Aging Clinical and Experimental Research

, Volume 28, Issue 5, pp 857–862 | Cite as

Prevalence of anemia and malnutrition and their association in elderly nursing home residents

  • Sevnaz Sahin
  • Pinar Tosun TasarEmail author
  • Hatice Simsek
  • Zeynep Çicek
  • Hulya Eskiizmirli
  • Fisun Senuzun Aykar
  • Fahri Sahin
  • Fehmi Akcicek
Original Article



Malnutrition is one of the most important geriatric syndromes in the elderly. The aim of this study was to investigate the association between anemia and malnutrition in elderly nursing home residents.

Materials and methods

Local nursing home residents over 60 years old in the Izmir were included in the study. Blood samples were taken from study participants for hemogram, iron, ferritin, total iron-binding capacity, vitamin B12 and folic acid analysis. WHO criteria were used to define anemia. Causes of anemia were classified as iron deficiency, vitamin B12 or folic acid deficiency, anemia of chronic disease or other hematologic causes. Anemia was defined as the dependent variable and malnutrition was defined as the independent variable. Correlation between MNA scores and Hb levels was determined using Pearson correlation analysis. The slope of causality between malnutrition and anemia was determined using the χ 2 test and logistic regression analysis.


The study included 257 elderly nursing home residents with a mean age of 78.5 ± 7.8 years. The overall prevalence of anemia was 54.9 %; 35.8 % of the study participants were at risk of malnutrition and 8.2 % were malnourished. Anemia risk was 2.12-fold higher in participants at risk of malnutrition and 5.05-fold higher in those with malnutrition. In the participants with malnutrition or malnutrition risk, the most common cause of anemia was anemia of chronic disease (57.1 and 46.5 %, respectively).


The prevalence of anemia among elderly nursing home residents is high in Turkey. Malnutrition and malnutrition risk increase the incidence of anemia.


Anemia Malnutrition Elderly Geriatrics 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/ or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

During the study, all participants signed a written informed consent form.


