Dungca 2012. Health Status of Elderly in Suburban

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Philippine Journal of Science

141 (2): 197-205, December 2012

ISSN 0031 - 7683

Date Received: 06 Dec 2011

Key Words: anemia, eosinophilia, hemoglobin, leukocytosis, nutritional intake, older persons (≥ 60 yrs)

*Corresponding author: [email protected]

197

Julieta Z. Dungca*, Aileen C. Patron, Ma. Cristina S.J. Liwanag,

Charito M. Bermido, Veron Balintona, and Erna V. Yabut

Hematological Indices, Nutrient Intake and HealthStatus of Older Adults in Selected Suburban

Filipino Community

Centro Escolar University, School of Science and Technology & College of

Medical Technology, 9 Mendiola, Manila, Philippines

This study investigated the health status of 90 male and 169 female community-dwelling

individuals ≥ 60 yrs in terms of the hematological values, nutritional status and medical history.

Hematological test results were obtained using an automated hematology analyzer. Interviews

and pretested questionnaires were used to obtain the demographic profile, medical history and

nutrient intake based on a 24-hour recall. Based on the WHO criteria of anemia (Hb < 120

g/L for female and < 130 g/l for male), 21.6% were anemic. Of these, 78.6% have normocytic

normochromic type, while 10.7% have hypochromic microcytic type. Leukocytosis was observed

in 8.1%, eosinophilia in 26% , and lymphocytosis in 7.7% of the participants. Age was found

to be inversely correlated with the erythrocyte count (p<0.01) but positively correlated with

the mean corpuscular volume (p<0.01). Arthritis (36%) and hypertension (29.3%) were the

most common health complaints. Inadequate protein, energy and calcium intake were noted

in 83.6%, 77.6%, and 91.1%, respectively. Almost all of those who were found anemic haddeficiency in iron and thiamine. The findings of high proportion of older adults with abnormal

hematological values and deficiencies in major nutrients, may suggest an impaired health

status that warrants immediate medical attention. Likewise, the high incidence of anemia with

eosinophilia and the very significant correlation between anemia and eosinophil count (p=0.01)

may imply helminthic parasitic infection in this group of older individuals which has to be

confirmed through fecalysis and allergy tests.

INTRODUCTION

Aging of the world population is anticipated in the next

four decades. According to the 2006 Revision of the World

Population Prospects, by 2045, there will be more people

age 60 years and above than children (World Population

Prospects 2006). Such a trend has become apparent in

Europe and in other countries like Japan, Germany, China,

and India (World Population Prospects 2006) and shall

continue to become evident in Asia in the next thirty

years (Hermalin 2002). In the Philippines, 4% of the

total population represent older people (≥ 60 yrs), and by2040, it is estimated to shoot up to 22 million (Philippine

Census Data 2007).

As people get older many diseases occur as a consequence

of age-related decline in the immune system (Weiskoff et

al. 2009) and poor nutritional status (Mowie et al. 1994).

Increased vulnerability to many diseases such as arthritis,

heart attack and diabetes, and heightened susceptibility to

a number of pathogenic organisms become apparent with

old age (Albright & Albright 1994).

source: http://philjournalsci.dost.gov.ph/vol141no2/pdf/Hematological%20indices.pdf



Dungca JZ et al: Hematological Indices, Nutrient Intake and Health

Status of Filipino Adults Philippine Journal of Science

Vol. 141 No. 2, December 2012

198

Hematological indices are common diagnostic tools used

by clinicians and other health professionals in evaluating

the current health status of an individual (McPherson and

Pincus 2009). Of the various hematological findings, anemia

is commonly reported among older people in developed

countries in Europe, United States, and Japan, and even in

Korea (Choi et al. 2004; Gaskell et al. 2008; Guralnik et al.2004; Salive et al. 1992). Increased mortality and morbidity

have been directly correlated with abnormal hematological

findings such as low hemoglobin (Jha 2006; Pennix et al.

2006; Zakai et al. 2005), low hematocrit (Kosiborod et al.,

2005), and elevated WBC count (Ruggiero et al. 2007,

Weiss et al. 1995). Thus, an early detection of hematological

disorders can be of help in preventing complications and even

early death of the elderly.

