Anemia Prevalence and Health Outcomes in Older Adults

Anemia is a common condition in later life, marked by reduced haemoglobin concentration and diminished oxygen-carrying capacity of the blood. Its prevalence increases with age and is especially high among hospitalised and care-home residents. Causes are often multifactorial, encompassing iron deficiency, chronic inflammation, renal impairment and age-related changes in bone marrow function. In many older individuals, anaemia is underdiagnosed and undertreated, despite clear links to adverse outcomes. These include frailty syndrome, reduced muscle strength, increased risk of falls, poorer quality of life, accelerated cognitive decline and elevated all-cause and cardiovascular mortality. Emerging evidence highlights the role of “inflammaging” and clonal haematopoiesis in the pathogenesis of anaemia in the elderly. Timely identification and appropriate management—ranging from iron repletion to judicious use of erythropoiesis-stimulating agents—have the potential to improve functional status and reduce health-care burden in ageing populations worldwide.

Research from Nature Portfolio

A large multicentre study of hospitalised older patients across geriatric and nephrology units reported that two-thirds of individuals exhibited anaemia at discharge. Significant diagnostic and treatment inertia was documented, with routine iron and vitamin B12 assessments omitted in up to one-third of cases and oral or parenteral supplementation withheld in the majority. Use of erythropoiesis-stimulating agents was particularly low in geriatric settings despite high rates of chronic kidney disease and anaemia. The findings underscore critical gaps in routine screening and tailored therapy, calling for systematic protocols to ensure timely correction of anaemia and reduction of related complications in acute care.

Anemia Prevalence and Health Outcomes in Older Adults publication trend

The graph below shows the total number of articles in anemia prevalence and health outcomes in older adults across all publications each year (not limited to Nature Index journals).

Technical terms

Anaemia: A reduction in blood haemoglobin concentration below age- and sex-specific normal ranges, leading to impaired oxygen delivery.

Haemoglobin (Hb): The iron-containing protein in red blood cells responsible for binding and transporting oxygen.

Frailty syndrome: A clinical state in older adults characterised by decreased physiological reserves, vulnerability to stressors and high risk of adverse outcomes.

Inflammaging: Chronic, low-grade inflammation associated with ageing that contributes to tissue dysfunction and disease.

Erythropoiesis-stimulating agents (ESA): Drugs that mimic erythropoietin to stimulate red blood cell production, used in anaemia related to chronic disease or renal failure.

Diagnostic inertia: Failure to initiate or complete appropriate laboratory assessments despite clinical indications.

Mean corpuscular volume (MCV): The average volume of individual red blood cells, used to characterise anaemia subtypes.

References

1. Dietary Iron, Anemia Markers, Cognition, and Quality of Life in Older Community-Dwelling Subjects at High Cardiovascular Risk. Nutrients (2023).
2. Anemia management and transfusion strategy in internal medicine units: Less is more. European Journal of Internal Medicine (2023).
3. Anemia-associated smaller brain volume and sex differences: a cross-sectional study of magnetic resonance imaging in brain health checkups. Frontiers in Aging Neuroscience (2024).
4. Prevalence, risk factors, and treatment of anemia in hospitalized older patients across geriatric and nephrological settings in Italy. Scientific Reports (2024).