IM - ORIGINAL Anemia in elderly hospitalized patients: prevalence and clinical impact Margherita Migone De Amicis • Erika Poggiali • Irene Motta • Francesca Minonzio • Giovanna Fabio • Cinzia Hu • Maria Domenica Cappellini Received: 18 October 2014 / Accepted: 14 January 2015 Ó SIMI 2015 Abstract Anemia is a common finding in elderly indi- viduals. Several studies haveshown a strong relationship between anemia, morbidity and mortality, suggestingan- emia as a significant independent predictor of adverse outcome in elderlyhospitalized patients. The pathophisiol- ogy of anemia in the elderly is not yet completelyunder- stood. Several mechanisms are involved. Weinvestigated the prevalence of anemia in a cohort of 193 elderly patients admitted tothe Internal Medicine Ward of Ca’Granda Policlinico Hospital along 6 months, and itsrelationship to comorbidities and to the length of hospitalization. Anemia was classifiedaccording to the WHO criteria. The majority of patients (48 %) had a mildmoderate,normocytic anemia; severe anemia was found in 8 out of 92 anemicpatients. In a subgroup of patients erythropoietin was tested and resulted statisticallyhigher if compared to non-anemic controls (p = 0.003). Considering the most commoncause of anemia, nutritional deficiency, chronic renal disease and anemia of chronicdisease were found respectively in 36, 15 and 25 % of cases. Unexplained anemiawas diagnosed in 24 % of patients, according to the literature. Anemia wa- sindependently associated with increased length of hospital stay. Our studyconfirmed a high prevalence of anemia in elderly patients, and its association with ahigher number of comorbidities and a longer stay. A correct clinical approach toanemia in elderly hospitalized patients is essential, considering its negative impact onpatients’ quality of life, and its social burden in term of healthcare needs and costs. Keywords Anemia Á Elderly Á Hemoglobin Á Morbidity Á Mortality Á Hospitalization Introduction A mild degree of anemia is very common in the elderly population. It occurs in more than 10 % of individuals who are older than 65 years [1], increases rapidly with age, reaching more than 50 % in individuals older than 80 years of age [2]. The reason why the prevalence of anemia is so high in the elderly population is still not completely clear. Several large-scale epidemiological studies have been conducted to describe the prevalence and the impact of anemia in the elderly. The National Health and Nutrition Examination Survey III (NHANES III) study shows that in one-third of elderly anemic individuals, the cause of ane- mia is due to nutritional defects, mainly iron deficiency, whereas the other two-thirds are affected by ‘‘the anemia of chronic disease,’’ (ACD) and ‘‘unexplained anemia’’ [1]. Tettamanti et al. have recently demonstrated that the prevalence of anemia increases with the age, and that it is typically mild, with a prevalence of severe anemia lower than 0.5 % [2]. In the elderly population, anemia is asso- ciated with many diseases and conditions, such as malig- nancies, bone marrow failure, chronic kidney disease, chronic inflammatory diseases, congestive heart failure, nutritional deficiencies, and malnutrition [3]. Although M. Migone De Amicis (&) Á E. Poggiali Á I. Motta Á F. Minonzio Á G. Fabio Á C. Hu Á M. D. Cappellini Department of Internal Medicine, IRCCS Fondazione Ca’ Granda Ospedale Maggiore Policlinico, Universita ` degli Studi di Milano, Via F. Sforza 35, 20122 Milan, Italy e-mail: margherita.migone@gmail.com; margherita.migone@unimi.it E. Poggiali Á G. Fabio Á M. D. Cappellini Dipartimento di Scienze Cliniche e di Comunita `, Ca’ Granda Ospedale Maggiore Policlinico, Universita ` degli Studi di Milano, Milan, Italy 123 Intern Emerg Med DOI 10.1007/s11739-015-1197-5