Prevalence and outcomes of anemia in geriatrics: a systematic review of the literature

doi:10.1016/j.amjmed.2003.12.009

The American Journal of Medicine

Volume 116, Issue 7, Supplement 1, 5 April 2004, Pages 3-10

https://doi.org/10.1016/j.amjmed.2003.12.009 Get rights and content

Abstract

Anemia is a common concern in geriatric health, but its exact incidence and prevalence are unclear. Several studies have addressed this issue with discrepant results. Estimates of anemia prevalence reported in the articles reviewed here range from 2.9% to 61% in elderly men and from 3.3% to 41% in elderly women. This variability is related to a number of factors, including the setting of the study, the health status of the subject population, and the criteria used to define anemia. The criteria set by the World Health Organization (WHO)—hemoglobin level <120.0 g/L for women and <130.0 g/L for men—are most frequently, but not universally, used. Even so, their appropriateness in older populations may be questioned. Most existing reports indicate that elderly men have higher rates of anemia than do elderly women, but the threshold values are, in general, higher for men than for women. Incidence of anemia rises with age; some studies report a particularly notable increase in prevalence of anemia in the oldest subjects, those ≥85 years of age. Whereas anemia is associated with symptoms ranging from weakness and fatigue to increased falls and depression, and in severe cases can lead to congestive heart failure, few studies have systematically examined functional, clinical, and economic outcomes or patient satisfaction in the elderly with anemia. Future directions for research on anemia should include a more detailed examination of the importance of aging or age-related diseases on the pathogenesis of anemia, an assessment of the importance of anemia on outcomes such as physical function and cognitive function, and an analysis of whether impairments associated with anemia are amenable to correction by improving hemoglobin concentration.

Section snippets

Etiology

Anemia in the elderly arises from a variety of causes: most are common to all age groups, but some are more characteristic of aging versus younger populations. The most common of these causes in the elderly is chronic disease.4, 5, 6 Anemia of chronic disease is associated with several conditions that are also more prevalent in older individuals, including chronic infection, inflammatory disease, and malignancy. Iron deficiency is frequently seen in the elderly, typically as a result of acute

Methods

The goal of this systematic literature search was to identify and review articles on the prevalence of anemia and its impact on a range of clinical, functional, and quality-of-life (QOL) outcomes in geriatric patients. Outcomes of interest included

•Clinical: morbidity, mortality, hospitalization, transfusion requirements, disease progression, responsiveness to therapy, adherence to therapy, and adverse events due to therapy in which anemia may be a contributing or exacerbating factor

•Functional:

Results

The comprehensive online database search yielded 3,685 titles related to anemia in geriatrics; 2,430 titles were retrieved from MEDLINE and 1,255 titles from EMBASE. The title review resulted in 513 titles accepted, 477 from MEDLINE and 36 from EMBASE. Of those titles, 280 were accepted after review of abstracts or forwarded for full article review if no abstract was available. Accepted abstracts included 251 from MEDLINE and 29 from EMBASE. After full review of those articles, 71 were accepted

Future directions

The literature on the prevalence of anemia in the elderly contains considerable diversity in type of populations studied, sample sizes used, and methodology used. Furthermore, the criteria for diagnosing anemia—including both the measures used (hemoglobin, hematocrit, or ICD-9-CM codes) and the threshold values—vary from study to study. The lack of consistent criteria for defining anemia makes comparisons across studies and subject populations all but impossible. One of the most critical

