Prevalence of Anemia among Community Dwelling Elderly in Dakahlia as a Representative of Rural Areas in Egypt and Its Impact on Their Functional Status


Background: Anemia is a common problem with serious consequences in older person but is often overlooked despite considerable evidence that low hemoglobin levels indicate physiologic decline in these patients. Multiple studies demonstrate that anemia is an independent risk factor for increased morbidity and mortality, and decreased quality of life in community-dwelling older persons. Increasing functional deterioration is associated with decreasing hemoglobin concentration in an inverse and linear manner. Aim: to assess the prevalence of anemia in free-living elderly subjects living in an urban community of Meet Abbad-Nabaroh, Dakahlia. Egypt and its impact on their functional level. Methodology: A cross-sectional study was done including 93 elderly ≥ 60 ys old, both males and females recruited from Meet Abbad-Nabaroh, Dakahlia, Egypt. All subjects underwent a complete medical history taking, clinical evaluation then blood hemoglobin level was measured, and anemia was defined according to the World Health Organization definition of anemia (hemoglobin level less than 13 g per dL [130 g per L] in men and less than 12 g per dL [120 g per L] in women). Results: The study revealed that the prevalence of anemia is 15.05% among the studied participants (14.5% among the male group and 16.1% among females), 14% had mild anemia and 1% had moderate anemia, with significant increase with age as there was significant difference (p = 0.042) between the different age groups of the studied participants, also history of blood loss and anemia showed positive significant correlation (p-value = 0.001), and highly significant correlations between intake of non steroidal anti inflammatory drugs (NSAID) and anemia (p-value = 0.000). The impact of anemia on functional status and risk of fall respectively showed significant difference between anemic and non anemic as regards instrumental activity of daily living (IADL) (p = 0.007), and timed up and go test (p-value = 0.01), also there is significant correlation between anemia and mini mental state examination (MMSE) (p-value 0.046) with worse performance among the anemic ones. Conclusion & Recommendation: anemia represents a health problem of significance among the community dwelling elderly with bad drawback on their functional level; their need for health & community services has a financial impact so this problem needs more assessment for better prevention and treatment.

Share and Cite:

