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Anemia, a common clinical syndrome in older adults, has been the focus of renewed attention over the last decade, as attested by the increasing number of publications addressing its clinical epidemiology. Anemia in older persons tends to be multifactorial in origin, and is often associated with a combination of chronic medical conditions. The clinical presentation of anemia in older adults is complex, and symptoms are often insidious and nonspecific. Unless severe, anemia it is often perceived as a relatively benign condition that is either a normal accompaniment to aging and/or merely a marker of prevalent chronic diseases. However, data gathered to date have established that this maybe an incorrect perception. Consistently, several studies have shown that anemia, even if mild, is a strong, independent, risk factor for major adverse outcomes in older adults, including decline in physical and cognitive function, frailty, disability, and mortality. Aside from its prognostic implication, it has been hypothesized that even nonsevere anemia could causally contribute to the occurrence of these adverse outcomes, and that anemia correction could potentially lead to improved outcomes in older adults. These hypotheses remain to be proven. Future studies, including large randomized clinical trials (RCTs), are expected to contribute key insight as to whether correction of anemia that is nonsevere in the broad older population could prevent additional morbidity and/or mortality. In this context, aiming to summarize valuable information for the health professional involved with the care of older adults, this chapter presents basic information on a number of relevant issues related to the topic of anemia in older adults, including insight regarding prevalence, associations with major adverse clinical outcomes, and potential intervention opportunities.

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Conceptually, anemia is a clinical syndrome caused by a reduced mass of circulating red blood cells (RBCs). In practice, anemia is often operationally defined as a decreased level in any of the following parameters: the concentration of hemoglobin (Hb) in the whole blood; the proportion occupied by RBCs in a sample of whole blood—that is, hematocrit (Hct); and/or the number of RBCs in a standardized volume of whole blood. Often, Hb is expressed as g/dL, Hct as %, and RBC count as the number of RBCs in millions per microliter. Consistent with the literature, we will use Hb as the key parameter to define anemia in this chapter.

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A widely used standard to define anemia in older adults is the one usually referred to as the World Health Organization (WHO) criteria, published in the 1968 WHO report on nutritional anemias. According to this criteria, anemia is defined as a Hb less than 12 g/dL in older women, and less than 13 g/dL in older men. This gender difference is primarily because of the differences in the distributions of Hb in older men and women. These criteria are the same as proposed earlier (1933) by Wintrobe. Lower Hb cutoffs have also been proposed for anemia definition in older adults, under the nonempirical argument that the concentration of Hb is ...

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