Anemia and the Frail Elderly

Frailty engenders a recognizable clinical syndrome of vulnerability to stressors related to impaired physiologic reserve that primarily occurs among older adults. Features of frailty include weight loss, exhaustion, muscle weakness, performance impairment, and cognitive slowing and can be identified independent of comorbid conditions. Among frail older adults, anemia prevalence is markedly increased. The interaction between anemia and frailty is complex and confidently separating cause and effect may not be possible. Nevertheless, anemia functions as a powerful prognostic factor for the development of frailty related problems such as muscle weakness, reduced performance, falls, and mortality. Further, mildly reduced hemoglobin shows a similar association with adverse outcomes. The data strongly intimate that anemia predisposes or accelerates the development of frailty. Anemia interventional studies are sorely needed to determine whether treatment may mitigate either the development of frailty and/or the sequela of frailty.