  1. 1.
    Beghe C, Wilson A, Ershler WB (2004) Prevalence and outcomes of anemia in geriatrics: a systematic review of the literature. Am J Med 116(Suppl 7A):3S–10SCrossRefPubMedGoogle Scholar
  2. 2.
    Bross MH, Soch K, Smith-Knuppel T (2010) Anemia in older persons. Am Fam Physician 82:480–487PubMedGoogle Scholar
  3. 3.
    Chaves PH et al (2002) Looking at the relationship between hemoglobin concentration and prevalent mobility difficulty in older women. Should the criteria currently used to define anemia in older people be reevaluated? J Am Geriatr Soc 50:1257–1264CrossRefPubMedGoogle Scholar
  4. 4.
    Thein M et al (2009) Diminished quality of life and physical function in community-dwelling elderly with anemia. Med (Baltimore) 88:107–114CrossRefGoogle Scholar
  5. 5.
    Reynish W, Vellas BJ (2001) Nutritional assessment: a simple step forward. Age Ageing 30:115–116CrossRefPubMedGoogle Scholar
  6. 6.
    Dorner B et al (2002) Position of the American Dietetic Association: liberalized diets for older adults in long-term care. J Am Diet Assoc 102:1316–1323CrossRefPubMedGoogle Scholar
  7. 7.
    Crogan NL, Pasvogel A (2003) The influence of protein-calorie malnutrition on quality of life in nursing homes. J Gerontol A Biol Sci Med Sci 58:159–164CrossRefPubMedGoogle Scholar
  8. 8.
    Thomas DR et al (2000) Nutritional management in long-term care: development of a clinical guideline. Council for nutritional strategies in long-term care. J Gerontol A Biol Sci Med Sci 55:M725–M734CrossRefPubMedGoogle Scholar
  9. 9.
    Anticona C, San Sebastian M (2014) Anemia and malnutrition in indigenous children and adolescents of the Peruvian Amazon in a context of lead exposure: a cross-sectional study. Glob Health Action 7:22888PubMedGoogle Scholar
  10. 10.
    Rothschild MA, Oratz M, Schreiber SS (1972) Albumin synthesis. 1. N Engl J Med 286:748–757CrossRefPubMedGoogle Scholar
  11. 11.
    Mitrache C et al (2001) Anemia: an indicator for malnutrition in the elderly. Ann Hematol 80:295–298CrossRefPubMedGoogle Scholar
  12. 12.
    Guigoz Y, Vellas B, Garry PJ (1996) Assessing the nutritional status of the elderly: the mini nutritional assessment as part of the geriatric evaluation. Nutr Rev 54(1 Pt 2):S59–S65PubMedGoogle Scholar
  13. 13.
    Guyatt GH et al (1990) Diagnosis of iron-deficiency anemia in the elderly. Am J Med 88:205–209CrossRefPubMedGoogle Scholar
  14. 14.
    Couderc AL et al (2015) Cobalamin deficiency in the elderly: aetiology and management: a study of 125 patients in a geriatric hospital. J Nutr Health Aging 19:234–239CrossRefPubMedGoogle Scholar
  15. 15.
    Andrews NC (2004) Anemia of inflammation: the cytokine-hepcidin link. J Clin Invest 113:1251–1253CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Callera F et al (2015) Prevalence of anemia in a sample of elderly southeastern Brazilians. Rev Bras Hematol Hemoter 37:43–47CrossRefPubMedGoogle Scholar
  17. 17.
    Tettamanti M et al (2010) Prevalence, incidence and types of mild anemia in the elderly: the “Health and Anemia” population-based study. Haematologica 95:1849–1856CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Guralnik JM et al (2004) Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. Blood 104:2263–2268CrossRefPubMedGoogle Scholar
  19. 19.
    Eisele L et al (2013) Prevalence and incidence of anemia in the German Heinz Nixdorf Recall Study. Ann Hematol 92:731–737CrossRefPubMedGoogle Scholar
  20. 20.
    Yildirim T et al (2015) The prevalence of anemia, iron, vitamin B12, and folic acid deficiencies in community dwelling elderly in Ankara, Turkey. Arch Gerontol Geriatr 60:344–348CrossRefPubMedGoogle Scholar
  21. 21.
    Nakashima AT et al (2012) Anemia prevalence and its determinants in Brazilian institutionalized elderly. Nutrition 28:640–643CrossRefPubMedGoogle Scholar
  22. 22.
    Reardon G, Pandya N, Bailey RA (2012) Falls in nursing home residents receiving pharmacotherapy for anemia. Clin Interv Aging 7:397–407CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Landi F et al (2007) Anemia status, hemoglobin concentration, and mortality in nursing home older residents. J Am Med Dir Assoc 8:322–327CrossRefPubMedGoogle Scholar
  24. 24.
    Vanasse GJ, Berliner N (2010) Anemia in elderly patients: an emerging problem for the 21st century. Hematol Am Soc Hematol Educ Program 2010:271–275Google Scholar
  25. 25.
    Corona LP, Duarte YA, Lebrao ML (2014) Prevalence of anemia and associated factors in older adults: evidence from the SABE Study. Rev Saude Publica 48:431–723CrossRefGoogle Scholar
  26. 26.
    Bhasin S, Buckwalter JG (2001) Testosterone supplementation in older men: a rational idea whose time has not yet come. J Androl 22:718–731PubMedGoogle Scholar
  27. 27.
    Marin GH et al (2008) Population study of the prevalence of anaemia in the adult population of Buenos Aires, Argentina. Aten Primaria 40:133–138CrossRefPubMedGoogle Scholar
