Anemia in the elderly: How should we define it, when does it matter, and what can be done?

Mayo Clinic Proceedings

Volumn 82, Issue 8, 2007, Pages 958-966

  Steensma, David P ^a   Tefferi, Ayalew ^a  

^a MAYO CLINIC   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AGED; ANEMIA; COGNITIVE DEFECT; FRAIL ELDERLY; HEMOGLOBIN BLOOD LEVEL; HOSPITALIZATION; HUMAN; INFLAMMATORY DISEASE; KIDNEY FAILURE; MYELODYSPLASTIC SYNDROME; NUTRITIONAL DEFICIENCY; REVIEW;

EID: 34547643762     PISSN: 00256196     EISSN: None     Source Type: Journal    
DOI: 10.4065/82.8.958     Document Type: Review

References (64)

1. Schrier SL. Hematology, ASH, and the anemia of the aged [editorial] . Blood. 2005;106:3341-3342.
2. Spivak JL. Anemia in the elderly: time for new blood in old vessels? [editorial]. Arch Intern Med. 2005;165:2187-2189.
3. Eisenstaedt R, Penninx BW, Woodman RC. Anemia in the elderly: current understanding and emerging concepts. Blood Rev. 2006 Jul;20:213-226. Epub 2006 Feb 10.
4. Guralnik JM, Ershler WB, Schrier SL, Picozzi VJ. Anemia in the elderly, a public health crisis in hematology. Hematology Am Soc Hematol Educ Program. 2005:528-532.
5. US Census Bureau. Age data. Available at: www.census.gov/population/www/ socdemo/age.html and www.census.gov/prod/2006pubs/07statab/pop.pdf. Accessed June 22, 2007.
6. Hobbs FB.The elderly population. Available at: www.census.gov/population/ www/pop-profile/elderpop_html. Accessed June 22, 2007.
7. Guralnik JM, Eisenstaedt RS, Ferrucci L, Klein HG, Woodman RC. Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. Blood. 2004 Oct 15;104:2263-2268. Epub 2004 Jul 6.
8. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. Plan and operation of the Third National Health and Nutrition Examination Survey, 1988-94. Vital Health Stat 1. 1994 Jul;32:1-407.
9. World Health Organization. Nutritional anemia: report of a WHO Scientific Group. World Health Organ Tech Rep Ser. 1968;405:5-37.
10. Beutler E, Waalen J. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? Blood. 2006 Mar 1;107:1747-1750. Epub 2005 Sep 27.
11. Woodman R, Ferrucci L, Guralnik J. Anemia in older adults. Curr Opin Hematol. 2005;12:123-128.
12. Hollowell JG, van Assendelft OW, Gunter EW, Lewis BG, Najjar M, Pfeiffer C, Centers for Disease Control and Prevention, National Center for Health Statistics. Hematological and iron-related analytes - reference data for persons aged 1 year and over: United States, 1988-94. Vital Health Stat 11. 2005 Mar;247:1-156.
13. Beutler E, Felitti VJ, Koziol JA, Ho NJ, Gelbart T. Penetrance of 845G→A (C282Y) HFE hereditary haemochromatosis mutation in the USA. Lancet. 2002;359:211-218.
14. Beutler E. West C. Hematologic differences between African-Americans and whites: the roles of iron deficiency and alpha-thalassemia on hemoglobin levels and mean corpuscular volume. Blood. 2005 Jul 15;106:740-745. Epub 2005 Mar 24.
15. Ruiz-Arguelles GJ. Altitude above sea level as a variable for definition of anemia. [letter]. Blood. 2006;108:2131.
16. Nordenberg D, Yip R, Binkin NJ. The effect of cigarette smoking on hemoglobin levels and anemia screening. JAMA. 1990;264:1556-1559.
17. Chaves PH, Xue QL, Guralnik JM, Ferrucci L, Volpato S, Fried LP. What constitutes normal hemoglobin concentration in community-dwelling disabled older women? J Am Geriatr Soc. 2004;52:1811-1816.
18. Boehringer PA, Darden IL. The quest for the normal hemoglobin concentration [letter]. Blood. 2006;108:777.
19. Zakai NA, Katz R, Hirsch C, et al. A prospective study of anemia status, hemoglobin concentration, and mortality in an elderly cohort: the Cardiovascular Health Study. Arch Intern Med. 2005;165:2214-2220.
20. Horwich TB, Fonarow GC, Hamilton MA, MacLellan WR, Borenstein J. Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failure. J Am Coll Cardiol. 2002;39:1780-1786.
