We aim to investigate the prevalence and risk factors for anaemia among the elderly in a tertiary hospital.
Methods:
A retrospective study was conducted on 742 consecutive geriatric patients who were admitted to the medical unit of our hospital. The demographic and laboratory values for patients were examined. Anaemia-related data were studied. Patients with no/missing demographical or laboratory data and those who passed away after admission were excluded.
Results:
There was a high prevalence of anaemia in the study population. Although there were a significant proportion of nutritional causes, non-nutritional causes formed the majority. Significant risk adjusted risk factors associated with anaemia are male gender, Charlson's co-morbidity index and abnormal serum creatinine levels ≤60ml/min. (OR=1.469 [1.177–1.833], p=0.001; OR=1.147 [1.107–1.189], p<0.001; OR=1.335 [1.064–1.675], p=0.013 respectively.) Contributory factors for sub-types of anaemia were further investigated. A non-Chinese ethnicity, NSAID and anti-platelet use were significant risk factors for iron deficiency anaemia. (OR=2.035 [1.207–3.432], p=0.008; OR=8.202 [3.628–18.540], p<0.001; OR=2.080 [1.260–3.435], p=0.004 respectively.) For B12 deficiency, significant risk factors were non-Chinese ethnicity and metformin use. (OR=1.869 [1.036–3.370], p=0.038; OR=3.314 [1.690–6.499], p<0.001 respectively) A high Charleson's co-morbidity score and male gender correlated with anaemia of chronic disease. (OR=1.192 [1.104–1.288], p<0.001; OR=2.030 [1.198–3.440], p=0.009 respectively.) For anaemia of chronic renal disease, no significant predictors were found.
Conclusion:
Anaemia remains prevalent in the hospitalised geriatric population. Specific risk factors may help in the diagnosis and management of sub-types of anaemia.
Nilsson-EhleHJagenburgRLandahlSSvanborgA. Blood haemoglobin declines in the elderly: Implications for the reference intervals from age 70 to 88. Eur J Haematol. 2000;65(5):297–305.
2.
FriedTRBradleyEHWilliamsCSTinettiME. Functional disability and health care expenditures for older persons. Arch Intern Med. 2001;161(21):2602–7.
3.
NgTPFengLNitiMYapKB. Albumin, haemoglobin, BMI and cognitive performance in older adults. Age Ageing. 2008;37(4):423–9.
4.
RivaETettamantiMMosconiPApoloneGGandiniFNobiliA. Association of mild anaemia with hospitalisation and mortality in the elderly: The Health and Anaemia population-based study. Haematologica. 2009;94(1):22–8.
5.
SahadevanSChooPWJayaratnamFJ. Anaemia in the hospitalised elderly. Singapore Med J. 1995;36(4):375–8.
6.
GuyattGHOxmanADAliMWillanAMcIlroyWPattersonC. Laboratory diagnosis of iron deficiency anaemia: An overview. J Gen Intern Med. 1992;7(2):145–53.
7.
CookJDBaynesRDSkikneBS. Iron deficiency and the measurement of iron status. Nutr Res Rev. 1992;5:189–202.
8.
GuyattGHPattersonCAliM. Diagnosis of iron deficiency anemia in the elderly. Am J Med. 1990;88(3):205–9.
9.
GuralnikJMEisenstaedtRSFerrucciLKleinHGWoodmanRC. Prevalence of anaemia in persons 65 years and older in the United States: Evidence for a high rate of unexplained anaemia. Blood. 2004;104(8):2263–8.
10.
AndrewsNC. Anaemia of inflammation: The cytokine-hepcidin link. J Clin Invest. 2004;113(9):1251–3.
11.
SearsDA. Anaemia of chronic disease. Med Clin North Am. 1992;76(3):567–79.
12.
CharlsonMEPompeiPAlesKLMacKenzieCR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J. Chronic Dis. 1987;40(5):373–83.