Studies on older individuals in many parts of the world have

largely been on the hemoglobin, hematocrit and RBC count

(Nillsson-Ehle et al. 2000; Salive et al. 1992), while in the

Philippines, the focus has been on the hemoglobin level andassessment of nutritional status (De Guzman et al. 1996;

Pedro & Barba 2001). For this reason, documented data on

WBC count and WBC differentials, which may be reflective

of other serious health conditions, are limited. This study is

one of the few studies that focused on WBC and its subtypes

among the older adults. We sought to assess the health

status of older individuals in Malolos, Bulacan, Philippines

using various hematological indices, medical history, and

nutrient intake. Hemoglobin, hematocrit, and RBC count

are used to determine anemia, while total WBC count and

WBC differential counts are used to test for occurrence of

infections in an individual. Furthermore, the RBC indices

(MCV, MCH, and MCHC) help the physician in evaluating

and identifying the morphologic types of anemia.

MATERIALS AND METHODS

Sampling Site

The study was conducted in Bulacan, a suburb located just

north of Metro Manila, Philippines. Bulacan comprises

three cities; 21 municipalities and 569 barangays

(Philippine Census 2007).

Population Frame and Sample Size

The study included community-dwelling older persons

residing with their families in two Barangays in Malolos,

Bulacan, namely: Barangay Longos with a total population

of 10808, and Barangay Bulihan at 12732 (Philippine

Census 2007). Of the combined population, 2% (n=259)

were people with ages 60 years and above who were

recruited to be part of this study. The research team

conducted a household census of the two barangays in

coordination with the Barangay officials. There were a

total of 735 older people in Longos and in Bulihan. The

sample size (n) of 259 was derived using the Sloven’s

formula at 0.05 marginal error. Systematic random

sampling of the households with older persons was

employed in the selection of the samples. In case the

randomly selected older person is not willing to participate

in the research, a replacement was done.

One-on-one structured interviews were conducted by

trained interviewers using pre-tested interview schedule

on the demographic profile, lifestyle, nutrient intake and

medical history. Each participant was also requested to

self-rate their health status. The instrument used in this

study was developed by the researchers and was pre-tested

to older adults of Malolos, Bulacan who were not included

in the actual survey.

Ethical ClearanceThis study was approved by the Ethics Committee of

Centro Escolar University. Written informed consents

were obtained from each participant both prior to blood

collection and at the time of the interview.

Blood Collection and Hematological Tests

Fasting blood samples were collected from antecubital

vein. These were placed in a plain evacuated tubes and

in ethylene diamine tetraacetic acid (EDTA) coated tubes.

Plain evacuated tube was set aside for the blood chemistry

analyses for use in another study. EDTA coated evacuated

tubes were used for the complete blood count (CBC).

Blood samples were transported to the laboratory within

4h of collection for the hematological analyses.

The following hematological indices were examined

to each sample: erythrocyte count, leukocyte count and

platelet count, hemoglobin (Hb), hematocrit (Hct), and

WBC differential count. In addition, mean corpuscular

volume (MCV), mean corpuscular hemoglobin (MCH),

mean corpuscular hemoglobin concentration (MCHC),

and red cell distribution width (RDW) were calculated.

All hematological tests were analyzed using an automated

hematology analyzer (Cell-Dyne Model 3200, Abbot

Company). The absolute counts for neutrophil,

lymphocyte, monocyte, eosinophil and basophil werecalculated by multiplying the total leukocyte count with

the results of WBC differential count using 100 leukocytes

(McPherson and Pincus 2009).

All hematological tests were performed at the Philippine

Medical Test System Clinical Laboratory (PMTSCL),

accredited by the Bureau of Health Services and Facilities,

Department of Health, Philippines. Results of various

hematological tests on each of the 259 elderly subjects

were interpreted using the reference values adapted by the




Status of Filipino Adults



199

PMTSCL which performed the hematological tests. The

reference values used in interpreting the absolute neutrophil,

lymphocyte, monocyte, eosinophil, and basophil counts

were taken from McPherson and Pincus (2009). For the

evaluation of anemia cases, the WHO criteria were used

(hemoglobin concentration of less than 120 g/L for women

and less than 130 g/L for men (WHO 1968).

