The elderly, traditionally defined as individuals aged 60 or older, are further categorized as "early elderly" (60-74 years) and "late elderly" (75 years and above)¹

Despite longer life expectancies, there is limited evidence that today's elderly enjoy better health than previous generations, particularly regarding mild to moderate disability, where changes have been minimal over the last three decades. While added years in good health would allow older adults to maintain similar activity levels to younger people, these extra years are often accompanied by declines in physical and mental health. Such declines can have significant implications for both individuals and society, underscoring the need for proactive attitudes and actions toward the aging population².

Elderly patients with anemia are heterogeneous in terms of clinical history, coexisting medical conditions, and concomitant medication use than young adults. In elderly, anemia is associated with poor performance status, increased frailty, dementia, depression, reduced mobility, increased risk of falls, and poor quality of life³.

Anemia is frequently overlooked in older adults, despite strong evidence showing that low hemoglobin levels are often a sign of physiological decline in this population. Numerous studies have identified anemia as an independent risk factor associated with increased morbidity and mortality, as well as a decreased quality of life among community-dwelling older adults⁴.

The present study was undertaken with the aim of evaluating the clinical profile of anaemia in geriatric patients. The objectives were to study both the clinical features and laboratory parameters of each patient, to identify the factors associated with anaemia, and to assess the effects and complications arising due to anaemia in this population.

Study Area

The present study was carried out in the Department of General Medicine at a tertiary care hospital (Government Medical College, Latur).

 Study Design

A prospective, hospital-based observational study was conducted over a period of two years following Institutional Ethical Committee approval.

 Study Population

Patients aged above 60 years, attending the hospital and diagnosed with anaemia, were included in the study as per the defined criteria. Anaemia was diagnosed when hemoglobin levels were less than 13 g/dl in males and less than 12 g/dl in females.

 Inclusion Criteria

• Patients aged >60 years.
• Patients with anaemia as per definition (Hb <13 g/dl in males, <12 g/dl in females).

 Method of Data Collection

Each participant was evaluated with detailed clinical history and thorough examination. Sociodemographic details, past medical history, medication use, smoking and alcohol status, dietary habits, physical activity, and family history of major illnesses were recorded.

Blood and other relevant samples were collected for laboratory investigations. The severity, clinical and etiological profile, as well as complications of anaemia, were assessed in all patients. All findings were recorded in a structured case record form.

The following investigations were carried out for each patient as per protocol:

1. Complete blood count (CBC) – Automated Hematology Analyzer
2. Hemogram – Automated Methods, Electrical Impedance
3. Blood urea – Enzymatic Method, Automated Analyzer
4. Serum creatinine – Enzymatic Method, Automated Analyzer
5. Reticulocyte count and iron studies
6. Mean corpuscular volume (MCV) and mean corpuscular hemoglobin concentration (MCHC)
7. Random blood glucose – Glucose Oxidase–Peroxidase method
8. Serum electrolytes – Ion-selective electrode method
9. Serum liver enzymes: ALT, AST, GGT
10. Stool examination for occult blood and ova/parasites
11. Urine examination
12. Bone marrow examination (when indicated)
13. Gastroscopy/Esophagoscopy (when indicated)

Sample Size

The prevalence of anaemia in the geriatric population in India is approximately 36%. The sample size was calculated using the formula:

n=Z2×p×qL2n=L2Z2×p×q

Where,

• Z=1.96Z=1.96 (for 95% confidence interval)
• p=36p=36 (prevalence in %)

Accordingly, the minimum required sample size was 2730. Over the study duration of two years, a total of 2700 geriatric anaemia patients were recruited and analyzed.

Figure 1: Distribution according to age group

Figure and table showsdistribution of 2700 patients The majority1835 (68%) are in the 61-70 age group. That's a significant portion. Then the 71-80 group is about 759 (28%), which is still a decent chunk. The over 80s are only 4%, which is quite small. Mean67.81 4.51 years.

Figure 2: Distribution according to gender

This tableindicates that out of the total 2,700 patients, 40.44% are male and 59.56% are female. In other words, there are more female patients (1,608) compared to male patients (1,092) in this dataset.

