Anemia In Older People Research Articles

FC60: Restless legs syndrome and ferritin levels in older people with dementia: a cross-sectional study

Objectives: To evaluate the relationship between Willis-Ekbom Disease/Restless Legs Syndrome and iron deficiency anemia in older people with dementia.Methods: A cross-sectional study was conducted with 70 older people diagnosed with dementia and restless leg syndrome in a Psychogeriatric outpatient clinic in a city in the interior of São Paulo, Brazil. The older people filled in instruments of sociodemographic characterization, measures to evaluate the Restless Legs Syndrome, neuropsychiatric symptoms, sleep quality, sleepiness and cognition. Blood data were also collected levels of creatinine, ferritin, red blood cells, hemoglobin and hematocrit, the latter collected in the patients’ medical records.Results: The sample consists mostly of older people with mixed dementia (i.e., Alzheimer’s disease + Vascular Dementia), with 39% of female patients and mean age of 77.80 years (9.36). This study identified a frequency of 15.7% of Restless Legs Syndrome. Patients with the syndrome present more frequency of neuropsychiatric symptoms, worse sleep quality, higher index of body mass and lower levels of ferritin (p < .05).Conclusions: A frequency of 15.7% was identified for restless leg syndrome among patients with dementia. In addition, patients with the syndrome have ferritin deficiency.

Association of adverse childhood experiences with anemia in older Chinese: Guangzhou Biobank Cohort Study.

To examine the association of adverse childhood experiences (ACEs) with anemia among older people. 24,116 participants aged 50years or above were recruited. Multivariable linear and logistic regression was used to assess the associations of self-reported ACEs number with hemoglobin concentrations (g/dL) and presence of anemia. Older individuals with two or more ACEs, versus no ACEs, showed lower hemoglobin concentrations (β = - 0.08g/dL, 95% confidence intervals (CI) - 0.12 to - 0.03) and higher odds of anemia (odds ratio = 1.26, 95% CI 1.01-1.59). A more pronounced association between ACEs and anemia in the lower education group was found, while the association became non-significant in those with higher education (P for ACEs-education interaction = 0.02). ACEs was associated with anemia in older people, and the association was stronger in those with lower education, highlighting the significance of early-life psychological stressors assessment and consideration of education background in geriatric care.

Lower cognitive function as a risk factor for anemia among older Japanese women from the longitudinal observation in theSONICstudy

The aging-related increase in the incidence of anemia potentially affects the mortality risk. Lower cognitive function is common among older adults, and anemia is one of the causes of cognitive decline. However, to the best of our knowledge, no study has investigated whether cognitive decline is a risk factor for anemia in older people. Therefore, in this study, we used a 3-year longitudinal evaluation to examine the association of cognitive function with anemia in community-dwelling older adults. This longitudinal study enrolled participants without anemia (diagnosed based on the World Health Organization's criteria) at baseline. Cognitive function was assessed using the Japanese version of the Montreal Cognitive Assessment. Multiple logistic regression models were used to examine the association between cognitive function at baseline and the presence of anemia 3 years later. Participants were in the 69-71 and 79-81 years age groups, and 974 older people (48.6% men) were enrolled, of whom 126 (12.9%) had anemia after 3 years. After adjusting, cognitive function at baseline was associated with anemia in women, but not in men. Older Japanese women with lower cognitive function have an increased risk for anemia 3 years later. The adoption of a lifestyle that utilizes or improves cognitive function might be important to prevent anemia in older women. Geriatr Gerontol Int 2023; 23: 334-340.

