Mortality and morbidity due to the failure to treat mild anemia unrelated to cancer in elderly Americans—Review of the literature and case presentation

Abstract

Even mild iron deficiency anemia, as defined by the World Health Organization, is associated with increased mortality and significant morbidity in elderly individuals who are cancer free. Yet, anemia in the elderly is often dismissed as a benign sign of aging. This problem is exacerbated by the fact that elderly individuals often suffer from gastrointestinal complaints that preclude treatment with iron supplements by mouth. The FDA has approved two brands of injectable iron for treating such patients. Nonetheless, a major American health maintenance organization refuses to treat elderly patients with injectable iron, even when it is indicated, unless their anemia is associated with cancer. This may well reflect a public health crisis afflicting many elderly residents of the United States.

Share and Cite:

Allen, A. (2013) Mortality and morbidity due to the failure to treat mild anemia unrelated to cancer in elderly Americans—Review of the literature and case presentation. Advances in Aging Research, 2, 154-159. doi: 10.4236/aar.2013.24022.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Aapro, M.S., Cella, D. and Zagari, M. (2002) Age, anemia, and fatigue. Seminars in Oncology, 29, 55-59.
[2] Smith, D.L. (2002) Anemia in the elderly. American Family Physician, 62, 1565-1572.
[3] Balducci, L., Ershler, W.B. and Krantz, S. (2006) Anemia in the elderly—Clinical findings and impact on health. Clinical Reviews in Oncology/Hematology, 58, 156-165.
[4] Agnihotri, P., Telfer, M., Butt, Z., Jella, A., Cella, D., Kozma, C.M., Ahuja, M., Riaz, S. and Akamah, J. (2007) Chronic anemia and fatigue in elderly patients: Results of a randomized, double-blind, placebo-controlled, crossover exploratory study with epoetin alfa. Journal of the American Geriatrics Society, 55, 1557-1565.
[5] Artz, A.S. (2008) Anemia and the frail elderly. Seminars in Hematology, 45, 261-266.
http://dx.doi.org/10.1053/j.seminhematol.2008.06.002
[6] Eisenstaedtr, R., Penninx, B.W.J.H. and Woodman, R.C. (2006) Anemia in the elderly: Current understanding and emerging concepts. Blood Reviews, 20, 213-226.
[7] Gabrilove, J. (2005) Anemia and the elderly: Clinical considerations. Best Practice & Research Clinical Haematology, 18, 417-422.
[8] Lipschitz, D. (2003) Medical and functional consequences of anemia in the elderly. Journal of the American Geriatrics Society, 51, 10-13.
http://dx.doi.org/10.1046/j.1532-5415.51.3s.6.x
[9] Kaltwasser, J.P., Kessler, U., Gottschalk, R., Stucki, G. and Moller, B. (2001) Effect of recombinant human erythropoeietin and intravenous iron on anemia and disease activity in rheumatoid arthritis. The Journal of Rheumatology, 28, 2430-2436.
[10] Bloxham, E. Vagadia, V., Scott, K., Francis, G., Saravanan, V., Heycock, C., Rynne, M., Hamilton, J. and Kelly, C.A. (2011) Anemia in rheumatoid arthritis: Can we afford to ignore it? Postgraduate Medical Journal, 87, 596-600. http://dx.doi.org/10.1136/pgmj.2011.117507
[11] Denny, S.D., Kuchibhatia, M.N. and Cohen, H.J. (2006) Impact of anemia on mortality, cognition, and function in community-dwelling elderly. The American Journal of Medicine, 119, 327-334.
http://dx.doi.org/10.1016/j.amjmed.2005.08.027
[12] Penninx, B.W.J.H., Pluijm, S.M.F., Lips, P., Woodman, R., Miedema, K., Guralnik, J.M. and Deeg, D.J.H. (2005) Late-life anemia is associated with increased risk of recurrent falls. Journal of the American Geriatrics Society, 53, 2106-2111.
[13] Penninx, B.W.J.H., Pahor, M., Cesari, M., Corsi, A.M., Woodman, R.C., Bandinelli, S., Guralnik, J.M. and Ferrucci, L. (2004) Anemia is associated with disability and decreased physical performance and muscle strength in the elderly. Journal of the American Geriatrics Society, 52, 719-724.
