International Journal of Nutrition, Pharmacology, Neurological Diseases

ORIGINAL ARTICLE
Year
: 2016  |  Volume : 6  |  Issue : 1  |  Page : 23--27

Assessment of prevalence of anemia in and its correlates among community-dwelling elderly of Assam, India: A cross-sectional study


Rashmi Agarwalla1, Anku Moni Saikia2, Mamta Parashar1, Rambha Pathak1, Farzana Islam1,  
1 Department of Community Medicine, Hamdard Institute of Medical Sciences and Research, New Delhi, India
2 Department of Community Medicine, Gauhati Medical College, Guwahati, Assam, India

Correspondence Address:
Rashmi Agarwalla
Department of Community Medicine, Hamdard Institute of Medical Sciences and Research, New Delhi - 110 062
India

Abstract

Background: Anemia in the elderly can have tremendous impact on their health and functionality. Many a time, anemia in the elderly is overlooked and due priority is not given regarding its causes and impact. Objectives: The present study was conducted to assess the prevalence of anemia in the elderly and study the various correlates associated with it. Materials and Methods: This cross-sectional study was conducted from December 2011 to May 2012 in Boko-Bongaon block, Kamrup District, Assam, India. A total of 30 clusters were selected and 11 elderly from each cluster were taken to get the desired sample size of 330. Hemoglobin estimation was performed to assess the presence of anemia. Results: Prevalence of anemia was 45.5% in the present study. Elderly with severe anemia constituted 15.3%. The associations of anemia with age, gender, calorie intake, type of diet, iron supplementation, and worm infestation were found to be significant. Conclusion: Further in-depth studies are needed regarding the causes of anemia and the role of nutritional prophylaxis. The provisions for adequate health care measures and services to combat anemia in the elderly is needed for timely action.



How to cite this article:
Agarwalla R, Saikia AM, Parashar M, Pathak R, Islam F. Assessment of prevalence of anemia in and its correlates among community-dwelling elderly of Assam, India: A cross-sectional study.Int J Nutr Pharmacol Neurol Dis 2016;6:23-27


How to cite this URL:
Agarwalla R, Saikia AM, Parashar M, Pathak R, Islam F. Assessment of prevalence of anemia in and its correlates among community-dwelling elderly of Assam, India: A cross-sectional study. Int J Nutr Pharmacol Neurol Dis [serial online] 2016 [cited 2020 Sep 30 ];6:23-27
Available from: http://www.ijnpnd.com/text.asp?2016/6/1/23/173788


Full Text

 Introduction



The elderly population is growing rapidly in both developed and developing countries. The health of the elderly is compounded by problems such as malnutrition, communicable diseases, and noncommunicable diseases. Anemia is an important determinant of nutritional status. Anemia is a common problem with serious consequences in older persons. Anemia in older persons is commonly overlooked despite mounting evidence that low hemoglobin levels are a significant marker of physiologic decline.[1]

It is easy to overlook anemia in the elderly since symptoms such as fatigue, weakness, and shortness of breath may be attributed to the aging process itself. However, the decline of hemoglobin and concomitant increased degree of anemia with age is not necessarily a result of normal ageing.[2]

The epidemiology of anemia and aging, in general, is particularly challenging because of increased heterogeneity in the distribution of social and biological risk factors with advancing age. Given that anemia is a multifactorial condition, the increased comorbidity in older adults makes it difficult to establish whether anemia is a marker of disease burden or a mediator in the causal pathway leading to adverse events.[3]

More than two-third of anemia cases in the elderly can be attributed to two major causes: (1) Nutritional deficiencies and (2) anemia of chronic diseases.[4] Although many anemic elderly patients can be diagnosed with nutritional deficiency, anemia of chronic inflammation, or comorbid diseases that explain their decreased hematocrit, the etiology of anemia in a significant fraction remains obscure.[5]

Elderly morbidity and malnutrition are posing a challenge to both caregivers and the health sector. Early detection of anemia will reduce the burden and help in effective policy-making and thereby will help in planning appropriate interventions.

