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March 21, 2007

Frail Older Adults and Palliative Care

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;297(11):1193-1195. doi:10.1001/jama.297.11.1194-a

To the Editor: Many symptoms and consequences of anemia, especially late-life anemia, are similar to those characterizing frailty (fatigue, weakness, and impaired physical and cognitive performance).1 In Table 1 of their discussion of palliative care for frail older adults, Drs Boockvar and Meier2 summarized operational definitions, assessment, and treatment methods for common symptoms of frailty. Anemia was listed as a remediable cause of fatigue but not as an underlying cause of falls. Although the association between anemia and increased risk of falls among elderly individuals has been recognized,3,4 anemia associated with long-term conditions other than renal disease may not be treated aggressively or considered in risk assessments for falls.5 The accepted definition of anemia (hemoglobin <12 g/dL in women; <13 g/dL in men) may no longer be clinically valid for elderly individuals.6 Symptoms of nonanemic iron depletion (serum ferritin ≤50 ng/mL [≤112 pmol/L]) also may be misinterpreted as age-related frailty and remain untreated.

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