Assessment of Nutrient Intake

The nutrient intake of each participant was determined

based on a 24-hour food recall. To ensure correct

assessment, sets of measuring spoons and cups and ruler

were used as models to serve as basis for comparing

the exact amount of food eaten. The nutrient content of

food eaten was computed using the Food and Nutrition

Research Institute (FNRI) menu calculator. The percent

adequacy of nutrient intake was calculated by dividing the

mean nutrient intake by the Recommended Energy and

Nutrient Intake (RENI) multiplied by 100.

Data Analysis

The two-tailed t-test was used to check for significant

difference on the results of each of the laboratory tests

of male and female elderly subjects. The comparison

and correlation of the hematological indices with age

were done using the analysis of variance (ANOVA)

and Pearson moment correlation, respectively. The

chi square was applied to determine the correlation of

hematological indices with illnesses based on medical

history. This was also used to establish the correlation

of hemoglobin/anemia with nutrient intake. The test ofdifference between groups and the association/correlation

of the hematological indices with the different variables

were analyzed at 0.05 level of significance. All statistical

analyses were performed using SPSS version 7.

RESULTS

Demographic Profile

The decrease in number of older persons with advancing

age is apparent (Figure 1). Age ranged between 60-94

yrs while mean age was computed at 74. Table 1 presentsthe summary of the other socio-demographic profile of

the participants. Female and male older adults comprised

65% (n=169) and 35% (n=90), respectively. Majority of

the participants were separated/widowed and with low

Figure 1. Distribution of Filipino adult subjects according to age.

Table 1. Socio-demographic characteristics of older adult participants

from Malolos, Bulacan.

VARIABLE n (%)

GENDER

Male

Female

TOTAL

90 (35)

169 (65)

259 (100)

MARITAL STATUS Married

Separated

Widowed

Single

TOTAL

5 (2)

140 (54)

88 (34)

26 (10)

259 (100)

EDUCATIONAL LEVELS

< 6 yrs education (primary)

intermediate

6-10 years education (secondary)

Tertiary education

TOTAL

113 (43.6)

77 (29.7)

46 (17.8)

23 (8.9)

259 (100)

SOURCES OF FINANCIAL SUPPORT

From children

From pension

EmployedSelf-employed

No definite Source of Income

TOTAL

96 (37.0)

38 (14.7)

37 (14.3) 45 (17.4)

43 (16.6)

259 (100)






200

educational background. Most of them have been relying

on their children (37%) and pensions (14.7%) for their

living. It is interesting to note however, that despite that

the participants were supposed to be on their retirement

age, 31.7% of them are still working.

Hematological Indices

The mean values for the different hematological

parameters of the 259 older individuals were found to

fall within the reference values (Table 2). More cases

of abnormal hematological findings were evident in

females than in males (Table 3). Anemia incidence was

seen at a rate of 21.6% based on the WHO criteria of

anemia (Hb < 120 g/L for female and < 130 g/L for

male). Data on the erythrocyte indices (MCV, MCH,

and MCHC) were used to classify the morphologic

types of anemia. Of these anemic individuals, 78.6%

had normocytic, normochromic anemia, 10.7% had

the hypochromic microcytic, and 10.7% normocytic

hypochromic types.

Higher than normal total leukocyte count (leukocytosis)was observed in 8.1%, while decreased count

(leukopenia) was seen in 3.8%. It is interesting to note

that absolute eosinophilia was seen in 25.8% of the

cases. Elevated absolute lymphocyte count was also

noted in 7.7% of the participants. There were 14 cases

with concurrent increase in total leukocyte and absolute

eosinophil counts, while there were eight cases with

both elevated total leukocyte and absolute lymphocyte

count (data not shown).

Table 2. Results of the various hematological indices of male (n=90) and female (n=169) Filipino older adults 60 years and over.

