Under Documentation of Anemia in Older Adults in Primary Care Practices
Authors: Hwang Min Woo , Chaudhary Hirra A , Ershler William B 
Published: December 2024

Introduction: Anemia is prevalent in adults over the age 65 years, and its occurrence increases with age. The common causes of anemia in this population include nutrient deficiencies, acute or chronic inflammation and unexplained anemia of aging. Anemia in older adults is associated with poorer quality of life, decreased function, falls, fractures, hospitalization, long-term care placement and higher mortality. It was our hypothesis that despite these well documented adverse consequences anemia is under recognized in the primary care setting.

Methods: This retrospective study evaluated patients aged 65 and older who were followed at internal medicine primary care clinics throughout northern Virginia over a one-year period from January to December 2023. The study population was identified using a slicer dicer program from the electronic health record, filtering for patients aged 65 and older who had a Medicare annual wellness exam in 2023. For this analysis, the study population was limited to approximately 1,500 patients, and chart reviews were performed on these patients. The World Health Organization's (WHO) definition of anemia, which specifies hemoglobin levels below 12 g/dL in women and below 13 g/dL in men, was used as the study definition for anemia. Any hemoglobin levels from 2022 to 2024 that met this definition was identified to have anemia. The primary objective was to identify the percentage of anemia cases correctly recognized and documented as a problem on the patients' problem list.

Results: Out of the 1525 randomly-selected from a broad network of primary care internal medicine practices, there were 643 males and 882 females, and the age group breakdown was 724 patients aged 65 to 74, 629 patients aged 75 to 84, and 172 patients aged 85 and older. From this study population, 310 patients were identified to have anemia. The breakdown of the anemia patients were 154 males and 156 females, and the age group was 113 patients aged 65 to 74, 127 patients aged 75 to 84, and 70 patients aged 85 and older. The prevalence of anemia was 24% for males and 18% for females. For the age groups, the prevalence was 16% for aged 65 to 74, 20% for aged 75 to 84, and 40% for aged 85 and older.

Out of the 310 patients with anemia, only 103 patients had anemia listed on the problem list. This indicates that only 33% of anemic patients had anemia correctly documented, while 67% did not. There were no significant differences in the recognition of anemia between sex and age groups. Anemia was correctly noted as a problem in 48 males (31%) and 55 females (35%). Additionally, anemia was correctly identified in 35 patients (31%) aged 65 to 74, 43 patients (34%) aged 75 to 84, and 25 patients (36%) aged 85 and older.

Conclusions: There is a significant under-recognition of anemia in the geriatric population at the primary care setting. The rates of under-recognition are comparable between sexes and across different age groups. However, anemia has been found to be more prevalent in females and with increased age. This unaddressed anemia likely contributes to a chronic decline in function and quality of life, particularly in the frailer and more vulnerable population. Increased awareness and appropriate management of anemia in primary care settings can help prevent its associated negative effects.