Figure 3 Distribution according to Clinical presentation

This data illustrates the distribution of various clinical presentations among the 2,700 patients. The most common clinical presentation is generalized weakness, affecting 811 (30.04% )of the patients. Breathlessness is the second most common presentation, found in 20.41% (551)of the patients. Giddiness and chronic kidney disease are also relatively common, present in381 (14.11%) and 330 (12.22%) of the patients, respectively. Other presentations, such as abdominal pain280 (10.37%), loss of weight 208 (7.70%), and loss of appetite35 (1.30%), are less common.

Figure 4 Distribution according to Radiological Findings.

This data illustrates the distribution of various radiological findings among the 2,700 patients. Radiological investigations performed being ultrasonography and C.T. Scan as and when necessary. The most common condition is chronic kidney disease, affecting 808 (29.93%) of the patients, followed closely by acute kidney disease (Bilateral kidney disease), which affects (786) 29.11% of the patients. Fatty liver is the third most common condition, found in(18.74%) of the patients. Cirrhosis and splenomegaly are present in 353 (13.07%) and 247 (9.15%) of the patients, respectively.

Table 1: Anaemia Grading and Hb Levels

Nearly three-fourths of the patients (74.6%) had moderate anaemia, with corresponding Hb levels between 7–10 gm/dl. Severe cases (<7 gm/dl Hb) comprised only 2.2%.

Figure 5 Distribution according to Peripheral Smear finding

This data illustrates that the most common peripheral smear findings are normocytic normochromic and normocytic hypochromic anaemia, each affecting 32% of the patients. Microcytic hypochromic anaemia is the next most common finding, present in 21% of the patients. Dimorphic anaemia and macrocytic anaemia are less common, affecting 10% and 5% of the patients, respectively.

Table 2: Association between Peripheral Smear Finding and anaemia

The highly significant association (p < 0.0001) highlights that peripheral smear findings are strongly tied to anemia severity. 

Figure 6: Distribution according to Causes of Anaemia:

This figure and table shows that most common cause of anaemia in geriatrics patients is kidney related disease. (Chronic kidney disease and acute kidney injury )[41.03%].

It is followed by nutritional anaemia [30.81%]. Individually observing, nutritional anaemia is the most common [30.81%], followed by chronic kidney disease [29.92%].Next most common was chronic liver disease [24.07%]. Other causes included Anaemia of chronic disease.

Fig 7: Distribution according to Anaemia in Chronic Diseases:

Table 3: Distribution according to Anaemia in Chronic Diseases:

This table and figure shows distribution of anaemia in chronic diseases. Most common was Hypothyroidism [40%]. Other causes included osteoarthritis [26.36%], rheumatoid arthritis [21.81%] and hyperthyroidism [11.81%].

Anaemia remains a significant health challenge among the geriatric population, closely linked with increased morbidity and mortality. Understanding its clinical, radiological, and haematological profiles is essential for accurate diagnosis and tailored management. In our study, the majority of patients (67.96%) were in the 61–70 year age group, with a mean age of 67.81 ± 4.51 years. This suggests that the younger segment of the geriatric population carries the highest burden of anaemia. Similar findings were reported by Agravatet al.¹⁰ . , who identified the 60–69 year group as most commonly affected in their clinico-pathological study. Dr. Surjeet Singh et al.¹¹. also reported a mean age of 67.25 years, with nearly 79% of patients being ≤70 years old. Their study further indicated an association between age and anaemia severity, with younger groups more often presenting mild anaemia, while older patients had a higher prevalence of moderate to severe forms.

With respect to gender distribution, our study identified a predominance among females (59.56%) compared with males (40.44%). This contrasts with the findings of Agravatet al.¹⁰. and Alsaeed et al.¹⁵, who reported a higher prevalence among males. Conversely, the meta-analysis by Mohammadi et al.¹². observed no significant gender-based difference.

In terms of symptomatology, generalised weakness (30.04%) was the most frequent clinical presentation in our cohort, followed by breathlessness (20.41%), giddiness (14.11%), and features of chronic kidney disease (12.22%). These symptoms are consistent with the cardinal features of anaemia described in previous work. Agravatet al.¹⁰. reported easy fatigability (88%), dyspnoea (70%), and giddiness (60%) as leading complaints, while Thyagaraja et al.¹⁶. described fatigue (70%) and dyspnoea (50%) as predominant.