Hematological Tests Reference ValuesMale Female

MEAN ± SD Mean ± SD

Total leukocyte count

Absolute NEUTROPHIL count *

Absolute LYMPHOCYTE count *

Absolute MONOCYTE count *

Absolute EOSINOPHIL count *

Absolute BASOPHIL count *

Erythrocyte count

Hemoglobin concentration**

Hematocrit

MCV

MCH

MCHC

PLATELET count

RDW

5-10 x 109/L

1.8-7.0 x 109/L

1.5-4 x 109/L

0.2 –1.0 x 109/L

<0.5 x 109/L

<0.2 x 109/L

4.5-5.5 x 1012/L

<120for female

<142g/L male

0.37-0.43

80-100 fl

25-40 pg

28.9-36.1 g/d

150-450 x 109/L

0-99 %

7.68 ± 1.8

3.88 ± 1.50

2.93 ± 0.77

0.42 ± 0.19

0.48 ± 0.38

0.03 ± 0.05

4.8 ± 0.5

135 ± 13

0.41 ± 0.04

88 ± 5

30 ± 4

32.4 ± 1.8

271 ± 90

12 ± 0.9

7.1 ± 1.7

3.39 ± 1.21

2.84 ± 0.81

0.41 ± 0.20

0.36 ± 0.35

0.03 ± 0.05

4.7 ± 0.5

131 ± 12

0.41 ± 0.03

87 ± 7

29 ± 3

32.4 ± 2.8

256 ± 85

12 ± 1.0

*reference range was taken from McPherson and Pincus (2009). Henry’s Clinical Diagnosis and Management by Laboratory Methods 21st ed.

*Absolute counts for the neutrophil, lymphocytes, monocyte, eosinophil, and basophil were taken by multiplying the total wbc count with the results of differential count

using 100 white blood cells.

**based on WHO standard

Table 3. Comparison of abnormal hematological findings across gender.

Hematological FindingsMale Female TOTAL

N (%) N (%) N (%)

Anemia * (Hb)

Normochromic normocytic**

Hypochromic microcytic**

Hypochromic normocytic**

Absolute Neutropenia

Absolute Neutrophilia

Absolute Eosinophilia

Absolute Basophilia

Absolute Lymphocytosis

Absolute Monocytosis

Leukocytosis

Leukopenia

Thrombocytopenia

16

13

2

1

2

2

27

0

8

4

8

4

5

(6.2)

(5.0)

(0.8)

(0.4)

(0.8)

(0.8)

(10.4)

(0)

(3.1)

(1.5)

(3.1)

(1.5)

(1.9)

40

31

4

5

3

1

40

1

12

5

13

6

6

(15.4)

(12.0)

(1.5)

(1.9)

(1.2)

(0.4)

(15.4)

(0.4)

(4.6)

(1.9)

(5.0)

(1.3)

(2.3)

56

44

6

6

5

3

67

1

20

9

21

10

11

(21.6)

(78.6)

(10.7)

(10.7)

(2.0)

(1.2)

(25.8)

(0.4)

(7.7)

(3.4)

(8.1)

(3.8)

(4.2)

Anemia cases were identified based on the WHO criteria of anemia (Hb < 120 g/L for female and < 130 g/L

for male)

** morphologic classification of anemia-based on red blood cell indices MCV, MCH & MCHC







201

Medical History of Patients

A summary of the medical history of the patients in Table

4 revealed that hypertension and heart disease (37.0%),

arthritis (35.9%), and respiratory ailments (12.7%) were

the top three common ailments of the participants.

Nutrient Intake

The greatest proportion of the participants show

inadequacy in the intake of the major nutrients, except for

niacin (Figure 2). Deficient iron and thiamine intake was

observed in 86.9% and 91.9 %, respectively. Inadequate

protein, energy and calcium intake was noted in 83.6%,

77.6%, and 91.1% respectively. Because assessment of

food intake was based on 24-hour recall which may not

offer conclusive results, then, it can be said that almost

all of the participants examined were at risk in having

nutrient deficiency.

Comparison of Hematological Indices Across Gender

Although males registered higher total leukocyte,

erythrocyte, and platelet counts, absolute neutrophil,

eosinophil, lymphocyte and monocyte counts, Hb,

MCH and MCV values, showed some differences, these

were statistically insignificant (p>0.05) (Table 5). Mean

absolute basophil count, MCHC and hematocrit werethe same for both genders. Males showed significantly

higher results for the Total WBC count ( p= 0.013< 0.05

) and Hb ( p=0.038<0.05) than the females.

Table 4. Distribution of the 259 participants according to occurrence

of self-reported chronic diseases.

