Elsevier

Seminars in Hematology

Volume 45, Issue 4, October 2008, Pages 210-217
Seminars in Hematology

Epidemiology of Anemia in Older Adults

https://doi.org/10.1053/j.seminhematol.2008.06.006Get rights and content

Anemia is a common, multifactorial condition among older adults. The World Health Organization (WHO) definition of anemia (hemoglobin concentration <12 g/dL in women and <13 g/dL in men) is most often used in epidemiologic studies of older adults. More than 10% of community-dwelling adults age 65 years and older has WHO-defined anemia. After age 50 years, prevalence of anemia increases with advancing age and exceeds 20% in those 85 years and older. In nursing homes, anemia is present in 48% to 63% of residents. Incidence of anemia in older adults is not well characterized. Among older adults with anemia, approximately one third have evidence of iron, folate, and/or vitamin B12 deficiency, another third have renal insufficiency and/or chronic inflammation, and the remaining third have anemia that is unexplained. Several studies demonstrate that anemia is associated with poorer survival in older adults. This review details the distribution and consequences of anemia in older adults and identifies future epidemiologic research needs.

Section snippets

Prevalence by Age and Sex

Estimates of anemia prevalence vary depending on the case definition applied and the demographic and health status composition of study samples. Although there is some debate on which hemoglobin thresholds should be used to define anemia in older adults, the World Health Organization (WHO) definition (hemoglobin concentration <12 g/dL in women and <13 g/dL in men) is the most frequently used in epidemiologic studies. Further, older persons with hemoglobin concentration below the WHO cutoffs are

Types of Anemia

The high burden of comorbidity and accompanying polypharmacy among older adults make it difficult to determine the underlying cause of anemia in this population. In the NHANES III, for example, approximately two thirds of participants with anemia had two or more age-associated diseases.10 Nonetheless, anemia in older persons is generally subdivided into four major types according to cause: anemia related to nutrient deficiencies, chronic kidney disease, chronic disease or inflammation, and

Association of Anemia With Mortality

Several large cohort studies have demonstrated that WHO-defined anemia is associated with increased risk of death among older adults.5, 6, 7, 8, 9 Associations were robust to extensive adjustment for potential confounding factors, with adjusted hazard ratios comparing anemic to non-anemic older adults ranging from 1.4 to 2.7. Three studies even showed that the effect of anemia on survival remained significant even after excluding participants with major age-associated conditions.6, 7, 8 Most

Conclusions

Anemia is a common, multifactorial condition among older adults that is associated with a variety of adverse outcomes, including mortality. While the epidemiology of anemia has advanced considerably in recent years, further investigation of several areas is needed. More outcomes-based research should be pursued to help define the hemoglobin threshold at which anemia occurs by race and sex. A larger effort is needed to better characterize the dynamics of anemia onset, chronicity, and recovery.

References (50)

  • F. Landi et al.

    Anemia status, hemoglobin concentration, and mortality in nursing home older residents

    J Am Med Dir Assoc

    (2007)
  • C.W. Choi et al.

    Incidence of anemia in older Koreans: Community-based cohort study

    Arch Gerontol Geriatr

    (2005)
  • W.H. Tang et al.

    Evaluation and long-term prognosis of new-onset, transient, and persistent anemia in ambulatory patients with chronic heart failure

    J Am Coll Cardiol

    (2008)
  • E. Joosten et al.

    Upper and lower gastrointestinal evaluation of elderly inpatients who are iron deficient

    Am J Med

    (1999)
  • D.G. Savage et al.

    Sensitivity of serum methylmalonic acid and total homocysteine determinations for diagnosing cobalamin and folate deficiencies

    Am J Med

    (1994)
  • S.P. Stabler et al.

    The use of homocysteine and other metabolites in the specific diagnosis of vitamin B-12 deficiency

    J Nutr

    (1996)
  • C.R. Keller et al.

    Kidney function and markers of inflammation in elderly persons without chronic kidney disease: The Health, Aging, and Body Composition Study

    Kidney Int

    (2007)
  • S.S. Strom et al.

    Epidemiology of myelodysplastic syndromes

    Semin Hematol

    (2008)
  • World Population ProspectsThe 2006 Revision

    (2007)
  • Older Americans Update 2008: Key Indicators of Well-Being

    (2008)
  • P.H. Chaves et al.

    What constitutes normal hemoglobin concentration in community-dwelling disabled older women?

    J Am Geriatr Soc

    (2004)
  • G.J. Izaks et al.

    The definition of anemia in older persons

    JAMA

    (1999)
  • B.W. Penninx et al.

    Anemia in old age is associated with increased mortality and hospitalization

    J Gerontol A Biol Sci Med Sci

    (2006)
  • N.A. Zakai et al.

    A prospective study of anemia status, hemoglobin concentration, and mortality in an elderly cohort: the Cardiovascular Health Study

    Arch Intern Med

    (2005)
  • E.M. Inelmen et al.

    Descriptive analysis of the prevalence of anemia in a randomly selected sample of elderly people living at home: some results of an Italian multicentric study

    Aging (Milano)

    (1994)
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    Supported by the Intramural Research Program of the US National Institute on Aging, National Institutes of Health.

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