[14] Penninx, B.W.J.H., Guralnik, J.M., Onder, G., Ferrucci, L., Wallace, R.B. and Pahor, M. (2003) Anemia and decline in physical performance among older persons. The American Journal of Medicine, 115, 104-110.
http://dx.doi.org/10.1016/S0002-9343(03)00263-8
[15] Hong, C.H., Falvey, C., Harris, T.B., Simonsick, E.M., Satterfield, S., Ferrucci, L., Metti, A.L., Patel, K.V. and Yaffe, K. (2013) Anemia and risk of dementia in older adults. Neurology, 81, 528-533.
http://dx.doi.org/10.1212/WNL.0b013e31829e701d
[16] Terekeci, H.M., Kucukardali, Y., Onem, Y., Erikci, A.A., Kucukardali, B., Sahan, B., Sayan, O., Celik, S., Gulec, M., Sanisoglu, Y.S., Nalbant, S., Top, C. and Oktenli, C. (2010) Relationship between anaemia and cognitive functions in elderly people. European Journal of Medicine, 21, 87-90. http://dx.doi.org/10.1016/j.ejim.2009.12.005
[17] Atti, A.R., Palmer, K., Volpato, S., Zuliani, G., Winblad, B. and Fratiglioni, L. (2006) Anemia increases the risk of dementia in cognitively intact elderly. Neurobiology of Aging, 27, 278-284.
http://dx.doi.org/10.1016/j.neurobiolaging.2005.02.007
[18] Penninx, B.W.J.H., Pahor, M., Woodman, R.C. and Guralnik, J.M. (2006) Anemia in old age is associated with increased mortality and hospitalization. The Journals of Gerontology: Series A, 61, 474-479.
[19] Riva, E., Tettamanti, M., Mosconi, P., Apolone, G., Gandini, F., Nobili, A., Tallone, M.V., Detoma, P., Giacomin, A., Clerico, M., Tempia, P., Guala. A., Fasolo, G. and Lucca, U. (2008) Association of mild anemia with hospitalization and mortality in the elderly: The health and anemia population-based study. Haematologica, 94, 22-28.
http://dx.doi.org/10.3324/haematol.13449
[20] Zakai, N.A., Katz, R., Hirsch, C., Shlipak, M.G., Chaves, P.H.M., Newman, A.B. and Cushman, M. (2005) A prospective study of anemia status, hemoglobin concentration, and mortality in an elderly cohort. Archives of Internal Medicine, 165, 2214-2220.
http://dx.doi.org/10.1001/archinte.165.19.2214
[21] Walsh, J.R. (1981) Hematologic disorders in the elderly. Western Journal of Medicine, 135, 446-454.
[22] Guralnik, J.M., Ershler, W.B., Schrier, S.L. and Picozzi, V.J. (2005) Anemia in the elderly: A public health crisis in hematology. American Society of Hematology Education Book, 2005, 528-532.
http://dx.doi.org/10.1182/asheducation-2005.1.528
[23] Pattrson, A.J., Brown, W.J. and Roberts, D.C.K. (2001) Dietary and supplement treatment of iron deficiency results in improvements in general health and fatigue in Australian women of childbearing age. Journal of the American College of Nutrition, 20, 337-642.
http://dx.doi.org/10.1080/07315724.2001.10719054
[24] Patterson, A.J., Brown, W.J., Roberts, D.C.K. and Seldon, M.R. (2001) Dietary treatment of iron deficiency anemia in women of childbearing age. American Journal of Clinical Nutrition, 74, 650-656.
[25] Firth, M. and Prather, C.M. (2002) Gastrointestinal motility problems in the elderly patient. Gastroenterology, 122, 1688-1700.
http://dx.doi.org/10.1053/gast.2002.33566
[26] Camilleri, M., Lee, J.S., Viramontes, B., Bharucha, A.E. and Tangalos, E.G. (2000) Insights into the pathophysiology and mechanisms of constipation, irritable bowel syndrome, and diverticulosis in older people. Journal of the American Geriatrics Society, 48, 1142-1150.
[27] Comparato, G., Pilotto, A., Franzè, A., Franceschi, M. and Di Mario, F. (2007) Diverticular disease in the elderly. Digestive Diseases, 25, 151-159.
http://dx.doi.org/10.1159/000099480
[28] Shoji, B.T. and Becker, J.M. (1994) Colorectal disease in the elderly patient. The Surgical Clinics of North America, 74, 293-316.