Health Conditions/Diseases N (%)

1. with hypertension/heart disease 96 (37.0)

2. with arthritis 93 (35.9)

3. Respiratory Ailments 33 (12.7)

4. with diabetes 23 (8.9)

5. with heart disease 20 (7.7)

6. with allergy 12 ( 4.6)

7. with anemia 11 (4.2)

8. with kidney disease 10 (3.9)9. with ulcer/gastritis 10 (3.8)

10. with hypercholesterolemia 7 (2.7)

11. with liver disease 4 (1.5)

12. with cancer 1 (0.4)

Figure 2. Comparison of Filipino adult subjects with adequate and inadequate food intake.

Adequate intake

Inadequate intake

Nutrient

P e r c e n t a g e






202

Comparison and Correlation of Hematological

Values Across AgeThe hematological indices in the different age groups did

not vary significantly (p> 0.05) (Table 6). While there was

a strong negative correlation between RBC concentration

and age (p<0.01), a strong positive correlation, however,

was apparent between age and MCV (p<0.01) (Table 7).

Correlation Between Hematological Indices and

Illnesses

Based on the hemoglobin level, anemia was seen in

56 out of the 259 (21.6%) participants examined. Of

these, 13 were positively diagnosed by their respective

physicians as anemic based on the complete blood countresults and clinical signs and symptoms. The remaining

43 represented new cases of anemia.

The present study identified 67 (25.8%) older adults

who had higher than normal absolute eosinophil count

(eosinophilia). Of these, only three confirmed to have

history of asthma/allergy on interview. Twenty five out

of these 67 (37.3%) with elevated eosinophil count were

anemic, though non-asthmatic suggesting a very strong

association between anemia and eosinophil count (p=0.01)

(Table 8). Of the 26 (10%) older persons who claimed

to have history of asthma, only one showed absolute

eosinophilia upon blood examination.

Furthermore, significant correlation was also seen between

the lymphocyte count and diabetes (p=0.048<0.05); and

neutrophil count and hypertension (p=0.014<0. 05).

Seven (7) of the 21 patients who had higher than normal

total leukocyte count were positively diagnosed by

physicians to have existing chronic infections based on

interview.

Correlation Between Anemia and Nutrient Intake

It is worthy to note that all those with lower than normal

Hb and Hct level had iron and thiamine deficiency at the

same time. However, data in Table 9 show that there was

no association between hemoglobin and iron, thiamine and

riboflavin intake (p>0.05). It is interesting to note that asignificant association was evident between the calcium

intake of male and the hemoglobin level (p=0.012<0.05).

DISCUSSION

The present study noted high cases of abnormal

hematological findings from the 259 volunteered

community-dwelling older adults (≥ 60 yrs) in two

Table 5. Comparison of hematological indices across gender

Hematological Indices T - value P-value


Absolute NEUTROPHIL count

Absolute LYMPHOCYTE count

Absolute MONOCYTE count

Absolute EOSINOPHIL countAbsolute BASOPHIL count

Erythrocyte count

Hemoglobin concentration

Hematocrit

MCV

MCH

MCHC

PLATELET count

RDW

2.507

1.757

-1.687

-1.162

1.607230

1.658

2.083

1.823

0.934

1.593

0.148

1.356

0.118

p= 0.013< 0.05 a

p= 0.08 > 0.05

p= 0.093 > 0.05

p = 0.246 > 0.05

p= 0.109 > 0.05 p= 0.819 > 0.05

p = 0.099 > 0.05

p =0.038 < 0.05 a

p=0.069 > 0.05

p= 0.351 > 0.05

p=0.112 > 0.05

p=0.882 > 0.05

p = 0.176 > 0.05

p =0.906 > 0.05

a = significant at 0.05 level

Table 6. Comparison of hematological indices with different age

groups.

Hematological Tests F- value P-value


Absolute NEUTROPHIL count

Absolute LYMPHOCYTE count

Absolute MONOCYTE count

Absolute EOSINOPHIL count

Absolute BASOPHIL count

Erythrocyte count

Hemoglobin concentration

Hematocrit

MCV

MCH

MCHC

PLATELET count

RDW

0.745

1.310

1.367

0.601

0.702

0.324

1.084

1.300

1.376

2.546

1.395

1.501

1.667

0.698

0.590

0.250

0.237

0.699

0.622

0.098

0.081

0.264

0.234

0.029

0.226

0.190

0.134

0.625

Table 7. Correlation of the hematological indices with age.

