Geriatric anemia is a significant global health concern due to its widespread prevalence and its strong association with increased morbidity and mortality. Anemia is characterized by a decrease in the overall circulating red blood cell mass, leading to reduced oxygen delivery to tissues and subsequent hypoxia, which diminishes the body's functional capacity. The impact of anemia is particularly pronounced in the geriatric population (aged ≥60 years), where it severely affects quality of life [1,2].

According to NHANES III data, the prevalence of anemia is 11% in men and 10.2% in women. However, studies conducted in India show considerably higher rates, with a prevalence of 67.09% in the Marathwada region and 68.5% in Karnataka. In contrast, research in the United States reports a prevalence range from 8% to 44%, while in Germany, it stands at 66.3% [3].

The significance of this prospective study on geriatric anemia has been further highlighted by the United Nations General Assembly's declaration on 14th December 2020, designating 2021-2030 as the UN Decade of Healthy Aging. This initiative was supported by the 73rd World Health Assembly through a written silence procedure on 3rd August 2020, and endorsed for consideration by the United Nations General Assembly [4].

The World Health Organization (WHO) predicts that by 2050, the global population aged 60 years and older will double, with those aged 80 years and above expected to reach approximately 400 million. The proportion of individuals over 60 is projected to rise from 8% to nearly 20% by 2050 [5]. While this increase in life expectancy is a testament to advancements in medical care and improved health services, it also reveals gaps in recognizing and addressing health issues among the aging population, with certain health challenges still being underappreciated in medical practice [6]. Therefore, this study aimed to determine the prevalence of anemia among the elderly population and prospectively evaluates the various hematological patterns of anemia across this age group.

This prospective study was conducted with the primary objective to assess the prevalence of anemia among the normal elderly population. The sampling was carried out among elderly residents and old age homes.

The inclusion criteria for the study encompassed individuals aged 60 years or older, regardless of sex. Participants were required to have anemia, defined as hemoglobin levels below 13 g/dL for males and below 12 g/dL for females, in accordance with WHO guidelines. Additionally, only elderly individuals who voluntarily agreed to participate and provided written informed consent were included. Informed consent was obtained from all participants before their enrollment in the study. The exclusion criteria included non-anemic elderly individuals, those with known hematological disorders, and individuals with a history of blood transfusion, chemotherapy, or radiotherapy within the preceding 12 weeks. Participants unwilling to provide consent or participate in the study were also excluded, as were elderly individuals already receiving treatment for anemia or other hematological conditions.

Detailed clinical history and examination findings were recorded along with the demographic parameters in a total of 234 elders. Appropriate statistical tests were used with p value <0.05 considered as significant.

The study included a total of 234 participants, predominantly within the 60–69 years age group (60.68%, n = 142), followed by 70–79 years (31.20%, n = 73), and ≥80 years (8.12%, n = 19). The mean age for each group was 64.02 ± 3.16, 74.42 ± 3.33, and 81.99 ± 3.33 years, respectively (Table 1). In terms of gender distribution, 38.46% (n = 90) of participants were male, while 61.54% (n = 144) were female (Table 2).

Table 1: Age distribution of study participants

Table 2: Gender details of study participants

Anemia was significantly more prevalent among females (n = 97) than males (n = 48), with a statistically significant difference (P = 0.03). Conversely, the non-anemic cohort comprised 42 males and 47 females (Table 3).

Table 3: Gender wise distribution of anemia

The most commonly reported symptom was easy fatigability (46.58%, n = 109), followed by dyspnea (24.36%, n = 57), palpitations (17.52%, n = 41), headache (11.54%, n = 27), tinnitus (3.85%, n = 9), and immobility (2.14%, n = 5) (Table 4).

Table 4: Presenting Complaints among study participants

Among participants with anemia, normocytic normochromic anemia was the most frequently observed type (54.70%, n = 128), followed by microcytic hypochromic anemia (23.08%, n = 54), macrocytic anemia (14.10%, n = 33), and dimorphic anemia (8.12%, n = 19) (Table 5).

Table 5: Morphologic types of anemia among elderly

The mean hemoglobin levels were 10.57 ± 1.85 g/dL for the 60–69 age group, 10.42 ± 1.76 g/dL for the 70–79 age group, and 10.97 ± 1.41 g/dL for those aged 80 and above, with no statistically significant difference (p < 0.05). Among 124 anemic individuals, the mean hemoglobin was 10.5 ± 1.77 g/dL (range: 2.0–12.9 g/dL). The mean hematocrit (Hct) was 36.2 ± 6.09%.

In this study, among the 234 elderly individuals, 145 were diagnosed with anemia based on the WHO classification. This indicates a 61.96% prevalence of anemia among elderly residents. The highest prevalence of anemia was observed in the age group 70-79 years at approximately 70%, followed by those aged >80 years at 69.86%. A chi-square test of independence revealed no significant association between age group and anemia status, suggesting that age does not significantly influence anemia prevalence. These findings align with study by Soni P et al. [7], which reported a 67.09% prevalence of anemia in the elderly, and with Srivastava et al., who found a similar rate of 68.5% [8].

In this study, 38.46% of males and 61.54% of females were anemic. The chi-square test yielded a statistically significant result. In each age group, the proportion of anemic females outnumbered males, with nearly double the number of anemic females compared to males overall. This finding is consistent with the study by Soni et al. [7], where anemia affected 64.74% of males and 70.58% of females. Srivastava et al. [8] also observed a higher proportion of anemic females (69.8%) compared to males (67.6%). In contrast, the NHANES-III study reported anemia prevalence in 11% of men and 10.2% of women aged 65 years and older. Nissenson et al. also found a significant gender disparity, with anemia prevalence at 7.5% in males and 20% in females among the geriatric population [9].

The mean hemoglobin levels were 10.57 ± 1.85 g/dL for the 60–69 age group, 10.42 ± 1.76 g/dL for the 70–79 age group, and 10.97 ± 1.41 g/dL for those aged 80 and above, with no statistically significant difference (p < 0.05). Among 124 anemic individuals, the mean hemoglobin was 10.5 ± 1.77 g/dL (range: 2.0–12.9 g/dL). The mean hematocrit (Hct) was 36.2 ± 6.09%. The mean hematocrit (Hct) was 36.2±6.09%. Similar results were reported by previous studies [10,11].

A chi-square test was used to statistically assess the relationship between hematocrit and hemoglobin levels among anemic versus non-anemic elderly individuals. The chi-square statistic indicated a highly significant result. The etiology of anemia in the elderly was varied. The leading cause was iron deficiency anemia, observed in 48 cases (20.51%), primarily due to nutritional deficiency, followed by anemia of chronic disease (41 cases, 17.52%) and chronic kidney disease (33 cases, 14.10%). Vitamin B12 and folic acid deficiencies each accounted for 28 cases (11.97%), while 20 cases (8.55%) were linked to endocrine disorders in diabetics. Hematological disorders and unexplained anemia were each found in 18 cases (7.69%). Similar findings were reported by Stauder et al [12] and Bianchi VE [13].

This study highlights that anemia in the elderly is not merely a consequence of aging but often has identifiable, treatable causes. Symptoms such as fatigue and breathlessness should prompt thorough evaluations rather than be dismissed as age-related. Timely diagnosis and management can address most cases, reducing morbidity and mortality. Physicians must prioritize investigating hemoglobin decline in the elderly to avoid delayed detection of treatable conditions, as early intervention is key to improving outcomes in this growing population.

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