II.

Summary of the Article

Among the elderly clients, one of the important diseases often found in the clinical
practice of hematological disorders is Anemia. This disease according to WHO criteria is
defined as a haemoglobin level of 13g/dl or lower for men and 12g/dl or lower for women.
However, in the elderly, organ function declines with age should de taken into account.

In terms of frequency, iron deficiency anemia and secondary anemia are high, and the
underlying malignant tumor is not rare. There are many causes of anemia, so is important to
determine if it is explained by physiologic changes or if there is an underlying disease such as
infectious diseases, bone fracture, rheumatoid arthritis, renal diseases and other conditions that
the treatment of which can improve the anemia.

There are variety of symptoms with anemic patients, these include: facial pallor,
orthostatic hypotension, or edema resulting from the decreased RBC, fatigability, malaise,
headache, vertigo, syncope, tinnitus, or chest pain due to insufficient oxygen supply, palpitations
or shortness of breath by compensatory mechanism and even hemoglobin levels of 9-10g/dl as a
result of aging may result to severe anemic symptoms.

There are consideration in differential diagnosis of anemia in the elderly such as

important past histories including gastrointestinal disease concerning to the presence or absence
of ulcers, benign tumor, malignant tumor, hemorrhoids, hepatitis, and liver cirrhosis; collagen
disease, chronic infectious disease such as tuberculosis, endocrine disease(thyroid dysfunction),
renal disease, and genitourinary disease. A history of gastrectomy or duodectomy is also
important to be considered the possibility if iron deficiency anemia or vitamin B12 deficiency
anemia. Consider examination of family history of jaundice, anemia, gallstones, and
splenectomy.

Life history taking is also important. Unbalanced diets particularly low intake of meat
and fish resulting to iron deficiency. When food intake is extremely unstable in patients with
dementia or paralysis, or alcohol consumption is high results to folic acid deficiency.

There are 5 types of anemia. When iron deficiency anemia is present, most cases are
derived from chronic hemorrhage so it necessary for repeated testing of stools for occult blood
and genitourinary examination. With the possibility of gastrointestinal malignancy borne in
mind, consider an examination of tumor markers and endoscopic study. The definitive diagnosis
can be made when the ferritin level is less than 12mg/ml, and total iron binding capacity
360µg/dl or higher. The mechanism if this disease with H. pylori is not well understood although
prolonged infection with this agent causes a decrease in iron storage in the body.

The second type is secondary anemia, a collective term anemia attributable to some
underlying disease such as infectious disease, collagen disease, renal disease, hepatic disease,
endocrine disease, and malignant tumors.
 Hepcidin, a peptide produced mainly on the liver is apparently involved in the
manifestation of chronic infectious disease, malignant tumors, and chronic inflammation which
referred as anemia of chronic disorders(ACD) serving as a negative regulator in the iron
metabolic control mechanism of the body. This induces ACD by inhibiting the absorption of iron
from the gastrointestinal tract and the release of iron from machrophages resulting a decrease in
iron available for erythropoiesiss. The severity of this type is mild to moderate, with the Hgb
level around 8-11g/dl.

The third type is megaloblastic anemia. Vitamin B12 deficiency often begins 5 years
after a patient has undergone gastrectomy. Supplementation of vit.B12 is more frequently
administrated to elderly because of poor response than younger patients. This is generally rare
but diagnosis is more frequent in the elderly in the combination of autoimmune disease. Atrophic
gastritis is considered the manifestation of pernicious anemia. Folic acid deficiency is likely to
occur in alcoholics or bedridden patients with nutritional deficit.

The fourth type is myelodysplastic syndrome, characterized by morphological dysplasia

in the blood cell and ineffective hematopoiesis. This occurs among elderly people in their 60s
and 90s. Currently, there is no established standard treatment, but determination of the
procedure to choose the proper treatment according to the type of disease is required. When
anemia do not respond to drug therapy and become transfusion dependent, precaution is
necessary as to organ damage due to iron overload. An iron-chelating drug, deferasirox, was
marketed in Japan , for more effective iron-removing effect.

The fifth type is senile anemia which responds poorly to erythropoietin, and slightly hypoplastic
or dysplastic marrow present. The cause is possibly the physiologic changes due to age-related
degeneration of bone marrow function, renal function and androgen production capacity.

On this article, the importance of knowing the past medical history, family history, and
drug history is essential in knowing the type of anemia present on a client. When anemia
becomes apparent, it is critical to find out if it represents physiological or pathological changes
so thorough assessment should be done to know its possible causes which is needed for proper
treatment and management or intervention for the client.

III. Comprehensive Discussion on the Relevance to the following:

A. Nursing Practice

As a student nurse, mainly a health care provider, this provided me an additional idea
on my nursing practice. In caring patients especially with those who have serious condition s like
on anemic elders, thorough and accurate assessment must be done in order to provide a proper
management for them. This helps me in applying my nursing interventions because of the health
topics concerning the types and causes of anemia.

B. Education
 The provides education to the health workers and also to the patients. It provides an
additional knowledge to health workers in treating and managing the client with anemia, and for
the patient, it serves a subject for them to understand their conditions so that they can also
participate on their treatment for better and easy recovery. These also relieves their fear because
they may be able to know the advantages and reason of curing their condition which will benefits
them.

C. Local Setting

In our country, the government sectors especially Department of Health and other health
departments may be encouraged to address the elders’ anemic condition. This may be done by
making programs regarding the topics related to anemia such as the symptoms, causes, effects,
intervention or management to be applied.

D. Client

From the topic, the elderly patient who manifests symptoms of anemia will be
diagnosed in earlier time. These helps to prevent further complications which affects the
patient’s physical activities like ADL ;his or her emotional status such may lower self-esteem,
isolation and impaired bonding with significant others; and in financial needs like for hospital
bills. These also encourage the patient to seek for consultation.

IV. References:

Journal of the Japan Medical Association July/August 2009- Vol.52,No.4

RESEARCH AND REVIEWS. Masatsugu OHTA.

Oh ill give my love and when i old your hans all alone.. d so tight nothing can can break it. It get
thrttoyuh the nibht i wont forget the mom=t tld not be hat it wou you thounce whnw t i see you,
you made me smile but don’t know the reason why. If this feeling inside is just merely a dream
so please stop it , and wake me up so i would nit bear th\is th

What is chance when you knew that it would noy happen for so long, what is chance when you
thought that it would not work as you thought to be?.

If i would listen to you, do you still do the promises you said? Even if you kow that it would hurt
for the both of us?
 SAINT LOUIS UNIVERSITY

COLLEGE OF NURSING

JOURNAL

“Management of Anemia in the Elderly”

SUBMITTED TO:

MS. JEANNIFER GITO

SUBMITTED BY:

EVANGELISTA, TIFFANY BLANCA

BSN II-4C
DATE SUBMITTED:

JANUARY 23, 2010a