13.
JoostenEPelemansWHieleMNoyenJVerhaegheRBoogaertsMA. Prevalence and causes of anaemia in a geriatric hospitalised population. Gerontology. 1992;38(1–2):111–7.
14.
LumanWNgKL. Audit of investigations in patients with iron deficiency anaemia. Singapore Med J. 2003;44(10):504–10.
15.
RockeyDCCelloJP. Evaluation of the gastrointestinal tract in patients with iron-deficiency anaemia. N Engl J Med. 1993;329(23):1691–5.
16.
NahonSLahmekPBarclayFMacaigneGPoupardinCJounnaudV. Long-term follow-up and predictive factors of recurrence of anaemia in a cohort of 102 very elderly patients explored for iron-deficiency anaemia. J Clin Gastroenterol. 2008;42(9):984–90.
17.
LindenbaumJHealtonEBSavageDGBrustJCGarrettTJPodellER. Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anaemia or macrocytosis. N Engl J Med. 1988;318(26):1720–8.
18.
LawrenceJMPetittiDBWatkinsMUmekuboMA. Trends in serum folate after food fortification. Lancet1999;354(9182):915–6.
19.
DietrichMBrownCJBlockG: The effect of folate fortification of cereal-grain products on blood folate status, dietary folate intake, and dietary folate sources among adult non-supplement users in the United States. J Am Coll Nutr2005;24(4):266–74.
20.
WeissG. Pathogenesis and treatment of anaemia of chronic disease. Blood Rev. 2002;16(2):87–96.
21.
VlagopoulosPTTighiouartHWeinerDEGriffithJPettittDSalemDN. Anaemia as a risk factor for cardiovascular disease and all-cause mortality in diabetes: The impact of chronic kidney disease. J Am Soc Nephrol. 2005;16(11):3403–10.
22.
ArtzASFergussonDDrinkaPJGeraldMBidenbenderRLechichA. Mechanisms of unexplained anaemia in the nursing home. J Am Geriatr Soc. 2004;52(3):423–7.
23.
WongHB. Thalassaemia in Singapore: Problems and solutions. Ann Acad Med Singapore. 1984 Jul;13(3):473–86.
24.
PenninxBWPahorMCesariMCorsiAMWoodmanRCBandinelliS. Anaemia is associated with disability and decreased physical performance and muscle strength in the elderly. J Am Geriatr Soc. 2004;52(5):719–24.
25.
IzaksGJWestendorpRGJKnookDL. The definition of anemia in older persons. JAMA. 1999;281(18):1714–7.
26.
BhasinSWoodhouseLCasaburiRSinghABBhasinDBermanN. Testosterone dose-response relationships in healthy young men. Am J Physiol Endocrinol Metab. 2001;281(6):E1172–81.
27.
KDOQI, National Kidney Foundation. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease. Am J Kidney Dis. 2006;47(5Suppl 3):S11–145.
28.
McClellanWAronoffSLBoltonWKHoodSLorberDLTangKL. The prevalence of anaemia in patients with chronic kidney disease. Curr Med Res Opin. 2004;20(9):1501–10.
29.
BleAFinkJCWoodmanRCKlausnerMAWindhamBGGuralnikJM. Renal function, erythropoietin, and anaemia of older persons: The InCHIANTI Study. Arch Intern Med. 2005;165(19):2222–7.
30.
AstorBCMuntnerPLevinAEustaceJACoreshJ. Association of kidney function with anemia: The Third National Health and Nutrition Examination Survey (1988–1994). Arch Intern Med. 2002;162(12):1401–8.
31.
De JagerJKooyALehertPWulffeléMGvan der KolkJBetsD. Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency: Randomised placebo controlled trial. BMJ. 2010;340:c2181
32.
SpivakJL. Anemia in the elderly: Time for new blood in old vessels?. Arch Intern Med. 2005 Oct 24;165(19):2187–9.
