Effects of Anemia on the Rehabilitation Outcomes in Elderly Patients in the Post-Acute Care Setting.

Background - More than 3 million people in the United States over the age of 65 are anemic. The evidence indicates that older people with anemia suffer hospitalizations, physical decline and disability more than people without anemia. Additionally there are reports that anemia is an independent risk factor for this decline in physical performance in those over the age of 65.

Objective - The goal of this study was to detail if anemia significantly affects patient’s rehabilitation outcomes by focusing on the ability to perform activities of daily living (ADL) as assessed by the physical therapist, the disposition upon discharge (meeting the therapy goals) and an analysis of length of stay (LOS) in relation to anemia.

Methods - We conducted a chart review of 260 medical records of patients who underwent rehabilitation therapy at the North Chicago Veterans Affairs Medical Center, and detailed the progress of 69 of these patients who received ADL therapy. The study is ongoing with a projected chart review of 437 medical records, and with an estimated final sample size of 150. Univariate and multivariate analysis was conducted in relation to our outcome measures.

Results - The anemic group had 43 patients and the non-anemic 26. Average values for anemic patients were: Hgb 11 Hct 32, MCV 88, MCH 29.2, RDW 15.6, Platelets 259, the non-anemic patients values were: Hgb 13.4, Hct 39, MCV 89, MCH 33.3, RDW 14.3, platelets 229. The patients with anemia had a median change in ADL scores of 9 versus non-anemic patients’ median change in scores of 12 (p=0.154). Length of stay was 51 days (median) for anemic patients and 36 days (median) for non-anemic patients (p=0.108) Of the non-anemic patients, 19 out of 26 (73%) met the goals of therapy and 21 out of 43 (49%) of the anemic patients met the goals of therapy (p=0.055). Surprisingly, only 3 out of the 43 (7%) anemic patients were treated for their anemia or had work up done to identify the cause of the anemia. The multivariate model for length of stay indicated that anemia was not significant (p=0.842), the morbidity of the patient was marginally not significant (p=0.089), however, the patients’ age was statistically significant at p=0.05. For the multivariate model of ADL improvement the results were: anemia p=0.186, sex p=0.298, Charlson index p=0.50.

Conclusion - There is a definite lack in the identification and treatment of anemia in patients undergoing rehabilitation. Anemia exerts an influence on the course of patient therapy/recovery and should be addressed as an individual problem. Anemic patients undergoing rehabilitation are scoring lower, and are admitted longer to the hospital.