While there are numerous studies conducted on anemia in other age groups, not many studies have been conducted to address the problem of anemia in the elderly. Most of the interventions have been targeted toward children and pregnant women. Considering these facts, the following study was undertaken with the objectives to assess the prevalence of anemia in the elderly and to study the various factors associated with it.

 Materials and Methods



This community-based cross-sectional study was conducted from December 2011 to May 2012 in Boko-Bongaon block of Kamrup district, Assam, India, which is a field practice area under the department of Community Medicine, Gauhati Medical College.

Inclusion criteria were the elderly above the age of 60 years of both the sexes who were included after obtaining written informed consent. The elderly who were seriously ill, the elderly living alone with severe hearing and speech impairment, and those who refused to participate were excluded.

A sample size of 313 was calculated by using the prevalence of 39%[6] with precision of 20% and a design effect of 2. The block consisted of 140 villages (Census 2001). Using a 30-cluster methodology, 30 villages were selected from the block and 11 elderly were selected from each village. Thus, a total sample of 330 elderly people was included in the study. A house-to-house visit was conducted and all the elderly who met the inclusion criteria in each household were considered. In obtaining the information from the elderly having hearing and speech impairment, information was verified with other responsible adult members involved with caregiving of the elderly.

A predesigned and pretested schedule was used for collecting information on the sociodemographic profile, financial status, functional status, dietary profile, and history of iron supplementation. Hemoglobin concentration was determined by Sahli&'s method. Anemia was categorized as per the World Health Organization (WHO) classification.[7] In the present study, functional dependency was measured by Katz Activities of Daily Living (ADL) scale.[8] On the basis of self-reporting, the elderly requiring help with one or more items of Katz ADL were assigned to the functionally dependent group. Elders who had one or other means of current income, which was sufficient for self-maintenance were considered to be financially independent.

Dietary survey was done by a 24-dietary recall method and adequacy of calorie intake was determined as recommended per kg body weight by Recommended Dietary Allowance (RDA) 2010 guidelines.[9] The elderly taking a vegetarian diet for the past 6 months or more were considered as vegetarians and vice versa.

Morbidity profile was assessed on the basis of history and medical records. The elderly taking iron supplements regularly for the past 1 month were considered in the iron intake category. A majority of the elderly who were taking supplementation were diagnosed with anemia before starting iron therapy. Some of the elderly were prophylactically taking iron for symptoms of fatigue and weakness.

The database was structured in Microsoft Office Excel 2007 and analyzed using Statistical Package for the Social Sciences (SPSS) software, version 11.5 Chicago, USA. To determine the correlates of anemia, the sample was categorized into two groups: Those who were anemic and those who were not anemic. Chi-square test was used to evaluate the associations among anemic and nonanemic and the sociodemographic, dietary and morbidity profile variables. The variables found to have a significant association on univariate analysis were further analyzed using logistic regression analyses to identify the predictors of anemia. The differences between the groups with and without anemia were analyzed. The strength of the association was calculated using a confidence interval of 95%.

Approval from the Institutional Ethics Committee was obtained before starting the study. Biochemical parameters of anemia including serum ferritin were not assessed. No attempt was made to see the types and causes of anemia.

 Results



Out of 330 elderly people, 150 (45.5%) were found to be anemic. Out of them, 15.33% were found to have severe anemia; the majority (61.33%) had mild anemia as per WHO grading. Severe anemia was more prevalent in males than females; however, the prevalence of mild to moderate anemia was more in females.