837 High Prevalence of Anaemia and Mortality in Older Patients Undergoing Emergency Laparotomy

Abstract Aim Anaemia affects 1in10 elderly (>65) patients with a myriad of causes. Elderly patients undergoing emergency laparotomy often present with anaemia. Little is known however about the prevalence of anaemia in older people who require emergency laparotomy and the influence it may have on their outcomes. Method Elderly patients (>65-years old) undergoing an emergency laparotomy between May2016-November2018 in a tertiary trauma centre were prospectively identified. Data included patient demographics, haemoglobin, MCV and ferritin, blood transfusions and iron products administered, readmissions and mortality. Results 231 patients underwent emergency laparotomy. Prevalence of pre-operative anaemia in this group was 43%. 5% were very-anaemic and 38% mildly-anaemic. Ferritin was checked within 89 patients; insufficient levels were present in 20%. 31% of all patients were given blood in the peri-operative period. 100% of patients discharged, were anaemic. For pre-operative anaemic vs non-anaemic patients, ASA grade was higher (4 vs 3), readmission rate was 19% vs 18%, 30-day mortality was 18% vs 14% and 1-year mortality rate high(34% vs 22%, p < 0.05). Very-anaemic patients (92%) received peri-operative blood compared to (41%) of mildly-anaemic patients. 30-day mortality was 0 vs 21% in very-anaemic vs mildly-anaemic patients. Mortality was 45.8% in patients who received transfusions compared to those who did not 19.9% (P < 0.0001). Conclusions The prevalence of anaemia in older patients undergoing emergency laparotomy is high and related to significantly increased mortality(12 months after surgery). We have identified a high-risk group of older patients with mild anaemia on presentation who may be at increased risk of mortality 3months after surgery.

Association of anemia and SRH in older people: the SONIC study.

The incidence of anemia increases with aging, and it is considered to affect mortality through complex pathophysiological outcomes. Although it has been suggested that self-rated health may also contribute to the prognosis of anemia in older people, the relationship between anemia and self-rated health is not well understood. This study thus examined the actual status of anemia in older community-dwelling Japanese people and clarified the relationship between anemia and self-rated health. We conducted medical interviews, physical measurements and blood testing in 2083 people aged 69-91 years who participated in the long-term observational Septuagenarians, Octogenarians, Nonagenarians, Investigation with Centenarians (SONIC) study. Subjects were divided into two groups according to whether they had anemia. Logistic regression analyses were used to assess the relationship between anemia and self-rated health after adjusting for possible confounding factors. The prevalence of anemia was 22.3% in all participants, 7.2% in men and 11.6% in women aged 69-71 years, 27.4% in men and 26.3% in women aged 79-81 years, and 55.8% in men and 44.9% in women aged 89-91 years. Multivariate analysis revealed a correlation between the presence of anemia and poor self-rated health in all (odds ratio 0.67, 95% confidence interval 0.48-0.93) and aged 69-71 years (odds ratio 0.47, 95% confidence interval 0.25-0.86). Anemia was associated with self-rated health in older Japanese people, suggesting that careful management of anemia may contribute to health and longevity. Geriatr Gerontol Int 2020; ••: ••-••.

A Study of Association between Nutritional Status and Anemia in Older People

A Study of Association between Nutritional Status and Anemia in Older People

Predictors of iron-deficiency anemia in primary care older adults: a real-world European multi-country longitudinal study.

Iron deficiency is a major cause of anemia in older people. Increasing the knowledge on the predictors of iron-deficiency anemia (IDA) may facilitate its timely diagnosis. To investigate the predictors of IDA in older people in four European countries. Retrospective longitudinal study. Primary care patients aged 65 or older (N = 24,051) in four European countries. IDA predictors were estimated using multivariate Cox regression based on information gathered from national primary care databases: Italy (years 2002-2013), Belgium, Germany and Spain (years 2007-2012). Adjusted hazard ratios (aHR) with 95% confidence intervals (CIs) were estimated. In Spain and Belgium, men were at greater risk of IDA than women, while they had a lower risk in Italy. Weakness, irritability, alopecia and xerostomia were signs and symptoms significantly associated with IDA. Concurrent diseases, potential causes of anemia, positively associated with IDA were small bowel polyposis, stomach cancer, obesity, gastritis and peptic ulcer, esophagitis, Crohn's disease, celiac disease, lymphangiectasis, gastrectomy or gastric atrophy, gut resection or bypass, and cardiac prosthetic valve. Aspirin users had a 12-35% higher hazard of IDA than non-users. Similarly, corticosteroids and anti-acids were positively associated with IDA. A higher level of comorbidity was associated with an increased hazard of IDA in all countries. Specific signs and symptoms, chronic conditions, a greater comorbidity burden, and specific pharmacological treatments registered in primary care databases represent relevant predictors and correlates of incident IDA in older people in Europe. General practitioners might employ this information to obtain early diagnosis of IDA in community-dwelling older adults.

No association between subnormal serum vitamin B12 and anemia in older nursing home patients.