Hematological IndicesPearson

Coefficientp- value

Total leukocyte count -0.038 P=0.539>0.05

Absolute NEUTROPHIL count -0.024 P=0.704 >0.05

Absolute LYMPHOCYTE count -0.046 P=0.461 >0.05

Absolute MONOCYTE count -0.008 P=0.896>0.05

Absolute EOSINOPHIL count 0.074 P=0.235 >0.05

Absolute BASOPHIL count -0.013 P=0.836>0.05

Erythrocyte count -0.183 P=0.003 < 0.05 a

Hemoglobin concentration Female 0.091 0.146 > 0.05

Hemoglobin Male 0.099 0.112> 0.05

Hematocrit -0.104 P=0.094>0.05

MCV 0.215 P=0.000 < 0.0 a

MCHC 0.023 0.711 > 0.05

PLATELET count -0.106 0.088 > 0.05

MCH 0.117 0.060 > 0.05

RDW -0.075 0.232 > 0.05

a=significant at 0.05 level







203

Table 8. Association between hematological indices and illnesses.

Hematological Indices x Illnesses Chi square value P-value

Eosinophil ct x Anemia 6.41 P=0.01 a

Neutrophil ct x Diabetes 0.094 P=0.76 >0.05

Lymphocyte x Diabetes 3.90 P=0.048<0.05 b

RBC ct X Diabetes 0.466 P=0.79 >0.05

Eosinophil ct X Diabetes 0.023 P=0.83 >0.05

Hemoglobin x Diabetes 1.427 P=0.49>0.05

Lymphocyte x Arthritis 0.63 P=0.739>0.05

Monocyte x Arthritis 2.875 P=0.24 >0.05

Basophil X Arthritis 3.49 P=0.175>0.05

MCV x Arthritis 0.597 P=0.742 >0.05

MCH x Arthritis 1.585 P=0.453>0.05

Neutrophil x hypertension 6.048 P=0.014> 0.05 b

a = very significant at 0.01 level

b = significant at 0.05 level

Table 9. Correlation of hemoglobin with nutrient intake.

Nutrient Gender Chi-Square P-value

Energy Male

Female

3.215

0.176

P=0.073>0.05

P=0.675 >0.05

Protein Male

Female

0.692

0.017

P=0.405>0.05

P=0.896>0.05

Iron Male

Female

0.000

0.004

P=0.996>0.05

P=0.953 >0.05*

Calcium Male

Female

6.367

0.582

P=0.012<0.05a

P=0.445>0.05 *

Vitamin A Male

Female

0.683

0.635

P=0.409>0.05

P=0.425>0.05

Vitamin C Male

Female

0.007

0.830

P=0.943>0.05 *

P=0.362>0.05 *

Thiamine Male

Female

0.019

0.358

P=0.891>0.05 *

P=0.549>0.05 *

Riboflavin Male

Female

0.092

0.0.472

P=0.761>0.05 *

P=0.492>0.05 *

Niacin Male

Female

5.227

0.026

P=0.022>0.05

P=0.872 > 0.05

* cells with less than 5 expected frequency count

a=significant at 0.05 level

barangays in Malolos, Bulacan. The data from the medical

history point to the possibility that diseases may have been

contributory to the high cases of abnormal hematological

findings observed.

Anemia was found in 21.6% of the participants, and is one

of the important hematological abnormalities identified. This

further supports the reports elsewhere that anemia remains to

be a major health issue concerning the older people (Salive

et al. 1992; Pennix et al. 2006; Spivak 2006). The prevalence

rate of 21.6% observed in the present study is higher as

compared to the 10% reported rate in the Third National

Health and Nutrition Examination Survey (NHANES III)

conducted in 2004 (Guralnik et al. 2004) and the 10.6%-

13.6% reported cases of anemia in community-dwelling

elderly in other countries such as US, Korea, and Italy

(Guralnik et al. 2004; Choi et al. 2004; Ferrucci et al. 2007).

