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Anaemia in older people

Systematic review
Results
Comment

Bandolier has long been interested in anaemia, but puzzled by varying figures for its prevalence, especially in older people. There are also some puzzles about the point at which anaemia has a major impact on health. A systematic review [1] has sought to examine studies of prevalence according to age, and by age and sex.

Systematic review

Studies of prevalence of anaemia were sought through electronic searching of two major databases up to the beginning of 2003. Studies could also examine functional status, or economic consequences of anaemia in older people. The age cut-off was set at 60 years. Certain studies were excluded, notably those relating anaemia to certain haematological disorders, cancer, drugs, or nutritional deficiencies. The definition of anaemia accepted was that used by authors of individual studies.

Results

There was great heterogeneity in the 71 studies found, in terms of size, populations studied, definitions of anaemia used, and where the study was performed. The most frequent definition of anaemia was that of the WHO: a haemoglobin level of less than 130 g/L for men and less than 120 g/L for women.

Nine studies from Europe and the USA reported prevalence by sex. Overall the prevalence was higher in men (range 3.3% to 61%) than in women (range 3.3% to 41%). Lower values were found in community dwellers, and higher values in patients admitted to geriatric wards.

Six larger studies with more than 700 people reported results by both age and sex. Again, the prevalence of anaemia was higher in men (Figure 1) than in women (Figure 2). In both there was a clear move towards high prevalence of anaemia amongst the oldest old.



Figure 1: Prevalence of anaemia (generally Hb <130 g/L) in men by age in six larger studies







Figure 2: Prevalence of anaemia (generally Hb <120 g/L) in women by age in six larger studies





Only three studies evaluated the consequences of anaemia in older people. Anaemia was associated with higher rates of Alzheimer's disease, poorer health, more hospital admission, and greater mortality, though none of the studies was large.

Comment

The higher prevalence of anaemia in older men than older women probably reflects the tendency to use higher cut points for defining anaemia. The higher the cut point, the more men will have lower haemoglobin values and thus be classified as having anaemia. Even so, anaemia is common in older people, and more common in the oldest old. There are probably many reasons for this.

We have no good information about the consequences of anaemia in the elderly, nor, at least from this review, any idea about whether treatment improves their health. This may be Bandolier being just plain dumb, but searching isn't bringing to light good references on the consequences of anaemia at different ages, and in each sex. Nor is it finding good information on treatment of haemoglobin levels at the lower end of normal, or the upper end of abnormal, whatever particular definition is used. If anyone has found it......

Reference:

  1. C Beghé et al. Prevalence and outcomes of anaemia in geriatrics: a systematic review of the literature. American Journal of Medicine 2004 116 (7A): 3S-10S.

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