21. Mozaffarian D, Nye R, Levy WC. Anemia predicts mortality in severe heart failure: the prospective randomized amlodipine survival evaluation (PRAISE). J Am Coll Cardiol. 2003;41:1933-1939.
22. Ezekowitz JA, McAlister FA, Armstrong PW. Anemia is common in heart failure and is associated with poor outcomes: insights from a cohort of 12 065 patients with new-onset heart failure. Circulation. 2003;107:223-225.
23. Caro JJ, Salas M, Ward A, Goss G. Anemia as an independent prognostic factor for survival in patients with cancer: a systemic, quantitative review. Cancer. 2001;91:2214-2221.
24. Fangman JJ, Scadden DT. Anemia in HIV-infected adults: epidemiology, pathogenesis, and clinical management. Curr Hematol Rep. 2005;4:95-102.
25. Patel KV, Harris TB, Faulhaber M, et al. Racial variation in the relationship of anemia with mortality and mobility disability among older adults. Blood. 2007 Jun 1;109:4663-4670. Epub 2007 Feb 6.
26. Ishine M, Wada T, Akamatsu K, et al. No positive correlation between anemia and disability in older people in Japan [letter]. J Am Geriatr Soc. 2005;53:733-734.
27. Chaves PH, Semba RD, Leng SX, et al. Impact of anemia and cardiovascular disease on frailty status of community-dwelling older women: the Women's Health and Aging Studies I and II. J Gerontol A Biol Sci Med Sci. 2005;60:729-735.
28. Penninx BW, Guralnik JM, Onder G, Ferrucci L, Wallace RB, Pahor M. Anemia and decline in physical performance among older persons. Am J Med. 2003;115:104-110.
29. Chaves PH, Carlson MC, Ferrucci L, Guralnik JM, Semba R, Fried LP. Association between mild anemia and executive function impairment in community-dwelling older women: the Women's Health and Aging Study II. J Am Geriatr Soc. 2006;54:1429-1435.
30. Atti AR, Palmer K, Volpato S, Zuliani G, Winblad B, Fratiglioni L. Anaemia increases the risk of dementia in cognitively intact elderly. Neurobiol Aging. 2006;27:278-284.
31. Chaves PH, Ashar B, Guralnik JM, Fried LP. Looking at the relationship between hemoglobin concentration and prevalent mobility difficulty in older women: should the criteria currently used to define anemia in older people be reevaluated? J Am Geriatr Soc. 2002;50:1257-1264.
32. Penninx BW, Pluijm SM, Lips P, et al. Late-life anemia is associated with increased risk of recurrent falls. J Am Geriatr Soc. 2005;53:2106-2111.
33. Dharmarajan TS, Norkus EP. Mild anemia and the risk of falls in older adults from nursing homes and the community. J Am Med Dir Assoc. 2004;5:395-400.
34. Cesari M, Pahor M, Lauretani F, et al. Bone density and hemoglobin levels in older persons: results from the InCHIANTI study. Osteoporos Int. 2005 Jun;16:691-699. Epub 2004 Sep 28.
35. Cesari M, Penninx BW, Lauretani F, et al. Hemoglobin levels and skeletal muscle: results from the InCHIANTI study. J Gerontol A Biol Sci Med Sci. 2004;59:249-254.
36. Onder G, Penninx BW, Cesari M, et al. Anemia is associated with depression in older adults: results from the InCHIANTI study. J Gerontol A Biol Sci Med Sci. 2005;60:1168-1172.
37. Penninx BW, Pahor M, Woodman RC, Guralnik JM. Anemia in old age is associated with increased mortality and hospitalization. J Gerontol A Biol Sci Med Sci. 2006;61:474-479.
38. Joosten E, Lemiengre J, Nelis T, Verbeke G, Milisen K. Is anaemia a risk factor for delirium in an acute geriatric population? Gerontology. 2006;52:382-385. Epub 2006 Aug 17.
39. Izaks GJ, Westendorp RG, Knook DL. The definition of anemia in older persons. JAMA. 1999;281:1714-1717.
40. Artz AS, Fergusson D, Drinka PJ, et al. Prevalence of anemia in skilled-nursing home residents. Arch Gerontol Geriatr. 2004;39:201-206.
41. Ania BJ, Suman VJ, Fairbanks VF, Rademacher DM, Melton LJ III. Incidence of anemia in older people: an epidemiologic study in a well defined population. J Am Geriatr Soc. 1997;45:825-831.
42. Jackson RT, Jackson FL. Reassessing 'hereditary' interethnic differences in anemia status. Ethn Dis. Winter 1991;1:26-41.
