Anemia in elderly populations represents a substantial healthcare challenge, leading to increased morbidity, functional decline, hospitalization, and mortality. Nutritional anemia in geriatric patients is a pressing and multifaceted public health issue that warrants significant attention, particularly in the context of an aging global population. This condition, primarily caused by insufficient intake or absorption of essential nutrients, has wide-ranging impacts on health outcomes among older individuals. It is not merely a laboratory finding but a clinical syndrome with considerable implications for overall health, functionality, and longevity. Anemia among the aged population is accompanied with a significant decline in quality of life, impairments in cognitive and physical functions, an increased risk of falls, greater susceptibility to infections, and heightened morbidity and mortality. Although aging itself is not directly related to development and type of anemia, several physiological and pathological changes associated with aging increase the susceptibility to this condition. Nutritional anemia, primarily driven by deficiencies in iron, vitamin B12, and folate, is especially common due to physiological changes with aging and dietary inadequacies (1). Epidemiological studies indicate that the prevalence of anemia increases with advancing age, particularly beyond 60 years, with developing countries facing a greater burden due to socioeconomic factors (2). Nutritional anemia significantly impairs quality of life, increases the risk of falls, cognitive dysfunction, and worsens chronic disease outcomes. In the aging population, the prevalence and consequences of anemia are amplified, making it a critical concern in geriatric medicine. Thus, early detection and appropriate intervention are vital.

A cross-sectional observational study was carried out at the Department of General Medicine, Rajshree Medical Research Institute, Bareilly, over a period of 12 months. A total of 332 patients aged 60 years and above, attending OPD or admitted to IPD, were included.
Inclusion criteria :
- Age ≥60 years
- Diagnosed anemia (Hb <13 g/dL for males, <12 g/dL for females) (3)
- Provided informed consent

 Exclusion criteria :
- Acute hemorrhage
- Known hematological malignancies

Investigations included CBC, iron studies (serum iron, TIBC, ferritin), serum vitamin B12, folic acid levels, stool occult blood, and renal function tests. Statistical analysis was performed using SPSS version 26.0. Categorical variables were expressed in frequencies and percentages; continuous variables were expressed as mean ± SD. A p-value <0.05 was considered statistically significant.

ETHICAL CONSIDERATIONS AND CONFIDENTIALITY:

Ethical approval for this study was provided by the Institutional Ethical Committee , and informed consent was obtained from each of the study participants. Participants were allowed to withdraw their names at any given time during the course of the study. Confidentiality of all the data was  ensured by keeping the responses anonymous.

Table 1 : Age Distribution Of The Patients

Table 2  : Types Of Anemia

Table 3 : Etiology Of Nutritional Anemia

Table 4 : Comorbidities Associated With Anemia

Table 5 : Hematological Parameters in Anemic Geriatric Patients

The World Health Organization gives as 12gm/dl and 13gm/dl as cut-offs for men and women respectively. Nutritional deficiencies, particularly iron deficiency, emerges as major cause of anemia in older adults (4) The present study demonstrated a high prevalence of nutritional anemia among geriatric patients, consistent with global data (5). Normocytic anemia predominated, aligning with previous studies linking chronic inflammation and CKD to normocytic patterns.

Vitamin B12 and folate deficiencies emerged as significant etiological factors, surpassing iron deficiency. These findings reflect the impact of dietary insufficiencies and malabsorption syndromes in elderly populations (6).

Hyperhomocysteinemia's prevalence suggests a functional vitamin B12/folate deficiency, meriting early nutritional interventions. Comorbidities such as diabetes, hypertension, and CKD showed significant correlations with anemia, echoing observations from earlier multicentric studies (7). The aging process itself does not directly cause anemia, but various physiological changes commonly seen in the elderly contribute to a heightened risk of developing this condition. These include malnutrition, reduced absorption of essential nutrients, diminished hematopoietic reserves, a decrease in erythropoiesis, more frequent inflammatory conditions, and gastrointestinal blood loss. Proactive screening, management of chronic diseases, and nutritional supplementation remain pivotal in reducing the burden of anemia in elderly patients.

This study evaluated the burden, both quantitative and qualitative, and etiology of nutritional anemia in geriatric patients at a tertiary care center. Anemia, particularly in elderly individuals, is well linked to diverse health outcomes, resulting in increased morbidity and mortality. The study assessed hematological and biochemical parameters, classified anemia based on etiology, and explored associations with comorbidities and nutritional deficiencies.

A total of 332 patients aged 60 years and older participated in this study. The results highlighted that normocytic anemia (49.7%) was the most prevalent form, followed by macrocytic anemia (23.4%) and microcytic anemia (26.9%). The mean hemoglobin level among the study participants was 8.92 g/dL, indicating a high burden of anemia in the elderly population. Gender-based analysis revealed an almost equal distribution of anemia among males (49.7%) and females (50.3%), suggesting that aging contributes equally to anemia irrespective of gender.

The study found that nutritional deficiencies played a crucial role in anemia development. Vitamin B12 deficiency (20.78%), folic acid deficiency (11.45%), and iron deficiency anemia (1.51%) were the major contributors. Hyperhomocysteinemia was detected in a significant proportion of patients (75.9%), reinforcing the link between nutritional deficiencies and anemia. The prevalence of comorbid conditions such as diabetes (48.4%), hypertension (48.5%), chronic kidney disease (47.9%), and malignancy (45.2%) further highlighted the complex interplay between anemia and systemic disorders in the elderly.

 FINANCIAL SUPPORT AND SPONSORSHIP : Nil

CONFLICT OF INTREST: There was no conflicts of interest.

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