Anemia in older adults

Abstract

Purpose of review: Anemia is common in older adults and is an independent predictor for increased morbidity and mortality in several disease states. Older persons with anemia suffer hospitalization, physical decline, and disability at higher rates than those people without anemia.

Recent findings: The prevalence and causes of anemia in community-dwelling older persons in the US were evaluated in the third National Health and Nutrition Examination Survey (NHANES) 1988-1994. In persons 65 years and older, anemia was present in 11.0% of men and 10.2% of women, with the prevalence rising to over 20% in people 85 years and older. One third of the cases were due to nutritional deficiencies, and one third was due to chronic illness, including but not limited to chronic kidney disease. About one third of the cases of anemia remain unexplained. Anemia is also prognostic for diminished physical performance and loss of mobility in people 65 years and older. A recent report suggests that the prevalence of anemia is even higher in elderly persons living in nursing homes. The data suggest that the risk of mortality and loss of mobility even extends to levels of hemoglobin normally considered low normal by WHO criteria, raising the question about optimal hemoglobin levels in the elderly.

Summary: Anemia is a common modifiable predictor of poor medical outcome in older adults and, as such, should be actively managed. Clinical studies are necessary to assess the effect of treatment of anemia on outcomes specific to the elderly, like disability.