43. 12 deficiency is the dominant nutritional cause of hyperhomocysteinemia in a folic acid-fortified population. Clin Chem Lab Med. 2005;43:1048-1051.
44. 12 (cobalamin) deficiency in elderly patients. CMAJ. 2004;171:251-259.
45. 12 deficiency in the aged: a population-based study. Age Ageing. 2007 Mar;36:177-183. Epub 2006 Dec 21.
46. Goodnough LT, Price TH, Parvin CA. The endogenous erythropoietin response and the erythropoietic response to blood loss anemia: the effects of age and gender. J Lab Clin Med. 1995;126:57-64.
47. Ble A, Fink JC, Woodman RC, et al. Renal function, erythropoietin, and anemia of older persons: the InCHIANTI study. Arch Intern Med. 2005;165:2222-2227.
48. Ershler WB, Sheng S, McKelvey J, et al. Serum erythropoietin and aging: a longitudinal analysis. J Am Geriatr Soc. 2005;53:1360-1365.
49. Ferrucci L, Guralnik JM, Bandinelli S, et al. Unexplained anaemia in older persons is characterised by low erythropoietin and low levels of proinflammatory markers. Br J Haematol. 2007;136:849-855.
50. Steensma DP, Gibbons RJ, Higgs DR. Acquired alpha-thalassemia in association with myelodysplastic syndrome and other hematologic malignancies. Blood. 2005 Jan 15;105:443-452. Epub Sep 9.
51. Steensma DP, Dewald GW, Hodnefield JM, Tefferi A, Hanson CA. Clonal cytogenetic abnormalities in bone marrow specimens without clear morphologic evidence of dysplasia: a form fruste of myelodysplasia? Leuk Res. 2003;27:235-242.
52. Steensma DP, Tefferi A. The myelodysplastic syndrome(s): a perspective and review highlighting current controversies [published correction appears in Leuk Res. 2005;29:117]. Leuk Res. 2003;27:95-120.
53. Mahmoud MY, Lugon M, Anderson CC. Unexplained macrocytosis in elderly patients. Age Ageing. 1996;25:310-312.
54. Beloosesky Y, Cohen AM, Grosman B, Grinblat J. Prevalence and survival of myelodysplastic syndrome of the refractory anemia type in hospitalized cognitively different geriatric patients. Gerontology. 2000;46:323-327.
55. Ferrucci L, Maggio M, Bandinelli S, et al. Low testosterone levels and the risk of anemia in older men and women. Arch Intern Med. 2006;166:1380-1388.
56. Gale RE, Fielding AK, Harrison CN, Linch DC. Acquired skewing of X-chromosome inactivation patterns in myeloid cells of the elderly suggests stochastic clonal loss with age. Br J Haematol. 1997;98:512-519.
57. Tefferi A. Practical algorithms in anemia diagnosis [letter]. Mayo Clin Proc. 2004;79:955-956.
58. Tefferi A, Hanson CA, Inwards DJ. How to interpret and pursue an abnormal complete blood cell count in adults. Mayo Clin Proc. 2005;80:923-936.
59. Wallen H, Gooley TA, Deeg HJ, et al. Ablative allogeneic hematopoietic cell transplantation in adults 60 years of age and older. J Clin Oncol. 2005 May 20:23:3439-3446. Epub 2005 Apr 11.
60. Hellstrom-Lindberg E, Gulbrandsen N, Lindberg G, et al, Scandanavian MDS Group. A validated decision model for treating the anaemia of myelodysplastic syndromes with erythropoietin + granulocyte colony-stimulating factor: significant effects on quality of life. Br J Haematol. 2003;120:1037-1046.
61. Agnihotri P, Ahuja M, Telfer MC, et al.Chronic anemia and fatigue in elderly patients: results of the first randomized double-blind placebo-controlled cross-over study with epoetin alfa [abstract]. Blood. 2005;106. Abstract 3553.
62. Crawford J. Erythropoietin: high profile, high scrutiny [editorial]. J Clin Oncol. 2007 Mar 20;25:1021-1023. Epub 2007 Feb 20.
63. Glaspy J, Smith R, Aapro M, et al. Results from a phase III, randomized, double-blind, placebo-controlled study of darbepoetin alfa (DA) for the treatment of anemia in patients not receiving chemotherapy or radiotherapy [abstract] . Presented at: American Association for Cancer Research Annual Meeting; Los Angeles, CA; April 17, 2007. Abstract LB-3.
64. Singh AK, Szczech L, Tang KL, et al, CHOIR Investigators. Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med. 2006;355:2085-2098.