Radiological findings in our study extended the understanding of systemic involvement. Chronic kidney disease (29.93%) and acute kidney disease (29.11%) were the most frequent abnormalities, followed by fatty liver (18.74%), cirrhosis (13.07%), and splenomegaly (9.15%). While the majority of prior research has concentrated on clinical and haematological variables, Abbasi et al. emphasized the potential diagnostic role of imaging, reporting features such as septal and aortic ring signs in elderly anaemic patients on non-contrast thoracic CT scans. Although they did not focus on hepatosplenic or renal findings, their work underscores the evolving role of radiology in evaluating anaemia. Our data further demonstrates the importance of radiological assessment for uncovering underlying causes in older patients with anaemia.

Haematological evaluation in our study showed that moderate anaemia was the most prevalent (74.59%), with 23.19% presenting with mild and only 2.22% with severe anaemia. Most patients had haemoglobin levels between 7–10 g/dl, reinforcing the predominance of moderate anaemia in this group. Peripheral smear analysis revealed normocytic normochromic and normocytic hypochromic patterns as equally common (32% each), followed by microcytic hypochromic (21%), dimorphic (10%), and macrocytic anaemia (5%). Importantly, there was no significant association between anaemia severity and either age (p > 0.05) or gender (p = 0.991), though a strong correlation was observed between morphological findings and severity (p < 0.0001). These patterns align closely with the observations of Neelima Deshpande et al. (2017) and Alsaeed et al.¹⁵, who reported anaemia of chronic disease (ACD) and iron deficiency anaemia (IDA) as the leading causes, often reflected in normocytic or hypochromic smear findings. Thyagaraja et al.¹⁶. further highlighted iron deficiency (36%) and vitamin B12/folate deficiency (24%) as frequent etiologies.

The clinical implications of our findings are substantial. Moderate anaemia was the overwhelming dominant type in this cohort, which is consistent with multiple prior studies. The recognition of normocytic normochromic and hypochromic anaemia as common morphological subtypes highlights their linkage with chronic diseases, particularly renal and liver dysfunction. Moreover, even mild anaemia has been emphasized in prior literature as a predictor of adverse outcomes, supporting the need for timely evaluation and management regardless of severity.

Overall, our study provides a comprehensive evaluation of 2700 patients with anaemia in the geriatric age group. The large sample size, detailed clinical and radiological assessment, and integration of peripheral smear findings contribute new insights into the spectrum of anaemia in older adults. While our results are consistent with much of the available literature, certain variations, especially regarding gender distribution and causes, highlight the influence of regional and population-specific factors. These findings reinforce the critical need for routine anaemia screening and individualized management strategies in elderly patients.

Anaemia represents a major health burden in the geriatric population, with a high prevalence of moderate severity and associations with chronic comorbidities such as kidney and liver diseases. Our comprehensive analysis of 2700 patients underscores the predominance of nutritional anaemia and normocytic morphological patterns, alongside common symptoms like generalized weakness and breathlessness that significantly impair quality of life. While no significant correlations were found between anaemia severity and age or gender, the strong link with peripheral smear findings emphasizes the value of haematological evaluation in guiding management. These insights align with existing literature, highlighting regional variations in gender distribution and etiological profiles, and reinforce the necessity for routine screening, radiological assessments, and individualized treatment strategies to address treatable causes, reduce complications, and enhance functional outcomes in elderly patients. Future research should focus on longitudinal interventions to further elucidate unexplained cases and optimize care in this growing demographic.

