Chronic Anemia and Fatigue in Elderly Patients
Chronic Anemia and Fatigue in Elderly Patients
Objectives: To evaluate the effect of epoetin alfa treatment on hemoglobin (Hb), fatigue, quality of life (QOL), and mobility in elderly patients with chronic anemia.
Design: An exploratory, 32 week, randomized, double-blind, crossover treatment trial.
Participants: Sixty-two community-dwelling individuals aged 65 and older with chronic anemia (Hb ≤11.5 g/dL).
Intervention: Subcutaneous epoetin alfa or placebo weekly for 16 weeks (Phase I) with crossover to the opposite treatment (Phase II).
Measurements: Hb and QOL scores from the Functional Assessment of Chronic Illness Therapy (FACIT) measurement system. Mobility was assessed as a secondary outcome using the Timed Up and Go (TUG) test.
Results: Of the 62 subjects enrolled, complete data were analyzed for 58 in Phase I and 54 participants in Phase II. Of those enrolled, most were African American (95%) and female (85%) and had multiple comorbidities and a mean age±standard deviation of 76.1±7.2. Mean baseline Hb was 10.5±0.9 g/dL (7.3-11.5). In Phase I, 67% of those taking epoetin alfa, and in Phase II, 69% of those taking epoetin alfa had an increase in Hb of more than 2 g/dL, significantly more than those taking placebo (P<.001). Similarly, elderly participants significantly improved on the fatigue and anemia subscales of the FACIT across phases (all P<.05). No significant differences were found between treatment and placebo on TUG scores. Epoetin alfa was well tolerated.
Conclusion: In this trial involving predominantly older African-American women with anemia, a direct relationship existed between increases in Hb during epoetin alfa therapy and improvements in fatigue and QOL.
It is projected that more than 3 million elderly adults are currently anemic as defined according to World Health Organization criteria, with a hemoglobin (Hb) level of less than 13 g/dL in men and less than 12 g/dL in women. The Third National Health and Nutrition Examination Survey (NHANES III; 1988-94) demonstrated that the overall prevalence of anemia in the United States in persons aged 65 and older is 10.6%. Nutritional deficiencies cause approximately one-third of these cases; chronic inflammation (19.7%), chronic kidney disease (CKD) (8.2%), or both (4.3%) cause another third; and anemia without a well-defined etiology causes the final third. Anemia of chronic inflammation (ACI) is common in older people, reflecting the presence of chronic diseases and inflammatory conditions in this group. The underlying mechanism of anemia associated with chronic disease is well recognized and may involve impaired reuse of iron for erythropoiesis, reduced production of erythropoietin in response to anemic hypoxia, decreased lifespan of red blood cells because of inflammatory cytokines, or a combination of the three. In approximately 34% of elderly patients with anemia, low hemoglobin has no clear etiology and is known as idiopathic anemia of aging (IAA). Regardless of the cause, the majority of anemia in older people is mild, with Hb between 11 and 12 g/dL.
The clinical symptoms of anemia are somewhat nonspecific and are often difficult to attribute directly to the anemia itself. However, anemic older adults have poorer cognitive function; greater healthcare utilization; and higher risk of falls, disability, and mortality than their nonanemic counterparts. Anemia is also highly associated with fatigue, the subjective sensation of weakness, lack of energy, and tiredness. Fatigue can adversely influence physical, emotional, cognitive, and even social aspects of quality of life (QOL) and is common in older people. The importance of fatigue and its effect on a patient's QOL has also been investigated in chronic diseases such as cancer, renal disease, and rheumatoid arthritis. Although anemia in older people may often be mild, the Women's Health and Aging Study suggested that mild anemia should not be considered a "normal" or clinically appropriate finding. Treatment considerations for patients with anemia depend on its etiology and may include correction of nutritional deficiencies, transfusion of red blood cells, and treatment of underlying conditions.
Erythropoiesis-stimulating agents (ESAs) such as epoetin alfa and darbepoetin alfa have shown benefit for correction of anemia associated with specific conditions but not for anemia in older people in general. Furthermore, there have been no interventional studies conducted to assess the benefits of treating chronic anemia in older adults. A Phase IV, exploratory, randomized, double-blind, placebo-controlled, crossover clinical trial using epoetin alfa was conducted to determine whether correction of chronic anemia in older people (ACI and IAA) would lead to improvement in Hb levels, fatigue, QOL, and mobility.