Kamel, M. , Ebeid, S. , Elakkad, R. and Shafeek, N. (2015) Prevalence of Anemia among Community Dwelling Elderly in Dakahlia as a Representative of Rural Areas in Egypt and Its Impact on Their Functional Status. Advances in Aging Research, 4, 168-176. doi: 10.4236/aar.2015.45018.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Balducci, L. (2003) Epidemiology of Anemia in the Elderly: Information on Diagnostic Evaluation. Journal of the American Geriatrics Society, 51, S2-S9.
[2] Nissenson, A.R., Goodnough, L.T. and Dubois, R.W. (2003) Anemia, Not Just an Innocent Bystander? JAMA Internal Medicine, 162, 1400-1404.
[3] World Health Organization (1968) Nutritional Anemia. Report of a WHO Scientific Group. World Health Organ Tech Rep Ser. Vol. 405, 5-37.
[4] Ania, B.J., Suman, V.J., Fairbanks, V.F. and Melton III, L.J. (1994) Prevalence of Anemia in Medical Practice: Community versus Referral Patients. Mayo Clinic Proceedings, 69, 730-735.
[5] Ania, B.J., Suman, V.J., Fairbanks, V.F., Rademacher, D.M. and Melton III, L.J. (1997) Incidence of Anemia in Older People: An Epidemiology Study in a Well-Defined Population. Journal of the American Geriatrics Society, 45, 825-831.
[6] Smith, D.L. (2000) Anemia in Elderly. American Family Physician, 62, 1565-1572.
[7] Guralnik, J.M., Eisenstaedt, R.S., Ferrucci, L., 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, 2263-2268.
[8] Izaks, G.J., Westendorp, R.G. and Knook, D.L. (1999) The Definition of Anemia in Older Persons. The Journal of the American Medical Association, 281, 1714-1717.
[9] Charlton, K.E., Kruger, M., Labadarios, D., Wolmarans, P. and Aronson, I. (1997) Iron, Folate and Vitamin B12 Status of an Elderly South African Population. European Journal of Clinical Nutrition, 51, 424-430.
[10] Ross, S.D., Fahrbach, K., Frame, D., et al. (2003) The Effect of Anemia Treatment on Selected Health-Related Quality-of-Life Domains: A Systematic Review. Clinical Therapies, 25, 1786-1805.
[11] Chaves, P.H., Carlson, M.C., Ferrucci, L., Guralnik, J.M., Semba, R. and Fried, L.P. (2006) Association between Mild Anemia and Executive Function Impairment in Community-Dwelling Older Women: The Women’s Health and Aging Study II. Journal of the American Geriatrics Society, 54, 1429-1435.
[12] Penninx, B.W., Guralnik, J.M., Onder, G., Ferrucci, L., Wallace, R.B. and Pahor, M. (2004) Anemia and Decline in Physical Performance among Older Persons. American Journal of Medicine, 115, 104-110.
[13] Terekeci, H.M., Kucukardali, Y., Onem, Y., Erikci, A.A., Kucukardali, B., Sahan, B., et al. (2010) Relationship between Anaemia and Cognitive Functions in Elderly People. European Journal of Internal Medicine, 21, 87-90.
[14] Kim, H.-S. and Lee, B.-K. (2008) Cross-Sectional Study on the Prevalence of Anemia among Rural Elderly in Asan. Nutrition Research and Practice, 2, 8-12.
[15] CAPMAS, Central Agency for Public Mobilization and Statistics, Egypt, 2006.
[16] Folstein, M.F., Folstein, S.E. and McHugh, P.R. (1975) “Mini-Mental State”. A Practical Method for Grading the Cognitive State of Patients for the Clinician. Journal of Psychiatric Research, 12, 189-198.
[17] El Okl, M.A. (2002) Prevalence of Alzheimer Dementia and Other Causes of Dementia in Egyptian Elderly. Master’s Thesis, Faculty of Medicine, Ain Shams University, Cairo.
[18] Sheikh, J.I. and Yesavage, J.A. (1986) Geriatric Depression Scale (GDS): Recent Evidence and Development of a Shorter Version. Clinical Gerontology: A Guide to Assessment and Intervention, 5, 165-173.
[19] Shehata, A.S. (1998) Prevalence of Depression among Egyptian Geriatric Community. Master’s Thesis, Faculty of Medicine, Ain Shams University, Cairo.
[20] Katz, S., Ford, A.B., Moswowitz, R.W., Jackson, B.A. and Jaffe, M.W. (1963) Studies of Illness in the Aged. The Index of ADL: Standardized Measure of Biological and Psychological Function. Journal of the American Medical Association, 185, 914-919.
[21] Lawton, M.P. and Brody, E.M. (1969) Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily Living. Gerontologist, 9, 179-186.
[22] Podsiadlo, D. and Richardson, S. (1991) The Timed “Up and Go” Test: A Test of Basic Functional Mobility for Frail Elderly Persons. Journal of American Geriatric Society, 39, 142-148.
[23] Vellas, B., Villars, H., Abellan, G., Soto, M.E., Rolland, Y., Guigoz, Y., et al. (2006) Overview of MNA—Its History and Challenges. The Journal of Nutrition Health and Aging, 10, 456-465.
[24] Linegar, A.G., Knottenbelt, J.D. and Wormald, P.J. (1991) Accuracy of a Portable Haemoglobinometer in Clinical Practice. South African Medical Journal, 79, 547-548.
[25] Mortagy, A.K., Farid, T.M. and El Rahman, O.A. (2008) Prevalence of Anemia among Elders Attending Elderly Clubs in Cairo. Master’s Thesis, Faculty of medicine, Ain Shams University, Cairo.
[26] Yamada, M., Wong, F.L. and Suzuki, G. (2003) Longitudinal Trends of Hemoglobin Levels in a Japanese Population—RERF’s Adult Health Study Subjects. European Journal of Haematology, 70, 129-135.
[27] Hayashi, F., Yoshiike, N., Yoshita, K. and Kawahara, K. (2008) Trends in the Prevalence of Anaemia in Japanese Adult Women, 1989-2003. Public Health Nutrition, 11, 252-257.
[28] Wang, J.-L. and Shaw, N.-S. (2005) Iron Status of the Taiwanese Elderly: The Prevalence of Iron Deficiency and Elevated Iron Stores. Asia Pacific Journal of Clinical Nutrition, 14, 278-284.
[29] Ferrucci, L., Guralnik, J.M., Bandinelli, S., Semba, R.D., Lauretani, F., Corsi, A., et al. (2007) Unexplained Anemia in Older Persons Is Characterised by Low Erythropoietin and Low Levels of Pro-Inflammatory Markers. British Journal of Haematology, 136, 849-855.
[30] Tettamanti, M., Lucca, U., Gandini, F., Recchia, A., Mosconi, P., Apolone, G., et al. (2010) Prevalence, Incidence and Types of Mild Anemia in the Elderly: The Health and Anemia Population Based Study. Haematologica, 95, 1849-1856.
[31] Choi, C.W., Kim, B.S., Yoon, S.Y., et al. (2001) Prevalence and Characteristics of Anemia in the Elderly: Community-Based Study. Blood, 98, 412b.
[32] Fleming, D.J., Jacques, P.F., Tucker, K.L., Massaro, J.M., D’Agostino, R.B., Wilson, P.W. and Wood, R.J. (2001) Iron Status of the Free-Living, Elderly Framingham Heart Study Cohort: An Iron-Replete Population with a High Prevalence of Elevated Iron Stores. The American Journal of Clinical Nutrition, 73, 638-646.
[33] Bhasin, S., Woodhouse, L., Casaburi, R., Singh, A.B., Bhasin, D., Berman, N., et al. (2001) Testosterone Dose-Response Relationships in Healthy Young Men. Endocrinology and Metabolism—American Journal of Physiology, 281, E1172-E1181.
[34] Niv, E., Elis, A., Zissin, R., Naftali, T., Novis, B. and Lishner, M. (2005) Iron Deficiency Anemia in Patients without Gastrointestinal Symptoms—A Prospective Study. Family Practice, 22, 58-61.
[35] Smith, D.L. (2000) Anemia in Elderly. American Family Physician, 62, 1565-1572.
[36] Gordon, S.R., Smith, R.E. and Power, G.C. (1994) The Role of Endoscopy in the Evaluation of Iron Deficiency Anemia in Patients over the Age of 50. American Journal of Gastroenterology, 89, 1963-1967.
[37] Denny, S.D., Kuchibhatla, M.N. and Cohen, H.J. (2006) Impact of Anemia on Mortality, Cognition, and Function in Community-Dwelling Elderly. The American Journal of Medicine, 119, 327-334.
[38] Andro, M., Le Squere, P., Estivin, S. and Gentric, A. (2013) Anaemia and Cognitive Performances in the Elderly: A Systematic Review. European Journal Neurology, 20, 1234-1240.

Copyright © 2022 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.