The research was reported at the 47th annual meeting of the American Society of Hematology in Atlanta.
Elderly people who are anemic may have up to three times the risk of falls resulting in injury than those with normal blood counts, says Richard C. Woodman, MD. Woodman is senior medical director at Ortho Biotech, a Johnson & Johnson subsidiary.
Youth vs. Elderly
"Most of the reasons for falls in the elderly aren't treatable or reversible, but anemia potentially is reversible," Woodman tells WebMD. "That is why there is a lot of excitement in the potential link of anemia and falls."
James George, MD, says there is increasing interest in anemia in the elderly, which could be a clue of an undiagnosed disease or may be an important risk factor on its own. George is president of the American Society of Hematology and professor of medicine at the University of Oklahoma Health Sciences Center in Oklahoma City.
"The study shows that degrees of anemia normally not expected to be of major importance in younger people may have a major impact on the health and well-being of the elderly," he says. "The bottom line is that if an older person is anemic it puts them at high risk of hip and head injuries."
Risks to Hip and Head
The researchers studied health claims data from 30 health plans from January 1999 through April 2004 in 47,530 patients over the age of 65. The patients had had a hemoglobin measurement taken.
Hemoglobin is a protein that carries oxygen in red blood cells. It is used in the evaluation of anemia. Elderly men with a hemoglobin measurement of less than 13 grams per deciliter (g/dL) were considered anemic; women with hemoglobin less than 12 g/dL were considered anemic.
Injuries were defined as fractures of the hip, pelvis, back, ribs, and lower limbs, as well as head injuries and hematoma (a collection of blood in soft tissue or an organ).
The study's results showed that anemia was significantly and independently associated with an increased risk of injurious falls, especially hip and head injuries.
The researchers found there was a trend of increasing risk of falls with decreasing hemoglobin numbers in the elderly.
After adjusting for age, sex, other diseases, and medications, the researchers found that, those with anemia had a 57% increased chance of an injurious fall if their hemoglobin was less than 10 g/dL compared with those who weren't anemic.
But those with anemia had even higher risks for falls that resulted in hip or head injuries. If the hemoglobin was 10 g/dL or less, elderly people had more than three times the chance of an injurious fall to the hip; they had almost twice the chance of a fall resulting in head injury compared with those who weren't anemic.
Woodman says after a fall, doctors need to include a hemoglobin study as part of the routine workup. "This needs to be assessed in an ongoing manner," he says. "Patients fall for a lot of different reasons, but if they do fall it puts them at risk for another fall."
The anemia isn't necessarily a result of a poor diet, but it could be the result of underlying disease, Woodman says. "There are a number of treatment options that can range from simple vitamins and iron pills to more specific therapy to treat any underlying disease."
The anemia could be due to iron deficiency that could mean a loss of blood, chronic kidney disease, or unexplained anemia, he says.
Woodman calls for further study to determine if correcting the anemia could reduce the number of injurious falls in these patients.
"The bottom line is that anemia in the elderly is very important," says George. "Yet anemia in the elderly is not on the radar of most physicians."
SOURCES: Annual meeting of the American Society of Hematology, Atlanta, Dec. 10-13, 2005. Richard C. Woodman, MD, senior medical director, Ortho Biotech. James George, MD, president, American Society of Hematology; professor of medicine, University of Oklahoma Health Sciences Center, Oklahoma City.
By Linda Little
Reviewed by Louise Chang, MD
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