TY - JOUR
T1 - Fatigability as a Predictor of Subclinical and Clinical Anemia in Well-Functioning Older Adults
AU - Simonsick, Eleanor M.
AU - Patel, Kushang V.
AU - Schrack, Jennifer A.
AU - Ferrucci, Luigi
N1 - Funding Information:
Funded by the Intramural Research Program, National Institute on Aging (NIA), National Institutes of Health. The BLSA is supported by the Intramural Research Program of the NIA. The authors have declared no conflicts of interest for this article. Study concept and design, analysis and interpretation of data, and preparation of manuscript: Simonsick. Interpretation of data and critical review of the manuscript: Patel and Schrack. Acquisition of participants and data, interpretation of data, and critical review of the manuscript: Ferrucci.
Funding Information:
Funded by the Intramural Research Program, National Institute on Aging (NIA), National Institutes of Health. The BLSA is supported by the Intramural Research Program of the NIA.
Publisher Copyright:
Published 2020. This article is a U.S. Government work and is in the public domain in the USA.
PY - 2020/10/1
Y1 - 2020/10/1
N2 - BACKGROUND/OBJECTIVES: Anemia is a common condition in older adults for which fatigue, the primary symptom, often goes unrecognized as individuals typically equilibrate their activity to avoid fatigue. Whether assessing fatigability (i.e., susceptibility to fatigue) facilitates identification of anemia is unknown. This study examines the association between fatigability and prevalent, incident, and persistent subclinical and clinical anemia in well-functioning older adults. DESIGN, SETTING, PARTICIPANTS: Longitudinal analysis of 905 well-functioning men and women aged 60 to 89 years and followed for 1 to 5 years from the Baltimore Longitudinal Study of Aging conducted at the National Institute on Aging, Clinical Research Unit, Baltimore, MD. MEASUREMENTS: Perceived fatigability was assessed as a rating of perceived exertion (RPE) from 6 to 20 following a 5-minute treadmill walk at 1.5 mph (.67 m/s); fatigue was assessed as reported unusual tiredness in the past month. Clinical anemia was defined using World Health Organization hemoglobin cutpoints of below 13 g/dL and below 12 g/dL for men and women, respectively, and subclinical anemia was defined as 13.0 to 13.9 g/dL and 12.0 to 12.9 g/dL, respectively. RESULTS: Overall, 14% of participants had clinical and 30% had subclinical anemia at baseline. Each increment (1 RPE) of fatigability was associated after covariate adjustment with 14% (95% confidence interval [CI] = 5–25%, P =.005) and 8% (CI = 1–17%; P =.031), respectively, greater likelihood of prevalent clinical and subclinical anemia. An average of 2.2 years later, each 1 RPE increment in baseline fatigability predicted an 11% (CI = 2–20%; P =.016) higher likelihood of incident and/or persistent subclinical and clinical anemia. Reports of unusual tiredness were associated with prevalent subclinical anemia only. CONCLUSION: This study provides evidence that perceived fatigability may help identify well-functioning older adults with borderline to clinical anemia who are on a trajectory of persistently suboptimal or worsening hemoglobin status. Assessing fatigability may facilitate earlier diagnosis of health conditions that underlie persistent suboptimal hemoglobin status. J Am Geriatr Soc 68:2297–2302, 2020.
AB - BACKGROUND/OBJECTIVES: Anemia is a common condition in older adults for which fatigue, the primary symptom, often goes unrecognized as individuals typically equilibrate their activity to avoid fatigue. Whether assessing fatigability (i.e., susceptibility to fatigue) facilitates identification of anemia is unknown. This study examines the association between fatigability and prevalent, incident, and persistent subclinical and clinical anemia in well-functioning older adults. DESIGN, SETTING, PARTICIPANTS: Longitudinal analysis of 905 well-functioning men and women aged 60 to 89 years and followed for 1 to 5 years from the Baltimore Longitudinal Study of Aging conducted at the National Institute on Aging, Clinical Research Unit, Baltimore, MD. MEASUREMENTS: Perceived fatigability was assessed as a rating of perceived exertion (RPE) from 6 to 20 following a 5-minute treadmill walk at 1.5 mph (.67 m/s); fatigue was assessed as reported unusual tiredness in the past month. Clinical anemia was defined using World Health Organization hemoglobin cutpoints of below 13 g/dL and below 12 g/dL for men and women, respectively, and subclinical anemia was defined as 13.0 to 13.9 g/dL and 12.0 to 12.9 g/dL, respectively. RESULTS: Overall, 14% of participants had clinical and 30% had subclinical anemia at baseline. Each increment (1 RPE) of fatigability was associated after covariate adjustment with 14% (95% confidence interval [CI] = 5–25%, P =.005) and 8% (CI = 1–17%; P =.031), respectively, greater likelihood of prevalent clinical and subclinical anemia. An average of 2.2 years later, each 1 RPE increment in baseline fatigability predicted an 11% (CI = 2–20%; P =.016) higher likelihood of incident and/or persistent subclinical and clinical anemia. Reports of unusual tiredness were associated with prevalent subclinical anemia only. CONCLUSION: This study provides evidence that perceived fatigability may help identify well-functioning older adults with borderline to clinical anemia who are on a trajectory of persistently suboptimal or worsening hemoglobin status. Assessing fatigability may facilitate earlier diagnosis of health conditions that underlie persistent suboptimal hemoglobin status. J Am Geriatr Soc 68:2297–2302, 2020.
KW - anemia
KW - fatigability
KW - hemoglobin
KW - older adults
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U2 - 10.1111/jgs.16657
DO - 10.1111/jgs.16657
M3 - Article
C2 - 32618359
AN - SCOPUS:85087387601
SN - 0002-8614
VL - 68
SP - 2297
EP - 2302
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 10
ER -