[Table 1] shows the association of sociodemographic and functional status with anemia. A significant association was found between gender, age group, and financial status. Significant association was also seen between calorie intake, type of diet, and iron supplementation [Table 2]. The elderly with a history of worm infestation and those with tuberculosis and cancer had a significant association with anemia [Table 3].{Table 1}{Table 2}{Table 3}

Logistic regression analysis was performed to assess the predictors of anemia. On analysis, the older age group, females, inadequate calorie intake, those not on iron supplementation, the elderly with worm infestation, and the elderly suffering from tuberculosis and cancer were found to have a significant association with anemia. Nagelkerke R value was found to be 0.64.

 Discussion



The prevalence of anemia was found to be 45.5% {95% confidence interval (CI) 42.7-48.5}. This finding was found to be in conformity with various studies.[10],[11],[12] However, this is just the tip of the iceberg and most of the cases may remain undetected in the community. The symptoms of anemia are attributed to be a part of the normal aging process most of the time. A considerably higher prevalence (68.2%) was reported by Sharma et al. in Chandigarh, India.[6]

Older age was found to be significantly associated with anemia. A similar finding was also revealed by various studies.[13],[14] It is thought that reductions in bone marrow erythroid precursors and decreased responsiveness of these precursors to stimulatory growth factors occurs with advanced age.[15] Other factors such as the inability to chew and loss of appetite with aging can be additive factors.

Females were found to be at a higher risk of anemia. Longer life span with functional and financial dependencies could be one of the reasons. Social norms and the status of women in society play a significant role in female nutritional status. A prevalence of 91.3% was found among rural Jat women in Haryana, India.[16] However, various studies revealed that the prevalence of anemia was found to be more in elderly males.[13],[14]

Financial dependency was found to be a significant risk factor. Financial independency does not only affect the purchasing power, per capita calorie availability, and health care utilization but also influences the role of the elderly in the family, which indirectly affects the nutritional status and hence, anemia.

Functional status did not show any significant association with anemia. Functional impairment can be a cause as well as impact of anemia. A study conducted by Elzen et al.[17] found that elderly who had anemia had more difficulties in carrying out activities of daily living. Various other conditions present in the elderly such as associated morbidities can act as confounders and further studies are needed to establish the effect of anemia on functional status and vice versa.

In the present study, anemia in the elderly taking inadequate calorie intake was more than that of the elderly taking adequate calorie intake. Nutritional status is a significant predictor of hemoglobin status.[18] Anemia in the elderly can be due to many causes and nutrition and type of diet significantly influence the status of anemia. A nonvegetarian diet was found to be protective. The quality of food in relation to iron content could not be assessed in the present study. Older people need to be educated on good sources of bioavailable iron and should be encouraged to consume food, which enhances iron absorption. Iron supplementation had a significant association with the status of anemia. The role of iron in anemia in the elderly needs to be evaluated well. Its role in improving the quality of life in the elderly needs to be given due importance. The finding raises an issue of whether iron prophylaxis should be considered in the elderly, which invites larger, extensive, and appropriately guided studies.

The elderly with worm infestation were more anemic. Mugisha et al. in their study conducted in Uganda found heavy worm infestation to be a major predictor for anemia.[14] Along with iron prophylaxis, deworming in the elderly needs to be given priority. The elderly with tuberculosis and cancer had a significant association with the status of anemia. The elderly having morbidity, which affects iron status, need to be assessed well in order to take timely and proper action.

 Conclusion



The study has shown that anemia is a major concern in this age group. More detailed and in-depth studies are needed for a proper understanding of the burden of the problem. This will become an evidence for the incorporation of screening for anemia as a component of comprehensive geriatric assessment. Strengthening of promotive, preventive, and rehabilitative services within the primary health care is crucial to add quality to the life of the elderly. Social security support needs to be ensured for financial independency. Considering the high prevalence of anemia in the present study, it is high time that the policymakers initiate interventions in this age group.

Acknowledgement

We would like to acknowledge Mrs. Anjana Moyee Saikia, Lecturer in Statistics, Department of Community Medicine, Gauhati Medical College for her kind help in statistical analysis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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