  28. 28.
    Guralnik JM et al (2005) Anemia in the elderly: a public health crisis in hematology. Hematol Am Soc Hematol Educ Program 2005:528–532Google Scholar
  29. 29.
    van Houwelingen AH et al (2013) Predictive value of a profile of routine blood measurements on mortality in older persons in the general population: the Leiden 85-plus Study. PLoS One 8:e58050CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Pasina L et al (2011) Prevalence and appropriateness of drug prescriptions for peptic ulcer and gastro-esophageal reflux disease in a cohort of hospitalized elderly. Eur J Intern Med 22:205–210CrossRefPubMedGoogle Scholar
  31. 31.
    Artz AS, Thirman MJ (2011) Unexplained anemia predominates despite an intensive evaluation in a racially diverse cohort of older adults from a referral anemia clinic. J Gerontol A Biol Sci Med Sci 66:925–932CrossRefPubMedGoogle Scholar
  32. 32.
    Ferrucci L et al (2010) Proinflammatory state, hepcidin, and anemia in older persons. Blood 115:3810–3816CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Bach V et al (2014) Prevalence and possible causes of anemia in the elderly: a cross-sectional analysis of a large European university hospital cohort. Clin Interv Aging 9:1187–1196PubMedPubMedCentralGoogle Scholar
  34. 34.
    Weiss G, Goodnough LT (2005) Anemia of chronic disease. N Engl J Med 352:1011–1023CrossRefPubMedGoogle Scholar
  35. 35.
    McIntyre AS, Long RG (1993) Prospective survey of investigations in outpatients referred with iron deficiency anaemia. Gut 34:1102–1107CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Retzlaff JA, Hagedorn AB, Bartholomew LG (1961) Abdominal exploration for gastrointestinal bleeding of obscure origin. JAMA 177:104–107CrossRefPubMedGoogle Scholar
  37. 37.
    Coban E, Timuragaoglu A, Meric M (2003) Iron deficiency anemia in the elderly: prevalence and endoscopic evaluation of the gastrointestinal tract in outpatients. Acta Haematol 110:25–28CrossRefPubMedGoogle Scholar
  38. 38.
    Cankurtaran M, Saka B, Sahin S et al (2013) Turkish nursing homes and care homes nutritional status assessment project (THN-malnutrition). European Geriatr Med 4:329–334CrossRefGoogle Scholar
  39. 39.
    Joosten E et al (1992) Prevalence and causes of anaemia in a geriatric hospitalized population. Gerontology 38:111–117CrossRefPubMedGoogle Scholar
  40. 40.
    Beloosesky Y et al (2000) Prevalence and survival of myelodysplastic syndrome of the refractory anemia type in hospitalized cognitively different geriatric patients. Gerontology 46:323–327CrossRefPubMedGoogle Scholar
  41. 41.
    Baik HW, Russell RM (1999) Vitamin B12 deficiency in the elderly. Annu Rev Nutr 19:357–377CrossRefPubMedGoogle Scholar
  42. 42.
    Carmel R (2000) Current concepts in cobalamin deficiency. Annu Rev Med 51:357–375CrossRefPubMedGoogle Scholar
  43. 43.
    Clarke R et al (2004) Vitamin B12 and folate deficiency in later life. Age Ageing 33:34–41CrossRefPubMedGoogle Scholar
  44. 44.
    Loikas S et al (2007) Vitamin B12 deficiency in the aged: a population-based study. Age Ageing 36:177–183CrossRefPubMedGoogle Scholar
  45. 45.
    Lindenbaum J et al (1994) Prevalence of cobalamin deficiency in the Framingham elderly population. Am J Clin Nutr 60:2–11PubMedGoogle Scholar
  46. 46.
    Petrosyan I et al (2012) Anaemia in the elderly: an aetiologic profile of a prospective cohort of 95 hospitalised patients. Eur J Intern Med 23:524–528CrossRefPubMedGoogle Scholar
  47. 47.
    Carmel R et al (2003) Update on cobalamin, folate, and homocysteine. Hematol Am Soc Hematol Educ Program 2003:62–81Google Scholar
  48. 48.
    Yildizhan E, Aydin Y, Coskun H et al (2014) The prevalence and characteristics of anemia in geriatrics in the west black Sea Region, Turkey. Turkisj J Geriatr 17:63–69Google Scholar
  49. 49.
    Borgstrom Bolmsjo B et al (2015) The nutritional situation in Swedish nursing homes—a longitudinal study. Arch Gerontol Geriatr 60:128–133CrossRefPubMedGoogle Scholar
  50. 50.
    Thakur N et al (2014) Anemia in severe acute malnutrition. Nutrition 30:440–442CrossRefPubMedGoogle Scholar
  51. 51.
    Cavalcanti DM et al (2007) Endogenous glucocorticoids control neutrophil mobilization from bone marrow to blood and tissues in non-inflammatory conditions. Br J Pharmacol 152:1291–1300CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Division of Geriatrics, Department of Internal MedicineEge University HospitalIzmirTurkey
  2. 2.Department of HealthcareDokuz Eylul University HospitalIzmirTurkey
  3. 3.Department of Nursing, School of Health SciencesIstanbul Arel UniversityIstanbulTurkey
  4. 4.Department of Internal MedicineEge University HospitalIzmirTurkey
  5. 5.Faculty of NursingEge University HospitalIzmirTurkey
  6. 6.Division of Hematology, Department of Internal MedicineEge University HospitalIzmirTurkey

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