Since evidence of an association between vitamin B12 (B12) deficiency and anemia in older people is limited and inconclusive, we wanted to investigate this association in old, frail nursing home patients. The study includes patients admitted to short-term, post-acute care (n = 765) and residents in long-term care (LTC) (n = 1665), in the municipality of Bergen. Anemia was defined according to the WHO criteria: Hb < 13g/dL in men and < 12g/dL in women, and as Hb < 11g/dL, in both sex (moderate/severe anemia). The presence of anemia was analyzed in patients with subnormal (< 250pmol/L), normal (250-650pmol/L) and high (> 650pmol/L) B12, and the association between anemia and clinical parameters, and including B12, was analyzed using logistic regression models. The use of B12 supplementation was investigated in the LTC patients. Mean age of the 2430 patients was 86 ± 7years. WHO-defined anemia was seen in 1023 (42%), and moderate/severe anemia in 384 (16%) of the patients. In multiple logistic regression analyses, we found no statistically significant associations of subnormal B12 with WHO-defined anemia or moderate/severe anemia. Renal insufficiency, iron deficiency and CRP > 10mg/L were significantly associated with both types of anemia, (p < 0.001). Among the LTC residents, 405 (24%) received B12 supplements, 112 (7%) of them had elevated B12 > 650pmol/L. In older nursing home patients, no association was observed between subnormal B12 and anemia. Older patients in Western societies with mild/moderate anemia should not be treated with B12 supplements without further investigation.

HUBUNGAN ANTARA ASUPAN PROTEIN, ZAT BESI, VITAMIN C, DAN INHIBITOR ABSORPSI ZAT BESI DENGAN STATUS ANEMIA PADA LANJUT USIA DI PAGUYUBAN “WIRA WREDHA” WIROGUNAN, YOGYAKARTA

The prevalence of anemia in older people based on data from NHANES III by 11,0% of men and 10,2% of women suffered from anemia. The study used observational study with cross sectional design. Subjects for the study were 99 older people at Paguyuban “Wira Wredha” Wirogunan, Yogyakarta who complied for inclusion and exclusion criteria. Data collected include protein intake, iron intake, vitamin C intake, iron absorption inhibitors intake, body weight, and hemoglobin concentration. Data related to intake of protein, iron, vitamin C, and iron absorption inhibitors obtained by interview using SQFFQ. Body weight measured using weight scales. Hemoglobin concentration measured using hemocue method. The statistical test used to analyze the relationship is a Chi Square test or Fisher’s exact test. The prevalence of anemia in older people was 18,2%. There was significant relationship between intake of protein (p=0,005) and iron (p=0,007) with anemia status in older people. There was no significant relationship between intake of vitamin C (p=0,636), iron absorption inhibitors (tannin, phytate, oxalate acid) with anemia status in older people (p=0,184; p=0,129; p=0,393) with anemia status in older people. There were significant relationship between intake of protein and iron with anemia status in older people at Paguyuban “Wira Wredha” Wirogunan, Yogyakarta. There were no significant relationship between intake of vitamin C and iron absorption inhibitors with anemia status in older people at Paguyuban “Wira Wredha” Wirogunan, Yogyakarta.&#x0D; Keywords: Anemia status, iron, iron absorption inhibitors, protein, vitamin C

Anemia in the aged

Anemia in the aged is still often an underestimated clinical problem; however, in recent years increasing research on this topic has permitted deeper insights, allowing adifferentiated approach to anemia in the aged. Meanwhile, multicausality and anegative impact on functional outcome have become characteristics of anemia in older people. This has led to ascientific discussion on the question of accepting anemia as ageriatric syndrome. The present article gives a concise overview of the current state of research on this clinically relevant subject.

A comparison of methods for adjusting biomarkers of iron, zinc, and selenium status for the effect of inflammation in an older population: a case for interleukin 6

