Editorial: Anemia of Old Age

Prevalence, risk factors, and treatment of anemia in hospitalized older patients across geriatric and nephrological settings in Italy

Anemia is a common but often underdiagnosed and undertreated geriatric syndrome in hospitalized older patients. In this retrospective multicenter study, we aimed at characterizing the prevalence, risk factors, diagnostic and treatment approach to anemia in older patients admitted to acute care hospitals, focusing on differences between nephrology and geriatrics units. Prevalence and risk factors for anemia, diagnostic inertia (lack of iron, vitamin B12, and folate status assessment), replacement inertia (omitted treatment with iron, vitamin B12 or folic acid), and erythropoiesis-stimulating agents (ESA) inertia were explored. 1963 patients aged 82.7 (6.8) years were included in the study; 66.7% of the study population had anemia; among anemic patients, diagnostic inertia and replacement inertia were common with rates of 22-31% and 50-87%, respectively; omitted treatment with ESA affected 67.2% of patients and was more prevalent in geriatric units. In most cases, patients with ESA inertia were not routinely screened for iron tests. COPD, cancer, eGFR 45-60 ml/min were associated with increased tendency to ESA inertia. In conclusion, anemia had a high prevalence in older patients discharged from acute care units, but it is often underdiagnosed and undertreated.

Association of anemia with all-cause mortality in Chinese centenarians: a prospective cohort study

OBJECTIVES

This study aimed to examine the relationship between anemia and all-cause mortality in Chinese centenarians.

DESIGN

Prospective cohort study.

SETTING AND PARTICIPANTS

We included 1002 Chinese centenarians from the China Hainan Centenarian Cohort Study (CHCCS) MEASUREMENTS: Standard procedures were followed to perform blood analysis, home interviews, and physical examinations. Anemia was defined as a hemoglobin level of less than 130 g/L for men and less than 120 g/L for women.

RESULTS

During the 9-year follow-up period, a total of 929 (92.7%) deaths were identified. Cox proportional hazards regression models revealed that anemia (hazard ratio [HR] 1.289, 95% confidence interval [CI]: 1.117-1.489) was significantly associated with all-cause mortality. There was an apparent dose-response relationship between anemia and all-cause mortality. Centenarians with severe anemia had approximately 1.6 times higher likelihood of all-cause mortality than those without anemia (HR 1.662; 95% CI: 1.154-2.394).

CONCLUSION

Anemia is associated with an increased risk of all-cause mortality in Chinese centenarians. Further research will be needed to collect more comprehensive data on the etiology of anemia and causes of death in centenarians.

Determinants and spatial factors of anemia in women of reproductive age in Democratic Republic of Congo (drc): a Bayesian multilevel ordinal logistic regression model approach

BACKGROUND

As a global public health problem, anemia affects more than 400 million women of reproductive age worldwide, mostly in Africa and India. In the DRC, the prevalence of anemia has decreased slightly from 52.9% in 2007, to 46.4% in 2012 and 42.4% in 2019. However, there is considerable regional variation in its distribution. The aim of this study is to determine the factors contributing to anemia in women of reproductive age and to explore its spatial distribution in the DRC.

METHODS

Based on the Bayesian Multilevel Spatial Ordinal Logistic Regression Model, we used the 2013 Democratic Republic of Congo Demographic and Health Survey (DHS-DRC II) data to investigate individual and environmental characteristics contributing to the development of anemia in women of reproductive age and the mapping of anemia in terms of residual spatial effects.

RESULTS

Age, pregnancy status, body mass index, education level, current breastfeeding, current marital status, contraceptive and insecticide-treated net use, source of drinking water supply and toilet/latrine use including the province of residence were the factors contributing to anemia in women of reproductive age in DRC. With Global Moran's I = -0.00279, p-value ≥ 0.05, the spatial distribution of anemia in women of reproductive age in DRC results from random spatial processes. Thus, the observed spatial pattern is completely random.

CONCLUSION

The Bayesian Multilevel Spatial Ordinal Logistic Regression statistical model is able to adjust for risk and spatial factors of anemia in women of reproductive age in DRC highlighting the combined role of individual and environmental factors in the development of anemia in DRC.