Considering the identified profound effects of anemia in

one’s health, and the reports that older anemic individuals

are more likely to be more frequently hospitalized and die

early than their non-anemic age-matched counterparts (Jha

2006; Nissenson et al. 2003; Pennix et al. 2006), the high

cases of anemia noted in the present study should be given

particular attention by the health authorities.

Although, a significant negative correlation between the

age and the erythrocyte count was observed, it may be said,

as reported in other studies that anemia in older people

cannot just be attributed to the normal aging process but

to age-related illnesses (Kosiborod et al. 2005; Salive et

al. 1992; Spivak 2006). A review of the medical history

of the older adults proved that many of them have chronic

infections which may have been contributory to the

development of anemia.

The study was able to categorize the anemia using

erythrocyte indices such as MCV, MCH and MCHC.

Results showed that normochromic normocytic anemia

which is considered as anemia of chronic infection, is the

most common type of anemia in this sample group at 78.6%

of all anemia cases. This may account for the high number

of older adults who admitted occurrence of chronic diseases

as diagnosed by their physicians. Also, the presence of

leukocytosis and lymphocytosis in these participants may

provide additional evidence of chronic diseases.






204

The identification of hypochromic microcytic type of

anemia in 10.7% of participants may be ascribed to

deficiency in the intake of iron, thiamine and riboflavin

which are vital to red blood cell production and

hemoglobin synthesis (Juguan et al. 1999; Mowie et al.

1994). However, this was not supported by the chi square

results. Since the nutrient intake was assessed using 24-hr recall, then this may account to the lack of statistical

evidence that support significant association between the

hemoglobin level and these essential nutrients. Adding to

the inconclusive results offered by the 24-hr food recall is

the poor memory of some older people to accurately recall

their food intake. We therefore, recommend that more

specific and sensitive assays such as those for ferritin/

transferrin, erythropoietin level, and serum iron be made

to have conclusive evaluation of the nutritional status.

Many of the older adults examined have been relying

so much on their children’s support and to their meager

pension. This may be contributory to the observed nutrientdeficiency. Also, the low educational attainment may

have a profound effect on their poor understanding of the

nutritional content of their diets. These findings emphasize

the important role played by nutrition on the development

of anemia among the older adults.

The study also considers the possibility that hypochromic

microcytic anemia may be associated with helmithic parasitic

infections as shown by the significant correlation noted in this

study between eosinophilia and hemoglobin. In developing

countries, like the Philippines, parasitic infections caused by

hookworm, whipworm and schistosomes have been reported

to be the most common cause of iron deficiency anemiawhich gives a characteristic hypochromic microcytic type of

anemia (McPherson and Pincus 2009). While it is true that

in the US, allergic reactions in the form of asthma and hay

fever are the most common cause of eosinophilia, we only

noted three cases of eosinophilic patients with consistent

positive history of asthma and allergic reactions. Considering

the role of eosinophilia in combating helminthic parasites,

the existence of chronic parasitic infections in the remaining

eosinophilic but non-asthmatic and non-allergic older persons

examined in this study cannot be discounted (McPherson and

Pincus 2009; Hurtado-Guerrero et al. 2005; Nuchaprayoon

1998). To date, there is a small, but compelling body of

literature which shows that the occurrence of parasiticinfections among elderly in Brazil (Hurtado-Guerrero

et al. 2005); Nepal (Shakya et al. 2006) and Thailand (

Nuchaprayoon 1998) may be a result of the age-associated

decline in their immune system (Albright & Albright 1994).

The findings of eosinophilia in large proportion of older

people examined serves as another significant result of

the present study aside from anemia which provides

evidences on the existence of parasitism in older people.

This, however has to be confirmed with comprehensive

follow up clinical evaluation coupled with laboratory

examinations such as fecalysis and allergy tests which is

the focus of the next phase of the study. In conclusion,

the high incidence of older persons with abnormal

hematological values, and nutritional deficiency suggest

a poor health status in this subset of population which

warrant further laboratory investigations and immediatemedical intervention. The high cases of neutropenia,

eosinophilia and lymphocytosis implied an impaired

health status in this group of older Filipinos which should

be attended to. These abnormal hematological findings

and the observed high cases of older individuals with

decreased hemoglobin and high eosinophil demand the

analysis of stool to confirm cases of parasitism in them.

