Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA.
Clin Geriatr Med. 2011 Feb;27(1):67-78. doi: 10.1016/j.cger.2010.08.005.
Although anemia is regarded as a relatively common occurrence in older adults, the vigor with which the medical community should intervene to correct this common problem is disputed. Epidemiologic data clearly correlate anemia with functional decline, disability, and mortality. Anemia may contribute to functional decline by restricting oxygen delivery to muscle, or to cognitive decline by restricting oxygen delivery to the brain. On the other hand, the erythron may be a separate target of the same biologic mediators that influence deterioration of physiologic systems that contribute to weakness, functional and cognitive decline, and mortality. Clinical trials aimed at treating anemia in older adults could assess whether physical performance is improved or whether mortality risk declines with improved hemoglobin, but sufficient evidence from such trials is currently lacking. With few guidelines regarding treatment of older adults and significant risk for adverse events associated with transfusion and erythroid stimulating agents, anemia often goes untreated or ignored in geriatric clinics. This article reviews the problem of anemia in older adults, with a particular emphasis on the frail elderly. The gaps in the evidence base for the treatment of anemia in older adults are reviewed and the options for advancing the field are assessed.
尽管贫血在老年人中被认为是一种相对常见的疾病，但医学界应该积极干预以纠正这一常见问题的程度仍存在争议。流行病学数据清楚地表明，贫血与功能下降、残疾和死亡相关。贫血可能通过限制肌肉供氧导致功能下降，或者通过限制大脑供氧导致认知能力下降。另一方面，红细胞可能是影响导致虚弱、功能和认知能力下降以及死亡的生理系统恶化的相同生物学介质的另一个靶点。旨在治疗老年贫血的临床试验可以评估血红蛋白改善是否能提高身体机能，或者是否能降低死亡率，但目前此类试验的证据还不够充分。由于针对老年人的治疗指南很少，而且输血和红细胞刺激剂相关的不良事件风险很大，因此贫血在老年科诊所中经常未得到治疗或被忽视。本文特别关注体弱老年人，综述了老年人贫血问题。本文还回顾了老年人贫血治疗的证据基础中的空白，并评估了推进该领域的选择。