Older people are at risk of micronutrient deficiencies, which can be under- or overestimated in the presence of inflammation. Several methods have been proposed to adjust for the effect of inflammation; however, to our knowledge, none have been investigated in older adults in whom chronic inflammation is common. We investigated the influence of various inflammation-adjustment methods on micronutrient biomarkers associated with anemia in older people living in aged-care facilities in New Zealand. Blood samples were collected from 289 New Zealand aged-care residents aged >65 y. Serum ferritin, soluble transferrin receptor (sTfR), total body iron (TBI), plasma zinc, and selenium as well as the inflammatory markers high-sensitivity C-reactive protein (CRP), α1-acid glycoprotein (AGP), and interleukin 6 (IL-6) were measured. Four adjustment methods were applied to micronutrient concentrations: 1) internal correction factors based on stages of inflammation defined by CRP and AGP, 2) external correction factors derived from the literature, 3) a regression correction model in which reference CRP and AGP were set to the maximum of the lowest decile, and 4) a regression correction model in which reference IL-6 was set to the maximum of the lowest decile. Forty percent of participants had elevated concentrations of CRP, AGP, or both, and 37% of participants had higher than normal concentrations of IL-6. Adjusted geometric mean values for serum ferritin, sTfR, and TBI were significantly lower (P<0.001), and plasma zinc and selenium were significantly higher (P<0.001), than the unadjusted values regardless of the method applied. The greatest inflammation adjustment was observed with the regression correction that used IL-6. Subsequently, the prevalence of zinc and selenium deficiency decreased (-13% and -14%, respectively; P<0.001), whereas iron deficiency remained unaffected. Adjustment for inflammation should be considered when evaluating micronutrient status in this aging population group; however, the approaches used require further investigation, particularly the influence of adjustment for IL-6.

Prevalence of anemia in relation to socio-economic factors in elderly Polish population: the results of PolSenior study.

Anemia is an independent risk factor for functional decline and mortality among older adults. Since mild anemia in older people is often under-diagnosed and ignored, its prevalence needs precise determination and recognition of predisposing factors. None of the previous studies based on the data obtained from the representative elderly population identified the influence of socio-economic factors on the prevalence of anemia. PolSenior was a cross-sectional population-based study performed on the nationally representative sample of Polish seniors. Complete blood count was assessed in 4003 respondents aged 65 years or above (1910 women) divided into six five-year cohorts and a reference group of 622 people aged 55 - 59 years (333 women). Anemia was defined based on the WHO criteria: Hb < 12.0 g/dL in women and Hb < 13.0 g/dL in men. The following socio-economic factors were evaluated through the multiple logistic regression analysis: education level, marital status, place of residence, living arrangements and self-reported poverty. The prevalence of anemia in older persons standardized for the population was 10.8% (17.4% of the study group) and was more frequent in men than in women (20.8% versus 13.6%). The frequency of anemia progressed with age from 5.3% in the youngest to 37.7% in the oldest cohort, and the progression was higher in men. The multiple logistic regression analysis revealed the link between anemia and age in both genders, as well as unmarried status and urban dwelling in men. When age was not taken into account, logistic regression showed the link between anemia and unmarried status, urban place of residence (both genders), and low level of education (women only). Among seniors, those poorly educated, unmarried and city inhabitants require intense screening for anemia.

Prevalence of Anaemia among the Elderly in Malaysia and Its Associated Factors: Does Ethnicity Matter?

Introduction Anaemia is common among the elderly, yet it remains an underresearched clinical condition. This study investigates ethnic differences in prevalence of anaemia and identifies potential factors associated with anaemia in the elderly. Methods Data from the National Health & Morbidity Survey (NHMS) 2015 conducted by Ministry of Health was analyzed. Haemoglobin levels were measured using point-of-care testing, HemoCue® Hb 201+ System©, from consenting individuals. Demographic information and other clinical information were obtained through a structured questionnaire. Descriptive and multivariate analyses were conducted and significant results were presented as adjusted odds ratio. Results A total of 3794 participants aged 60 years and older responded to the anaemia module with a response rate of 93.7%. 64.0% of respondents were of Malay ethnicity, 21.6% were Chinese, 6.1% were Indians, and 8.3% were of other ethnicities. The overall prevalence of anaemia among older people was 35.3%. The highest prevalence of anaemia was found among respondents of Indian ethnicity (45.5%). The Indian (aOR: 1.72; 95% CI 1.26–2.34) and Malay (aOR: 1.25; 95% CI 1.04–1.49) ethnic groups were more likely to be anaemic in comparison to those of Chinese ethnicity. Anaemia in older people was also associated with increasing age, history of hospital admission, and the presence of diabetes mellitus. Conclusion Anaemia in the elderly is associated with Indian and Malay ethnicities, increasing age, hospitalization, and diabetes. Our study has identified important information on a common condition which will guide and assist future studies in reducing the burden of anaemia.

