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Anemia in the elderly: a public health crisis in hematology
Jack M Guralnik1, William B Ershler, Stanley L Schrier
1Virginia Mason Clinic, 1100 Ninth Avenue, Seattle, WA 98101-2799, USA.
Insights
Anemia affects over 3 million older adults in the U.S., causing functional decline and mortality. This consensus review covers its epidemiology, causes, diagnosis, and management in the elderly.
Area of Science:
- Gerontology
- Hematology
- Public Health
Background:
- Anemia is prevalent in individuals aged 65 and older, affecting over 3 million in the U.S.
- This condition is linked to significant functional impairment and increased mortality rates in the elderly population.
- A consensus panel of experts convened to address key aspects of anemia in older adults.
Purpose of the Study:
- To review the epidemiology of anemia in the elderly, including definitions, racial variations, and manifestations.
- To explore the pathophysiology of anemia in older adults, focusing on nutritional, chronic disease, and unexplained categories.
- To provide a practical diagnostic and management approach for anemia in elderly patients for hematologists.
Main Methods:
- A review of the epidemiology of anemia in the elderly.
- An examination of the pathophysiology of anemia, categorized by etiology.
- A proposed diagnostic and management strategy for practicing hematologists.
Main Results:
- The epidemiology of anemia in the elderly is characterized by specific definitions, racial disparities, and diverse clinical presentations.
- Pathophysiological mechanisms, including nutritional deficiencies, chronic diseases, and unexplained factors, contribute to anemia in older adults.
- A practical framework for diagnosing and managing anemia in this demographic has been established.
Conclusions:
- Anemia in older adults is a significant public health issue with broad implications.
- Understanding the unique pathophysiological mechanisms is crucial for effective management.
- A consensus-driven approach to diagnosis and treatment is recommended for practicing hematologists.
Abstract:
Over 3 million people in the United States aged 65 years and older are anemic. This condition is associated with significant functional impairment and, perhaps, increased mortality. In March 2004, the American Society of Hematology (in conjunction with the National Institute of Aging) convened a "blue ribbon" panel of twenty physicians who are experts on various aspects of this topic. This paper highlights important consensus concepts resulting from that meeting. In particular, four areas of thought are shared. First, the epidemiology of anemia in the elderly is reviewed, including its definition, its expression in different racial groups, and its wide-ranging manifestations. Second, the pathophysiology of anemia in the elderly is reviewed as pertains to three general etiological categories (nutritional, chronic diseases, and so-called "unexplained" anemias). Particular emphasis is given to pathophysiologic mechanisms of anemia that are potentially unique to this age group. Third, a practical approach to the diagnosis and management of anemia for this patient population for the practicing hematologist is provided. Finally, the public health implications of anemia in the elderly for key stakeholder constituencies will be discussed in the oral presentation.
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