1. Orimo H, Ito H, Suzuki T, Araki A, Hosoi T, Sawabe M. Reviewing the definition of “elderly”. GeriatrGerontol Int 2006; 6(3): 149–58.
2. Bertrand Fougère, François Puisieux, Pascal Chevalet, Cédric Annweiler, Michel E, Joly L, et al. Prevalence of iron deficiency in patients admitted to a geriatric unit: a multicenter cross-sectional study. BMC Geriatrics. 2024 Jan 30;24(1).
3. Samanta NT, Nath S, Sen NM, Chaudhuri A, Badal N. A cross-sectional study on the etiological spectrum and morbidity profile among geriatric patients: A hospital-based study. Asian Journal of Medical Sciences. 2024 Jan 1;15(1):119–26.
4. Al-Jaf DA, Hussein AL, Niranji SS. Clinical, biochemical, and hematological profile of Iron deficiency anemia in The Garmian population, Kurdistan region of Iraq. Passer Journal of Basic and Applied Sciences. 2024 May 5;6(1):237–45.
5. Shyma OK, Salam Kenny Singh et al. CLINICAL AND HEMATOLOGICAL PROFILE OF ANEMIA IN GERIATRIC PATIENTS: A TERTIARY CARE HOSPITAL BASED CROSS SECTIONAL STUDY International Journal of Academic Medicine and Pharmacy Int J Acad Med Pharm 2023; 5 (6); 840-845.
6. Ashwini. Aithal et al. (2023) Incidence and factors associated with anemia among the geriatric population at a tertiary care hospital in southern India Rwanda Medical Journal, Vol. 80, no. 1, p. 29-34, 2023.
7. Pratik P. Bhat et al. Prevalence of Anemia in Geriatric population: A one year hospital-based study. International Journal Dental and Medical Sciences Research (2023) 05(01) 447-454.
8. Lohmror A, Seervi D, Yadav M, Yadav R, Agarwal MK. Prevalence and etiological profile of anemia in hospitalized geriatric patients. J Indian AcadGeriatr2023;19:267‑72.
9. Sujanitha, T. Sooryakumar, T. Kumarasiri, N. Rajeshkannan, S. Tharmiga. Evaluation of anaemia in geriatric patients: a retrospective hospital-based study from Northern Sri Lanka. Asian journal of internal medicine. 2022 Aug 16;1(2):21–31.
10. Agravat AH, Pujara K, Kothari RK, Dhruva GA. A clinico- pathological study of geriatric anemias. Aging Med. 2021;4:128–134.
11. Singh S, Singh I, Singh K, Nirman HS, Singh B. Clinicopathological profile of anaemia in geriatric patients. Int J Lab Res. 2024;13(10):180-185.
12. Mohammadi A, Kazeminia M, Chogan A, Jalali A. Prevalence of anemia in older adults: A systematic and meta-analysis study. Int J Africa Nurs Sci. 2024;20:100739. Available from: https://www.sciencedirect.com/science/article/pii/S2214139124000842
13. Garry PJ, Goodwin JS, Hunt WC. Iron Status and Anemia in the Elderly: New Findings and a Review of Previous Studies. J Am Geriatr Soc. 1983 Jul;31(7):389-395. Available from: https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.1983.tb03712.x
14. Lanier JB, Park JJ, Callahan RC. Anemia in Older Adults. Am Fam Physician. 2018 Oct 1;98(7):437-442. Available from: https://www.aafp.org/pubs/afp/issues/2018/1001/p437.html
15. Alsaeed M, Ahmed SS, Seyadi K, Ahmed AJ, Alawi AS, Abulsaad K. The prevalence and impact of anemia in hospitalized older adults: A single center experience from Bahrain. J Taibah Univ Med Sci. 2022 Aug;17(4):587-595. Available from: https://www.sciencedirect.com/science/article/pii/S1658361222000415
16. Thyagaraja K, Benny S, Bhat SV, Nair AG. Study of clinical and hematological profile of anemia in hospitalized geriatric patients. Int J Adv Med. 2019 Jul-Aug;6(4):1212-1215. Available from: https://www.ijmedicine.com/index.php/ijam/article/view/1885
17. Abbasi B, Seyed Hosseini M, Moodi Ghalibaf A, Akhavan R, Emadzadeh M, Bolvardi E. Evaluating anemia on non-contrast thoracic computed tomography. Sci Rep. 2022 Dec 10;12(1):2022-24265-8. Available from: https://www.nature.com/articles/s41598-022-24265-8
18. Neelima Deshpande, Harshal Et al. Anaemia in Senior Citizens. (2017) MedPlus- International Medical Journal, March 2017; 4(3): 349-350. https://www.medplus.in