Anemia Is Associated with Disability and Decreased Physical Performance and Muscle Strength in the Elderly

Brenda W.J.H. Penninx, Marco Pahor, Matteo Cesari, Anna Maria Corsi, Richard C. Woodman, Stephania Bandinelli, Jack M. Guralnik, Luigi Ferrucci

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OBJECTIVES: To examine the association between anemia and disability, physical performance, and muscle strength in older persons. DESIGN: Cross-sectional. SETTING: Community-dwelling older persons in the Chianti area in Italy. PARTICIPANTS: A total of 1,156 persons aged 65 and older participating in the InChianti Study ("Invecchiare in Chianti," i.e., Aging in the Chianti Area). MEASUREMENTS: Anemia was defined according to World Health Organization criteria as a hemoglobin concentration below 12 g/dL in women and below 13 g/dL in men. Disability in six basic and eight instrumental activities of daily living was assessed. Physical performance was assessed using the short physical performance battery (4-m walk, balance, and chair stands), which yields a summary performance score ranging from 0 to 12 (high). Muscle strength was determined using knee extensor and handgrip strength assessments. RESULTS: Overall, 11.1% of the men and 11.5% of the women had anemia. After adjustment for age, sex, body mass index, Mini-Mental State Examination score, creatinine level, and presence of various comorbid conditions, anemic persons had more disabilities (1.71 vs 1.04, P=.002) and poorer performance (8.8 vs 9.6, P=.003) than persons without anemia. Anemic persons also had significantly lower knee extensor strength (14.1 vs 15.2 kg, P=.02) and lower handgrip strength (25.3 vs 27.1 kg, P =.04) than persons without anemia. Further adjustment for inflammatory markers (interleukin-6, C-reactive protein, tumor necrosis factor-α) did not change these associations. CONCLUSION: Anemia is associated with disability, poorer physical performance, and lower muscle strength. Further research should explore whether treating anemia has a beneficial effect on the functional status of older persons.

Original languageEnglish
Pages (from-to)719-724
Number of pages6
JournalJournal of the American Geriatrics Society
Issue number5
Publication statusPublished - 1 May 2004


  • Anemia
  • Disability
  • Older persons
  • Physical performance
  • Strength

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