Abstract and Introduction
Abstract
Objectives: To evaluate the effect of epoetin alfa treatment on hemoglobin (Hb), fatigue, quality of life (QOL), and mobility in elderly patients with chronic anemia.
Design: An exploratory, 32 week, randomized, double-blind, crossover treatment trial.
Participants: Sixty-two community-dwelling individuals aged 65 and older with chronic anemia (Hb ≤11.5 g/dL).
Intervention: Subcutaneous epoetin alfa or placebo weekly for 16 weeks (Phase I) with crossover to the opposite treatment (Phase II).
Measurements: Hb and QOL scores from the Functional Assessment of Chronic Illness Therapy (FACIT) measurement system. Mobility was assessed as a secondary outcome using the Timed Up and Go (TUG) test.
Results: Of the 62 subjects enrolled, complete data were analyzed for 58 in Phase I and 54 participants in Phase II. Of those enrolled, most were African American (95%) and female (85%) and had multiple comorbidities and a mean age±standard deviation of 76.1±7.2. Mean baseline Hb was 10.5±0.9 g/dL (7.3-11.5). In Phase I, 67% of those taking epoetin alfa, and in Phase II, 69% of those taking epoetin alfa had an increase in Hb of more than 2 g/dL, significantly more than those taking placebo (P<.001). Similarly, elderly participants significantly improved on the fatigue and anemia subscales of the FACIT across phases (all P<.05). No significant differences were found between treatment and placebo on TUG scores. Epoetin alfa was well tolerated.
Conclusion: In this trial involving predominantly older African-American women with anemia, a direct relationship existed between increases in Hb during epoetin alfa therapy and improvements in fatigue and QOL.
Introduction
It is projected that more than 3 million elderly adults are currently anemic as defined according to World Health Organization criteria, with a hemoglobin (Hb) level of less than 13 g/dL in men and less than 12 g/dL in women. The Third National Health and Nutrition Examination Survey (NHANES III; 1988-94) demonstrated that the overall prevalence of anemia in the United States in persons aged 65 and older is 10.6%. Nutritional deficiencies cause approximately one-third of these cases; chronic inflammation (19.7%), chronic kidney disease (CKD) (8.2%), or both (4.3%) cause another third; and anemia without a well-defined etiology causes the final third. Anemia of chronic inflammation (ACI) is common in older people, reflecting the presence of chronic diseases and inflammatory conditions in this group. The underlying mechanism of anemia associated with chronic disease is well recognized and may involve impaired reuse of iron for erythropoiesis, reduced production of erythropoietin in response to anemic hypoxia, decreased lifespan of red blood cells because of inflammatory cytokines, or a combination of the three. In approximately 34% of elderly patients with anemia, low hemoglobin has no clear etiology and is known as idiopathic anemia of aging (IAA). Regardless of the cause, the majority of anemia in older people is mild, with Hb between 11 and 12 g/dL.
The clinical symptoms of anemia are somewhat nonspecific and are often difficult to attribute directly to the anemia itself. However, anemic older adults have poorer cognitive function; greater healthcare utilization; and higher risk of falls, disability, and mortality than their nonanemic counterparts. Anemia is also highly associated with fatigue, the subjective sensation of weakness, lack of energy, and tiredness. Fatigue can adversely influence physical, emotional, cognitive, and even social aspects of quality of life (QOL) and is common in older people. The importance of fatigue and its effect on a patient's QOL has also been investigated in chronic diseases such as cancer, renal disease, and rheumatoid arthritis. Although anemia in older people may often be mild, the Women's Health and Aging Study suggested that mild anemia should not be considered a "normal" or clinically appropriate finding. Treatment considerations for patients with anemia depend on its etiology and may include correction of nutritional deficiencies, transfusion of red blood cells, and treatment of underlying conditions.
Erythropoiesis-stimulating agents (ESAs) such as epoetin alfa and darbepoetin alfa have shown benefit for correction of anemia associated with specific conditions but not for anemia in older people in general. Furthermore, there have been no interventional studies conducted to assess the benefits of treating chronic anemia in older adults. A Phase IV, exploratory, randomized, double-blind, placebo-controlled, crossover clinical trial using epoetin alfa was conducted to determine whether correction of chronic anemia in older people (ACI and IAA) would lead to improvement in Hb levels, fatigue, QOL, and mobility.
Source...