Chronic idiopathic normocytic anaemia in older people: the risk factors and the role of age-associated renal impairment.

To characterise the risk factors for chronic idiopathic normocytic anaemia (CINA) in older people, particularly the role of age-associated renal impairment. Patients aged ≥65years admitted to a medical unit over 12months were assessed. Those with secondary causes of anaemia including chronic kidney disease (CKD) were excluded. CINA was defined as a haemoglobin <130g/l for men and <120g/l for women for at least 6months without any apparent cause. Renal function was determined by estimating creatinine clearance (CrCl) using Cockcroft-Gault formula, and glomerular filtration rate (GFR) using modification of diet in renal disease (MDRD) and chronic kidney disease epidemiology collaboration (CKD-EPI) formulas. 116 had CINA. Controls were 572. The mean estimates of renal function were significantly lower in cases as compared with controls (P<0.001). The risk of CINA increased by 12.6, 10.4 and 12%, respectively, for each unit decrease in CrCl, MDRD-eGFR and CKD-EPI-eGFR, independent of age and other covariates. The adjusted odds ratios for CINA in those with CrCl, MDRD or CKD-EPI eGFR <60ml/min/1.73m2 were 2.68 (CI 1.53-4.70); 2.70 (CI 1.57-4.62) and 2.12 (CI 1.46-3.74), respectively. Other covariates in the model that were independently associated with CINA included advanced age, diabetes mellitus (DM), use of angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB), history of dementia and living in a residential care facility. Age-associated renal impairment independently contributes to CINA. Other potential risk factors for CINA include advanced age, DM and ACEI or ARB use.

O-051: Systematic review and meta-analysis: What is the evidence for oral iron supplementation in treating anaemia in older people?

O-051: Systematic review and meta-analysis: What is the evidence for oral iron supplementation in treating anaemia in older people?

The prevalence of anemia, iron, vitamin B12, and folic acid deficiencies in community dwelling elderly in Ankara, Turkey

ObjectiveAnemia is a common problem among older people. Deficiency of essential erythropoiesis elements (iron, vitamin B12, and folic acid) is one of the major causes of anemia in older people. Studies evaluated prevalence of anemia in our country generally consisted of older people admitted to hospital. Studies conducted on community dwelling older people were much more less. The aim of this study is to evaluate prevalence of anemia and nutritional deficiencies in community dwelling elderly in our country. Totally 827 elderly individuals living in community participated in this study. Materials and MethodsAnemia was defined according to the World Health Organization (Hb<13g/dl for men and Hb<12g/dl for women). Iron, vitamin B12, and folic acid deficiencies were evaluated. Iron deficiency anemia was diagnosed when anemia with iron level <60μg/dl and ferritin level <12ng/ml. Vitamin B12 deficiency anemia was diagnosed when anemia with vitamin B12 level <200pg/ml. Folic acid deficiency anemia was diagnosed when anemia with folic acid level <2.6ng/ml. ResultsPrevalence of anemia was found 7.3%. Prevalence of iron deficiency, vitamin B12, and folic acid deficiency were found 7.1%, 64.2% and 10.9%, and 10.9%, respectively. Prevalence of iron deficiency anemia was found 2.8%. Prevalence of vitamin B12 deficiency anemia was found 4.4% and folic acid deficiency anemia was found 1%. ConclusionsPrevalence of anemia was seen 7.3% in our study, but more studies are needed on anemia in community dwelling elderly in our country. Deficiency of iron, vitamin B12, and folic acid is also high in Turkey

Prevalence and determinants of anemia in older people with diabetes attending an outpatient clinic: a cross-sectional audit.

In BriefThis cross-sectional audit investigates the prevalence and determinants of anemia in older people with diabetes attending an outpatient clinic. Anemia was found to be highly prevalent, affecting 59% of patients. Older age and longer duration of diabetes were the main predictors of anemia, whereas the presence of chronic kidney disease was a mediator rather than a direct cause.

Prevalence, types, risk factors and clinical correlates of anaemia in older people in a rural Ugandan population.

