From the Guidelines
For a 92-year-old female with deconditioning, I recommend a comprehensive blood panel including complete blood count (CBC), comprehensive metabolic panel (CMP), thyroid-stimulating hormone (TSH), vitamin B12, vitamin D, folate, and iron studies. These tests will help identify common reversible causes of deconditioning in elderly patients. The CBC can detect anemia, infection, or other hematologic abnormalities. The CMP evaluates kidney and liver function, electrolyte balance, and glucose levels, which may reveal metabolic disturbances contributing to weakness. Thyroid dysfunction, particularly hypothyroidism, commonly presents as fatigue and weakness in older adults, making TSH testing essential 1. Vitamin deficiencies, especially B12, D, and folate, are prevalent in the elderly and can cause or worsen deconditioning. Iron studies help determine if iron deficiency is present, which can cause fatigue independent of anemia. Additionally, consider C-reactive protein or erythrocyte sedimentation rate to assess for underlying inflammation, and possibly B-type natriuretic peptide if heart failure is suspected, as suggested by the American College of Cardiology Foundation/American Heart Association guidelines 1.
Some key points to consider when interpreting these tests include:
- Age-related changes in laboratory values and multiple medication use can complicate interpretation in geriatric patients
- The presence of elevated mean corpuscular volume (MCV) or normal MCV and low serum ferritin may require additional testing, such as serum ferritin, serum iron, transferrin, and transferrin saturation 1
- The comprehensive metabolic panel should include serum electrolytes, including calcium and magnesium, as well as tests of both renal and hepatic function 1
- Thyroid function tests, especially TSH, should be measured routinely in patients with suspected heart failure or deconditioning 1
These tests should be interpreted in the context of the patient's clinical presentation, medication list, and comorbidities to guide further management and treatment.
From the Research
Blood Tests for Deconditioning in a 92-Year-Old Female
- The patient's deconditioning may be related to underlying anaemia, which can be caused by a nutritional deficiency of iron, vitamin B12, or folate 2.
- A full blood count is the first-line laboratory test for suspected anaemia, and results may suggest a nutritional deficiency 2.
- Additional tests, such as iron panel, vitamin B12, and folate levels, can help determine the cause of anaemia 3.
- Deconditioning can also be caused by immobility, which can lead to functional decline and compound conditions such as frailty and sarcopenia 4.
- A comprehensive evaluation, including a thorough history and physical examination, complete blood cell count, and supplemental tests, is essential to investigate the cause of anaemia and deconditioning 3.
Relevant Tests
- Full blood count 2, 3
- Iron panel (ferritin and iron levels, total iron-binding capacity, transferrin saturation) 3
- Vitamin B12 and folate levels 2, 3
- Peripheral blood smear 3
- Reticulocyte count 3
- Lactate dehydrogenase, haptoglobin, and bilirubin levels 3
Considerations
- Deconditioning can affect multiple body systems and result in reduced functional capacity, particularly in elderly individuals 5, 6.
- A multifaceted approach, including mobilisation strategies, nutrition, medical management, and psychologic support, is necessary to prevent and manage deconditioning 6, 4.