tailieunhanh - Anemia in the Elderly: How Should We Define It, When Does It Matter, and What Can Be Done?

Under the base enrollment scenario, the ACA is predicted to result in an additional 900,000 individuals enrolling in Medi-Cal by 2014, increasing to million by 2019. is includes an estimated 500,000 individuals predicted to be enrolled in county Low-Income Health Programs who will be automatically enrolled in Medi-Cal in Under the enhanced scenario, with a more aggressive enrollment and outreach strategy, additional Medi-Cal enrollment would reach million by 2014 and million by 2019. Under the base enrollment scenario, we project that in 2014, 900,000 individuals will take advantage of premium subsidies in the Exchange to buy coverage. With more aggressive outreach and enrollment assistance contemplated under the enhanced scenario | REVIEW Anemia in the Elderly How Should We Define It When Does It Matter and What Can Be Done David P. Steensma MD and Ayalew Tefferi MD Anemia signifies an underlying disease and is associated with poor clinical outcomes. In elderly patients in whom anemia has a high prevalence 10 neither the hemoglobin threshold for concern nor the identity of the anemia-causing disease is easily established. This is an important shortfall because even mild anemia can compromise patients well-being and survival regardless of the underlying cause. This review discusses definitions of normal hemoglobin levels in adults common causes of anemia in people aged 65 years and older eg nutritional deficiency renal insufficiency inflammatory disorders and myelodysplastic syndrome and potential consequences of anemia in elderly patients eg poorer cognitive status increased frailty and an elevated risk of hospitalization and of complications during hospitalization . We also outline a practical initial diagnostic approach that helps determine appropriate treatment and we weigh therapeutic options in light of new safety concerns regarding erythropoiesis-stimulating agents. Mayo Clin Proc. 2007 82 8 958-966 Epo erythropoietin ESA erythropoiesis-stimulating agent GI gastrointestinal MCV mean corpuscular volume MDS myelodysplastic syndrome NHANES III Third US National Health and Nutrition Examination Survey WHO World Health Organization Anemia is extremely frequent in elderly persons defined in this article as those aged 65 years and older and is growing in importance as a public health issue and a biomedical research In response to reports describing a heavy health burden from anemia in the elderly the American Society of Hematology and the National Institute of Aging organized joint symposia in 2004 and 2005 to review the problem and define a research agenda and the National Institutes of Health offered a special request for research proposals in 4 The issue is driven by .