BackgroundStudies conducted in high income countries have shown that anaemia is a common medical condition among older people, but such data are scarce in Africa. The objectives of this study were to estimate the prevalence, types, risk factors and clinical correlates of anaemia in older people.MethodsParticipants were aged (≥ 50) years recruited from a general population cohort from January 2012 to January 2013. Blood samples were collected for assessing hemoglobin, serum ferritin, serum vitamin B12, serum folate, C-reactive protein, malaria infection and stool samples for assessment of hookworm infection. HIV status was assessed using an algorithm for HIV rapid testing. Questionnaires were used to collect data on sociodemographic characteristics and other risk factors for anaemia.ResultsIn total, 1449 people participated (response rate 72.3%). The overall prevalence of anaemia was 20.3 % (95% CI 18.2-22.3%), and this was higher for males (24.1%, 95% CI=20.7-27.7%) than females (17.5%, 95% CI=15.0-20.1%). In males, the prevalence of anaemia increased rapidly with age almost doubling between 50 and 65 years (p-trend<0.001). Unexplained anaemia was responsible for more than half of all cases (59.7%). Anaemia was independently associated with infections including malaria (OR 3.49, 95% CI 1.78-6.82), HIV (OR 2.17, 1.32-3.57) heavy hookworm infection (OR 3.45, 1.73-6.91), low fruit consumption (OR 1.55, 1.05-2.29) and being unmarried (OR 1.37 , 95% CI 1.01-1.89). However, the odds of anaemia were lower among older people with elevated blood pressure (OR 0.47, 95% CI 0.29-0.77).ConclusionAnaemia control programmes in Uganda should target older people and should include interventions to treat and control hookworms and educational programs on diets that enhance iron absorption. Clinicians should consider screening older people with HIV or malaria for anaemia. Further studies should be done on unexplained anaemia and serum ferritin levels that predict iron deficiency anaemia in older people.

Causes of recurrent or persistent anemia in older people from the results of the São Paulo Ageing &amp; Health Study

Anemia is a prevalent condition in older people, and associated with increased morbidity and mortality. Previous studies identified various causes of anemia in this population. We aimed to determine the frequency and main causes of persistent or recurrent anemia in participants 2 years after their inclusion in the São Paulo Ageing & Health Study (SPAH). The SPAH is a cohort study of 2072 individuals aged 65 years or older living in poor neighborhoods of São Paulo, Brazil. A total of 2 years after inclusion, participants were reassessed; those with anemia at baseline were eligible for this ancillary study. Individuals were invited to a medical re-evaluation, including taking blood samples to determine serum iron, ferritin, total iron-binding capacity, folic acid, vitamin B(12), creatinine and transferrin saturation levels, and blood cell and reticulocyte counts. Anemia diagnosis was based on WHO criteria. Information about cause of death before follow-up assessment was obtained from death certificates. Of the 203 participants with anemia at inclusion, 97 (47.8%) were reassessed, 48 (23.6%) died before follow-up assessment, 33 (16.3%) refused to participate and 25 (12.3%) were not traced. A total of 57 (58.8%) of the 97 re-evaluated participants had persistent or recurrent anemia. Lower baseline hemoglobin was a predictor of anemia during follow up. Major causes of persistent or recurrent anemia at follow up were renal disease (62%) and chronic inflammation (35%). Anemia was a prevalent and persistent disease in this low-income sample of older individuals. Micronutrient-related anemia, chronic blood loss and renal disease are important mechanisms for perpetuating low hemoglobin levels.

Iron deficiency anemia in the elderly

The numbers of older people in the world have been growing rapidly. Anemia is the most common hematologic problem encountered in older adults. However, anemia should not be accepted as an inevitable consequence of aging. Anemia in the elderly signifies an underlying disease. Iron Defi ciency Anemia (IDA) is being one of the most common causes of anemia in older people. IDA in the elderly is often associated with such non specific symptoms. The diagnosis of IDA is typically based on laboratory results. Hence, the utilization of the various laboratory tests plays an important role for the diagnosis of IDA. The presence of IDA in the elderly is usually related with gastrointestinal disorders. Thus, gastrointestinal evaluation should be contemplated in all patients with IDA unless there is a history of clinically important non gastrointestinal blood loss. Older people with IDA should have iron supplementation both to correct anemia and to replenish body iron stores. However, the underlying cause should always be treated to prevent further iron loss. (Med J Indones 2011; 20:71-7) Keywords: anemia, elderly, gastrointestinal, iron deficiency