[29] van Geloven, A.A.W., Biesheuvel, T.H., Luitse, J.S.K., Hoitsma, H.F.W. and Obertop, H. (2000) Hospital admissions of patients aged over 80 with acute abdominal complaints. European Journal of Surgery, 166, 866-871.
http://dx.doi.org/10.1080/110241500447254
[30] Pirzio-Biroli, G. and Finch, C.A. (1957) Treatment of iron deficiency anemia in the adult. Journal of Chronic Diseases, 6, 302-306.
http://dx.doi.org/10.1016/0021-9681(57)90025-5
[31] http://www.pdr.net/drug-summary/infed?druglabelid=2087&id=1319
[32] http://www.pdr.net/drug-summary/dexferrum?druglabelid=1310&id=3102
[33] Patel, K.V., Harris, T.B., Faulhaber, M., Angleman, S.B., Conneley, S., Bauer, D.C., Kuller, L.H., Newman, A.B. and Guralnik, J.M. (2007) Racial variation in the relationship of anemia with mortality and mobility disability among older adults. Blood, 109, 4663-4670.
http://dx.doi.org/10.1182/blood-2006-10-055384
[34] Zakai, N.A., McClure, L.A., Prineas, R., Howard, G., McClellan, W., Holmes, C.E., Newsome, B.B., Warnock, D.G., Audhya, P. and Cushman, M. (2009) Correlates of anemia in American blacks and whites. American Journal of Epidemiology, 169, 355-364.
http://dx.doi.org/10.1093/aje/kwn355
[35] Allen, A.D. (1989) The realities of tobacco addiction. Journal of Clinical Psychiatry, 50, 148.
[36] Allen, A.D. (2012) State of the art in cardiac intervention: A case report. International Journal of Clinical Medicine, 3, 628-632. http://dx.doi.org/10.4236/ijcm.2012.37112
[37] González, Z.M., Barrasa, A.G., Lorenzo, L.R. and Renua, A.R. (2009) Hierro intravenoso (intravenous iron). Cirugia Espanola, 86, 196-203.
http://dx.doi.org/10.1016/j.ciresp.2009.05.012
[38] Leitgeb, C., Pecherstorfer, M., Fritz, E. and Ludwig, H. (1994) Quality of life in chronic anemia of cancer during treatment with recombinant human erythropoietin. Cancer, 73, 2532-2542
[39] Cella, D. (1997) The functional assessment of cancer therapy-anemia (FACT-An) scale: A new tool for the assessment of outcomes in cancer anemia and fatigue. Seminars in Hematology, 34, 13-19.
[40] Yellen, S.B., Cella, D.F., Webster, K., Blendowski, C. and Kaplan, E. (1997) Measuring fatigue and other anemiarelated symptoms with the functional assessment of cancer therapy (FACT) measurement system. Journal of Pain and Symptom Management, 13, 63-74
http://dx.doi.org/10.1016/S0885-3924(96)00274-6
[41] Ludwig, H. and Fritz, E. (1998) Anemia in cancer patients. Seminars in Oncology, 25, 2-6.
[42] Cella, D. (1998) Factors influencing quality of life in cancer patients: Anemia and fatigue. Seminars in Oncology, 25, 43-46.
[43] Caro, J.J., Salas, M., Ward, A. and Goss, G. (2001) Anemia as an independent prognostic factor for survival in patients with cancer. Cancer, 91, 2214-2221.
http://dx.doi.org/10.1002/1097-0142(20010615)91:12<2214::AID-CNCR1251>3.0.CO;2-P
[44] Knight, K., Wade, S. and Balducci, L. (2004) Prevalence and outcome of anemia in cancer: A systematic review of the literature. The American Journal of Medicine, 116, 11-26. http://dx.doi.org/10.1016/j.amjmed.2003.12.008
[45] Hecht, D. and Boujoukos, A. (2010) Anemia in the ICU: Are your patients needin’ erythropoetin? Critical Care, 14, 332.
[46] Halstenson, C.E., Macres, M., Katz, S.A., Schnieders, J.R., Watanabe, M., Sobota, J.T. and Abraham, P.A. (1991) Comparative pharmacokinetics and pharmacodynamics of epoetin alfa and epoetin beta. Clinical Pharmacology and Therapeutics, 50, 702-712.
http://dx.doi.org/10.1038/clpt.1991.210
[47] MacDougall, I.C., Gray, S.J., Elston, O., Breen, C., Jenkins, B., Browne, J. and Egrie, J. (1999) Pharmacokinetics of novel erythropoiesis stimulating protein compared with epoetin alfa in dialysis patients. Journal of the American Society of Nephrology, 10, 2392-2395.

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.