Increased hemoglobin concentration and related factors in maintenance hemodialysis patients in Anhui, China

To investigate the hemoglobin (Hb) concentration and related factors among maintenance hemodialysis (MHD) patients in Anhui province in 2020, so as to compare with the results in 2014. The cases of 3025 MHD patients were investigated in 27 hemodialysis centers of Anhui province from January 2020 to December 2020. The data of age, sex, primary disease, dialysis age, dialysis mode, drug use and laboratory tests were collected and analyzed. Compared with the survey in 2014, the average Hb level of MHD patients in Anhui province was increased (107.41 ± 20.40 g/L vs 100.2 ± 28.1 g/L), the anemia prevalence was decreased (65.9% vs 82.4%), and the percentage of patients with standard Hb level was increased significantly (47.1% vs 32.9%). Compared with low-Hb patients (Hb < 110 g/L), patients with Hb ≥ 110 g/L had lower age, higher proportion of males, longer dialysis age, higher levels of serum Alb, creatinine, total cholesterol, triglyceride, low density lipoprotein, calcium, phosphorus, magnesium, and lower high-density lipoprotein (P < .05). The multivariate logistic regression analysis results showed that male, longer duration of dialysis therapy, treatment with iron, higher triglyceride and albumin were protective factors of anemia, but older age was independent risk factors. The anemia treatment in MHD patients in Anhui province was significantly improved. Male, long dialysis age, use of iron, high serum albumin and triglyceride levels may be protective factors for Hb reaching standard level, and old age may be an independent risk factor.

Relationship between Anemia and Falls among Postmenopausal Women in Korea

This study was conducted to explore the relationship between anemia and falls in postmenopausal women. The relationships between energy, protein, iron, and vitamin C intake were also checked. The data of this study are a combination of data from the Korea National Health and Nutrition Examination Survey (KNHANES) collected from the KNHANES VI-2,3 (2014–2015) and VII-1,2,3 (2016–2018). Falls and anemia were compared according to the subjects’ characteristics. Phi and Cramer’s V coefficient were applied to find the strength of association. Energy, protein, iron, and vitamin C intake and anemia were investigated. The relationship between the status as anemic and the occurrence of falls was analyzed using binary logistic regression. Of the 6665 subjects, 274 had a fall, and 596 had anemia. If the energy intake did not meet the estimated energy requirements, the state of anemia was significantly higher with a weak association. When protein, iron, and vitamin C did not meet the recommended nutrient intake, the anemia state was considerably higher with a weak to moderate association. Postmenopausal women with anemia were more likely to fall than subjects without anemia (OR = 1.88, p = 0.003). Additionally, anemia was confirmed to be related to insufficient energy, protein, iron, and vitamin C intake.

The prevalence and impact of anemia on hospitalized older adults: A single center experience from Bahrain

Objectives

This study reports the prevalence of anemia and investigates its associated correlates and outcomes among elderly hospitalized patients in a single hospital in Bahrain.

Methods

A retrospective study was conducted on 227 consecutive elderly patients admitted under general internal medicine in the biggest tertiary hospital in Bahrain. Medical records were reviewed for all patients, including clinical characteristics, laboratory results, and outcomes.

Results

Anemia was highly prevalent among hospitalized elderly patients (71.6%). Males were significantly more affected than females (p = 0.031). In terms of severity, the most common type was moderate anemia (56.1%); with regards to etiology, the most common type was anemia associated with chronic disease (48.1%). Anemia was as common as other comorbidities, including hypertension (71.4%) and diabetes mellitus (53.7%). When comparing anemic to non-anemic patients, the length of hospital stay was significantly longer (p < 0.001) and inversely correlated to the level of hemoglobin; furthermore, 1-year mortality was significantly higher (p < 0.001). When compared to those with mild anemia, patients with moderate/severe anemia were more likely to die (odds ratio [OR] = 2.2, 95% confidence interval [CI]: 1.27–4.92).

Conclusion

The prevalence of anemia in our study was higher than previously reported. Even so, anemia receives minimal attention and is usually seen as a minor problem. Our results reiterate the need to recognize the high importance of anemia especially when diagnosing and treating older patients. This, in turn, could positively affect a number of outcomes such as mortality, length of stay, and the functional decline of admitted individuals.

A 25-y longitudinal dolphin cohort supports that long-lived individuals in same environment exhibit variation in aging rates

Aging is a degradative process that varies among individuals. Due to limitations in defining and differentiating aging rates in human populations, understanding why some people appear to age slower than others has proven difficult. We analyzed 44 blood-based indices of health as candidate aging rate biomarkers collected over a 25-y period on a relevant, long-lived population of dolphins. Evidence of subsets of dolphins exhibiting slow and accelerated aging rates were detected, despite sharing the same environment, diet, and health care. Furthermore, some dolphin subsets were more likely to develop clinically relevant conditions, including anemia and immunosenescence. Our results support the notion that aging rates in long-lived mammals may be defined and provide insight into novel interventions to delay aging.

