Is anaemia associated with cognitive impairment and delirium among older acute surgical patients?

Phyo Kyaw Myint, Stephanie Owen, Kathryn McCarthy, Lyndsay Pearce, Susan J Moug, Michael J Stechman, Jonathan Hewitt, Ben Carter

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)
6 Downloads (Pure)


Aim The determinants of cognitive impairment and delirium during acute illness are poorly understood, despite being common among older people. Anemia is common in older people, and there is ongoing debate regarding the association between anemia, cognitive impairment and delirium, primarily in non-surgical patients.
Methods Using data from the Older Persons Surgical Outcomes Collaboration 2013 and 2014 audit cycles, we examined the association between anemia and cognitive outcomes in patients aged ≥65 years admitted to five UK acute surgical units. On admission, the Confusion Assessment Method was carried out to detect delirium. Cognition was assessed using the Montreal Cognitive Assessment, and two levels of impairment were defined as Montreal Cognitive Assessment <26 and <20. Logistic regression models were constructed to examine these associations in all participants, and individuals aged ≥75 years only.
Results A total of 653 patients, with a median age of 76.5 years (interquartile range 73.0–80.0 years) and 53% women, were included. Statistically significant associations were found between anemia and age; polypharmacy; hyperglycemia; and hypoalbuminemia. There was no association between anemia and cognitive impairment or delirium. The adjusted odds ratios of cognitive impairment were 0.95 (95% CI 0.56–1.61) and 1.00 (95% CI 0.61–1.64) for the Montreal Cognitive Assessment <26 and <20, respectively. The adjusted odds ratio of delirium was 1.00 (95% CI 0.48–2.10) in patients with anemia compared with those without. Similar results were observed for the ≥75 years age group. 
Conclusions There was no association between anemia and cognitive outcomes among older people in this acute surgical setting. Considering the retrospective nature of the study and possible lack of power, findings should be taken with caution.
Original languageEnglish
Pages (from-to)1025-1030
Number of pages6
JournalGeriatrics and Gerontology International
Issue number7
Early online date1 Mar 2018
Publication statusPublished - Jul 2018

Bibliographical note

This manuscript has been written by the authors on behalf of the OPSOC. We acknowledge the respective Surgical Departments and Audit Departments for their cooperation. We also acknowledge the contribution of data collectors/collaborators of OPSOC as listed in We acknowledge the support of the National Institute for Health Research (NIHR) Biomedical Research Center at South London and Maudsley NHS Foundation Trust, and King's College London (BC).


  • Anaemia
  • Cognitive impairment
  • Delirium
  • Older surgical patients


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