Elderly studies of anemia (ESAs) needed

Abstract

Anemia is a common problem in elderly patients. The National Health and Nutrition Examination Survey (NHANES III) reported that the incidence of anemia steadily increases after age 50. Anemia is found in 10% and 11% ofwomen andmen respectively who were older than age 65, and in 20% of individuals≥85 years. In this sameseries, the causes of anemia inpatients over 65 years were equally attributed to nutritional deficiency, anemia of inflammation, and “unexplained” causes. Anemia in the geriatric population has unique significance because it is an independent predictor ofmorbidity,mortality, and frailty. Consistently an inverse relationship between the number of co-morbid medical conditions and anemia is observed. The anemia associated with malignancy is complex and multifactorial. It may be caused by blood loss, marrow infiltration, erythrophagocytosis, or inflammation. The treatment of anemia in geriatric oncology patients is likely to be evenmore complex. In younger patients with cancer, the impetus to correct anemia has largely been driven by a desire to improve patients' quality of life. Using the FACT to assess fatigue in a mixed population of cancer patients, Cella demonstrated an inverse association between the level of hemoglobin and the selfreporting of fatigue. In elderly patients the imperative to correct anemia is further driven by the physiologic consequences of low oxygen carrying capacity on already compromised cardiac, pulmonary, and renal reserves. Either transfusion of red blood cells or the administration of erythropoietin stimulating agents (ESAs) has been used to correct anemia in individuals with cancer. The tenuous fluid and electrolyte balance experienced by elderly patients make transfusion a somewhat less desirable approach.