EXTREMELY OLD PATIENTS HOSPITALIZED IN INTERNAL MEDICINE: WHAT ABOUT THEIR ANEMIA?

Anemia in the elderly

In the western countries about half of the hospitalized patients are anemic. Generally, these patients are old, often with multiple diseases and anemia worsens the prognosis finally increasing the risk of death. We describe here a monocentric, observational study that evaluates 249 consecutive adult patients (160 women and 89 men) with anemia admitted in the internal medicine department over 5 months period. They represent 71.5% of all patients admitted in the study period. Demographic, historic and clinical data, laboratory tests, duration of hospitalization, re-admission at 30 days and death were recorded. Patients were stratified by age (75-84= old, >85 years= oldest-old), anemia severity, and etiology of anemia.

In 37 old and 25 oldest-old patients anemia was mild, in 43 old and 46 oldest-old moderate and in 20 old and 7 oldest-old severe in agreement with WHO criteria. Moderate anemia was significantly more common in oldest-old (p=0.01)

The causes of anemia were iron deficiency in 19 patients, other deficiencies in 5, chronic diseases in 68, hematologic neoplasms in 11, multifactorial in 43 and undetermined in 32. Oldest-old have higher frequency of multifactorial anemia (p=0.04) while hematologic neoplasms were more common in old patients (p=0.03). Most patients with undetermined anemia had mild/moderate forms.An anti-anemic treatment, mainly blood transfusion, was adopted in 100% of oldest-old patients and in 60% of old (p= 0.04). Anemia (and/or its treatment) was reported in the discharge letter in 19 old and in 22 oldest old patients.

From a general point of view, physicians seem to disregard anemia, in the context of more important pathologic conditions. In oldest-old patients, multifactorial anemia seems to be consider only “one more cause of disability”. When a border line anemia occurs, even if it can represent a relevant adverse condition in frailty, is poorly considered.