ANEMIA IN OLD PATIENTS
Anemia is the hemoglobin concentration in the blood being below normal values according to the patient's age and gender. Anemia is a common health problem in the elderly population, defined by the World Health Organization as those over the age of 65, and causes a decrease in quality of life and an increase in morbidity and mortality. The World Health Organization defines anemia in the under-65 age group as a hemoglobin value below 13 g/dl in men and 12 g/dl in women, but this value varies depending on ethnicity and decreases with age. Although different studies have concluded that it would be more appropriate to take a reference range above these values, the use of these reference values has also been accepted in the elderly patient group. The frequency of anemia in older ages appears to have increased due to reasons such as increased ease of access to health centers, demographic reasons, and the need for routine examinations and tests from more people. Although the prevalence of anemia in the elderly population is around 20%, this figure is higher in those living in nursing homes and hospitalized patients. It has been found that this rate increases up to 50% in men over the age of 80. An evaluation of patients aged 65 and older found that new-onset anemia and reduced hemoglobin levels without anemia may increase the risk of decreased quality of life and death, regardless of underlying disease. In acute anemia, patients will have symptoms and signs secondary to volume depletion, such as dizziness, fainting, and hypotension. Chronic anemia may be asymptomatic, but in cases of significant hemoglobin levels, conditions that reduce the quality of life may occur, such as weakness, fatigue, depression, decreased cognitive functions-dementia, increased risk of falling, and difficulty in performing ordinary daily tasks. In addition, symptoms may occur due to a decrease in low oxygen carrying capacity, such as shortness of breath and chest pain, delirium, which is a neuropsychiatric disorder seen especially in hospitalized and nursing home patients, worsening of concomitant conditions such as heart failure, chronic renal failure and chronic obstructive pulmonary disease. snow. These conditions are more common in elderly patients and can cause many of the same clinical symptoms as anemia.
Anemia should be considered as a finding rather than a disease, and the cause or reasons causing anemia must be determined. There may be one or more underlying reasons for the occurrence of anemia in older ages. When the causes of anemia are evaluated, they can be divided into anemias due to nutritional deficiency (B12, iron, folate deficiency), anemias caused by bleeding, hyperinflammatory anemias and clonal anemias. Chronic renal failure is an important cause of hyperinflammatory anemias. In addition, cancer, rheumatological/autoimmune diseases and chronic infection can also be counted among other hyperinflammatory anemias. In elderly patients, bone metastasis of non-hematological cancers, as well as hematological cancers such as myelodysplastic syndrome and multiple myeloma, should be included in the differential diagnosis among the causes of anemia. In a very small number of patients, the cause cannot be found. These patients can be defined as idiopathic cytopenia of unknown significance, and clonal disorders can be detected in some of them. These patients should be monitored for a return to myelodysplastic syndrome.
In addition to clinical symptoms, risk factors for anemia should guide the evaluation. Risk factors more common in elderly patients include chronic alcohol use, malnutrition, polypharmacy, use of blood thinners, chronic kidney disease, liver disease, myelodysplastic disorders, gastrointestinal bleeding, cancer, androgen deficiency, and age-related decrease in stem cell proliferation. . In addition to identifying these risk factors, the clinical history should focus on symptoms that may suggest a specific condition. Bloody stools and vomiting may indicate gastrointestinal bleeding. Recurrent skin infections may be a sign of immunosuppression suggestive of myelodysplastic syndrome. The presence or absence of these risk factors should guide further evaluation and treatment.
As a result, it is necessary to evaluate anemia as a finding rather than a disease in itself. Investigating one or more underlying causes and correcting them as necessary Further research is important for the diagnosis of chronic diseases as well as for the evaluation of hematological cancer and precancerous diseases.
Read: 0
