Diagnosis and Treatment Approaches for Anemia in Patients Who Are Older, Hospitalized

Anemia is common among older hospitalized patients, but it is frequently underdiagnosed and undertreated due to a lack of specific symptoms in these individuals. Chronic diseases, nutrition deficiencies, and aging-associated decline in serum hemoglobin concentration contribute to the onset of anemia in older adults. To date, no study has examined the quality of diagnostic and therapeutic approaches for anemia in hospitalized older patients admitted to specific medical specialties. To fill this gap, Luca Soraci, MD, and colleagues conducted a multicenter, cross-sectional study investigating the prevalence, risk factors, and quality of diagnostic and therapeutic approaches to anemia in older patients admitted to acute care hospitals in Italy, focusing on the differences between geriatric and nephrological practices.

The researchers studied prevalence and risk factors for anemia, diagnostic inertia (lack of iron, vitamin B12, and folate status assessment), replacement inertia (omitted treatment with iron, vitamin B12, or folic acid), and erythropoiesis-stimulating agents (ESA) inertia. Their results appeared in Scientific Reports.

The study population comprised 1903 patients. The mean age was 82.7 years, 51.9% were male, and 66.7% had anemia (hemoglobin concentration <12 g/dL in women and <13 g/dL in men).

Anemia was somewhat more common in nephrology units than in geriatric units (75.6% vs 63.3%; P <.001); this may be partly explained by lower median estimated glomerular filtration rate (eGFR) values in nephrology units.

Diagnostic inertia occurred in 22% to 31% of study participants with anemia; replacement inertia was also common, occurring in 50% to 87% of participants. ESA inertia affected 67.2% of participants and was more prevalent in geriatric units (85%) than in nephrology units (37%). In most instances, patients with ESA inertia were not routinely screened for iron status. Factors associated with ESA inertia included COPD, cancer, and eGFR 45–60 ml/min.

“Anemia significantly burdens older individuals discharged from geriatrics and nephrology acute care units, but its pathogenetic mechanisms are explored in a minority of patients, and undertreatment is also highly prevalent, with selected differences between geriatrics and nephrology units,” the researchers concluded. “Considering the detrimental effects of anemia on patients’ overall functioning and quality of life and on health care demands and expenses, efforts should be made to increase the attention and to improve the approach to anemia.”

Source: Scientific Reports