While it is believed that humans age at different rates, a lack of robust longitudinal human studies using consensus biomarkers meant to capture aging rates has hindered an understanding of the degree to which individuals vary in their rates of aging. Because bottlenose dolphins are long-lived mammals that develop comorbidities of aging similar to humans, we analyzed data from a well-controlled, 25-y longitudinal cohort of 144 US Navy dolphins housed in the same oceanic environment. Our analysis focused on 44 clinically relevant hematologic and clinical chemistry measures recorded during routine blood draws throughout the dolphins’ lifetimes. Using stepwise regression and general linear models that accommodate correlations between measures obtained on individual dolphins, we demonstrate that, in a manner similar to humans, dolphins exhibit independent and linear age-related declines in four of these measures: hemoglobin, alkaline phosphatase, platelets, and lymphocytes. Using linear regressions and analyses of covariance with post hoc Tukey–Kramer tests to compare slopes (i.e., linear age-related rates) of our four aging rate biomarkers among 34 individual dolphins aging from 10 y to up to 40 y old, we could identify slow and accelerated agers and differentiate subgroups that were more or less likely to develop anemia and lymphopenia. This study successfully documents aging rate differences over the lifetime of long-lived individuals in a controlled environment. Our study suggests that nonenvironmental factors influencing aging rate biomarkers, including declining hemoglobin and anemia, may be targeted to delay the effects of aging in a compelling model of human biology.

Association of Anemia with Activities of Daily Living in Chinese Female Centenarian

OBJECTIVES

Although anemia and activities of daily living (ADL) disability in female elderly are common conditions and are more likely to occur as people age, little is known about the association of anemia with ADL in female centenarians. The objective of this study was to examine the relationship between anemia and ADL disability in Chinese female centenarians.

DESIGN, SETTING AND PARTICIPANTS

We conducted a population-based cross-sectional study of a sample of 822 Chinese female centenarians from 2014 to 2016.

MEASUREMENTS

Blood analysis, home interview, and physical examination were performed following standard procedures. ADL disability was defined as a Barthel Index total score≤60.

RESULTS

The prevalence of anemia and ADL disability were 66.8% and 29.7% respectively in Chinese female centenarians. Multiple logistic regression analyses revealed that inflammation (OR = 2.280, 95% CI, 1.524-3.410), underweight (OR = 1.653, 95% CI, 1.186-2.303), anemia (OR = 1.775, 95% CI, 1.250-2.521), and living with family (OR = 0.518, 95% CI, 0.302-0.888) were significant factors related to ADL disability. Centenarians with severe anemia had an approximately fourfold greater likelihood of ADL disability than those without anemia (OR =3.747; 95% CI 1.525-9.206). An apparent dose-response relationship was found between anemia and ADL disability.

CONCLUSION

These findings may provide some insights into targeted intervention for maintaining ADL independence in female centenarians, especially encouraging the interventions of anemia to improve ADL.

Does aging have an impact on hemoglobin? Study in elderly population at rural teaching hospital

BACKGROUND

The prevalence of anemia increases with age. Some serious underlying conditions may lead to anemia in the old age. The present study was undertaken to detect and do morphological typing of anemia and further delineate etiological factors in elderly patients.

METHODS

In this hospital-based prevalence study carried out a tertiary care center over one and half years, a total of 90 patients were fully evaluated for etiology and typing of anemia in elderly (>60 years age) patients. Details of other significant medical and surgical history were noted. Laboratory investigations were conducted, which included complete hemogram, peripheral blood smear, reticulocyte count, erythrocyte sedimentation rate estimation, serum urea, serum creatinine and serum lactate dehydrogenase, bone marrow examination (with Prussian blue marrow iron staining), serum iron and serum total iron-binding capacity, serum ferritin, and stool and urine examination.

RESULTS

The mean hemoglobin as per age was 60-64 years- 5.95 gm%, 65-69 years - 6.7 gm%, 70-74 years - 6.58 gm%, and 75-79 years - 6.87 gm%. The difference not being significant (p = 0.33). Morphologically, 53 patients (24 males and 29 females) had microcytic anemia, 27 (17 males and 10 females) had normocytic anemia, and 10 (8 males and 2 females) had macrocytic anemia. Anemia of chronic disease (ACD) was the most common occurrence (50, 55.56%), followed by iron deficiency anemia (IDA) (27, 30%), macrocytic anemia (9, 10%), and others 4 (4.44%). The cause of anemia was found in 10 out of 27 (37.03%) patients in the IDA group, 28 out of 50 (56%) in the ACD group, whereas the etiology was discernible in only one out of nine cases (11.1%) of macrocytic anemias.

CONCLUSION

There was no significant difference observed in the mean hemoglobin levels as the age increased. Morphologically, the majority of the patients had microcytic anemia, followed by normocytic anemia. A population-based study is recommended for further assessment of the prevalence and causes of anemias in asymptomatic elderly subjects.