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Comparison of anemia, renal function, and nutritional status in older women with femoral neck fracture and older women with osteoarthritis of the hip joint
2023, Journal of Orthopaedic Science
Several studies in older patients with femoral neck fracture found that preoperative anemia and malnutrition were associated with higher mortality and poorer physical function. Therefore, we compared nutritional status, Hb level, and renal function in women with femoral neck fracture and women of the same age with osteoarthritis of the hip joint.
We enrolled 257 women aged 70 years and older who suffered femoral neck fracture (F group) or who were scheduled to undergo total hip arthroplasty for osteoarthritis of the hip joint (OA group). The F and OA groups were further divided into 2 groups on the basis of age, ie, 74 years old and younger (F70 and OA70) and 75 years old and older (F75 and OA75). To assess whether patients had undernutrition, mortality risk, anemia, and renal dysfunction, we assessed Geriatric Nutritional Risk Index (GNRI), Hb, and eGFR.
We found a significant difference in the mean Hb levels and GNRI scores between the F75 and OA75 and F70 and OA70. Moreover, we found a moderate correlation between Hb level and GNRI score in the F75 and OA75. With respect to the GNRI category, the percentage of patients at moderate or major risk was 42.1% in the F70 group and 57.6% in the F75 group but only 1.9% in the OA70 group and 4.3% in the OA75 group.
We found that women with femoral neck fracture had significantly lower Hb levels and lower GNRI scores than women with hip OA in the same age and that anemia and undernutrition were closely linked in women aged 75 and above. Moreover, we found that more than 40% of patients with a femoral neck fracture had a moderate to major risk on the basis of their GNRI scores.
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To investigate the impact of pelvic exenteration (PelvEX) on patient-reported pain, distress, and quality of life along with physiologic indicators of health in cancer survivors with radiated, non-repairable rectourethral fistula (RUF).
We reviewed a prospectively maintained quality improvement database of RUF patients at our institution from 2012 to 2020. Patients with radiated, non-repairable RUF who underwent PelvEX and had follow up to 1 year were included. Pain and distress scores were collected preoperatively and at 1-year follow up. Number of narcotic prescriptions in the 3 months before surgery and the year after surgery were abstracted. Short Form 12 surveys were administered in the postoperative period. Serum albumin, creatinine, carbon dioxide, hematocrit, and glucose were abstracted from electronic health records. Statistical analysis was performed using Wilcoxon signed-rank and Mann-Whitney tests.
Eleven patients met inclusion criteria. Patient-reported pain significantly decreased at 1 year follow-up compared to preoperative scores (median pre: 4 vs 1 year post: 0, P = .0312). Patient-reported distress significantly decreased pre- versus post-PelvEX (median pre: 5 vs post: 0, P = .0156). At the time of postoperative pain and distress surveys, 9 (82.8%) patients did not have narcotic prescriptions. Postoperative Short Form 12 scores were similar to an age-matched United States population (mental: P = .3125; physical: P = .1484). Serum-based indicators of health were not different in the pre- versus postoperative period (all P >.05).
PelvEX may be a valuable treatment option to decrease patient-reported pain and distress without compromising quality of life or physiologic health in patients with radiated, non-repairable RUF.
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^☆: This article was sponsored by the National Anemia Action Council, Inc., and funded by an educational grant from Amgen, Inc.

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Prevalence and outcomes of anemia in geriatrics: a systematic review of the literature☆

Abstract

Section snippets

Etiology

Methods

Results

Future directions

Blood Rev

Am J Clin Nutr

Mayo Clin Proc

Ann Epidemiol

Am J Clin Nutr

Am J Med

Epidemiology of anemia in the elderlyinformation on diagnostic evaluation

J Am Geriatr Soc

Anemia in the elderly

Am Fam Physician

Prevalence and causes of anaemia in a geriatric hospitalized population

Gerontology

Incidence of anemia in older peoplean epidemiologic study in a well defined population

J Am Geriatr Soc

Anaemia in elderly patientsincidence and causes of low haemoglobin concentration in a city general practice

Scand J Prim Health Care

Age-associated increased interleukin-6 gene expression, late-life diseases, and frailty

Annu Rev Med

Biological interactions of aging and anemiaa focus on cytokines

J Am Geriatr Soc

Hematopoietic growth factors in the older cancer patient

Curr Opin Hematol

Prevalence of anemia and correlation of hemoglobin with age in a geriatric screening clinic population

J Am Geriatr Soc

The anemia of senescence

Am J Hematol

Incidence of anemia in women in fishing villages

Tokushima J Exp Med