21, 2007

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