Anemia is common in the older adult population.

While the anemia is typically mild, it

has been associated with substantial morbidity and mortality.
Normal values would be a hemoglobin <14.0 g/dL (<140 g/L) in men and <12.3 g/dL
(<123 g/L) in women.
Values for hemoglobin and hematocrit in apparently healthy older adults are generally
lower than those in younger adults, and differences between males and females that
are seen in younger adults are lessened with aging
Anemia is very prevalent in non-institutionalized older adults.
• In large studies of community-dwelling older adults from the United States and
Europe, prevalence rates for anemia ranged from 8 to 25 percent
• In the community-dwelling NHANES III population, 10.2 percent of women and
11 percent of men ≥65 were anemic
In 2008, the estimated world population was 6.7 billion with 98 million people ≥80
years of age. By 2030 this is estimated to grow to 8.4 billion total population.
It is plausible to suggest that anemia, potentially leading to increased cardiac output
and/or local tissue hypoxia, could aggravate functional decline in the older adult
population.
Anemia is also very prevalent in non-institutionalized older adults.
• In large studies of community-dwelling older adults from the United States and
o Europe, prevalence rates for anemia ranged from 8 to 25 percent
• In the community-dwelling NHANES III population, 10.2 percent of women and
11 percent of men ≥65 were anemic
A number of studies have highlighted the association between mild anemia, and even
low-normal hemoglobin values, and impaired performance-based mobility function
Anemia in the older adult has been found to be associated with other markers of
impaired physical function, including increased frailty, muscle weakness
Anemia in the elderly is also associated with impaired cognitive performance,
depressive symptoms, and reduced quality of life
• In the Women's Health and Aging Study (WHAS II) of 364 women age 70 to 80
with a hemoglobin ≥ 10 g/dL, the presence of mild anemia (Hgb 10 to 12 g/dL)
was associated with significantly poorer performance on the Trail Making Test,
Parts B and A, concerning tests of executive function
The causes for anemia were estimated as follows:
• Iron deficiency, alone or in combination with folate or B12 deficiency,
constituted more than one-half of this group.
 • One-third were related to chronic kidney disease and/or other chronic
disorders (eg, arthritis, diabetes, increased serum C-reactive protein, or a
positive rheumatoid factor).
• Unexplained anemia: 35 percent
• Hematologic malignancy (including myelodysplastic syndrome (MDS) or
suspicion of same): 22 percent
• Iron deficiency anemia: 12 percent
• Treatment for non-hematologic malignancy: 11 percent
• The absolute reticulocyte count and/or reticulocyte production
• Evaluation of the patient's nutritional status plays an important part in the
diagnostic approach to anemia in the older adult.
Effective management of anemia in the older adult requires detection and correction
of any treatable underlying etiology for example
• Deficiencies of iron, vitamin B12, or folic acid
• Underlying infection, inflammation, or malignancy
• Myelodysplastic syndrome
• Renal disease
Other disorders that should be considered include, but not be limited to, the following:
• Bleeding disorder
• Hypothyroidism
• Alcohol abuse
Testing should include, as a minimum:
• Complete blood count with red cell indices, reticulocyte count, platelet count,
white blood cell differential and a review of the peripheral smear
• BUN, creatinine, and urinalysis
• Stool examination for occult blood if a component of iron deficiency is
suspected
• Serum iron, total iron binding capacity (transferrin) and ferritin
• Serum B12 and folate
Treatment
• For those with unexplained, mild, asymptomatic anemia, treatment is not
indicated.
• For those with unexplained, symptomatic anemia, options include red cell
transfusions or erythropoiesis-stimulating agents
• While neither the optimal threshold for initiating therapy nor the optimal
therapeutic
• target have been established for SYMPTOMATIC anemia in the older adult, we
• suggest a target hemoglobin level in the range of 10 to 12 g/dL
References
- Price , Elizabeth A. Anemia in the Older Adult, 19 Mar. 2013