Likewise, there is a need to undertake a health program

that guarantees improvement of their nutritional intake.

ACKNOWLEDGMENT

We thank Dr. Florencia Claveria for her invaluable

comments and suggestions. This work was supported by

the Centro Escolar University, Research and Development

Foundation.

REFERENCES

ALBRIGHT JW, ALBRIGHT JF. 1994. Ageing alters the

competence of the immune system to control parasitic

infection. Immunol Lett 40(3):279-85.Philippine Census Data, 2000

CHOI C, LEE J, PARK KH., YOON SY, CHOI IK,

OH SC, SEO JH, KIM BS, SHIN SW, KIM YH, KIM

JS. 2004. Prevalence and characteristics of anemia in

the elderly: cross sectional study of three urban Korean

population samples. Am J Haematol 77:26-80.

DE GUZMAN MP, NARCISO Z, LARA R, ADRIANO

M, MAGSAYSAY C, MAGBITANG J, PEDRO MR.

1996. An assessment of the Nutritional Status of

Selected Filipino Urban Elderly. Philipp J Sci 125(1)

p. 69-88.

FERRUCCI L, GURALNIK JM, BANDINELLI S,

WOODMAN R, LAURETANI F, CORSI AM,

CHAVES P, ERSHLER W, LONGO D. 2007.

Unexplained anaemia in older persons is characterized

by low erythropoi et in and low leve ls of pro-

inflammatory markers. Br J Haematol 136(6):849-55.

GASKELL H, DERRY S, ANDREW MOORE R, MCQUAY

H. 2008. Prevalence of anemia in older persons. BMC

Geriatrics 8:1doi:10.1186/1471-2318-8-1.







205

GURALNIK JM, EISENSTAEDT RS, FERRUCCI

L, KLEIN HG, WOODMAN RC. 2004. Prevalence

of anemia in persons 65 years and older in the United

States: evidence for a high rate of unexplained anemia

Blood 104(8):2263-8.

HERMALIN A. 2002. The well-being of the elderly inAsia: A four-country comparative study. University of

Michigan Press.648p. In: The American Journal of

Sociology. Vol. 109, No. 3 (Nov., 2003), p. 797-800.

Review by Bogue, Donald

HURTADO-GUERRERO AF, ALENCAR FH,

HURTADO-GUERRERRO JC. 2005. Occurrence

of enteroparasites in the elderly population of Nova

Olinda do Norte, Amazonas, Brazil. Acta Amaz 35(4):

487-490.

JHA A. 2006. Anemia is an important predictor of

decline and death in community-dwelling elders. J

Clin Outcomes Manage 13(5):259-260.

JUGUAN JA, LUKITO W, SCHULTINK W. 1999.

Thiamine Deficiency is Prevalent in a Selected

Group of Urban Indonesian Elderly People. J Nutr

129:366-371.

KOSIBOROD M, CURTIS JP, WANG Y, SMITH GL,

MASOUDI FA, FOODY JM, HAVRANEK EP,

KRUMHOLZ HM. 2005. Anemia and outcomes in

patients with heart failure: a study from the National

Heart Care Project. Arch Intern Med 165:2237-2244.

MCPHERSON R, PINCUS M. 2009. Henry’s Clinical

Diagnosis and Management by Laboratory Methods.(ed). 21th ed. Singapore. Saunders Elsevier. 1555 pp.

MOWIE M, BOHMER T, KINDT E. 1994. Reduced

nutritional status in an elderly population (> 70 y) is

probable before disease and possibly contributes to the

development of disease. Am J Clin Nutr 60(2):298.

NILLSSON-EHLE H, JAGENBURG H, LANDAHL R,

SVANBORG S. 2000. Blood hemoglobin declines in

the elderly; implications for reference intervals from

age 70-88. Eur J Haematol 65:297-305.

NISSENSON AR, GOODNOUGH LT, DUBOIS RW.

2003. Anemia: not just an innocent bystander. Arch

Intern Med 163:1400-1404.

NUCHAPRAYOON I. 1998. Eosinophilia, anemia and

parasitism in a rural region of northwest Thailand.

Southeast Asian J Trop Med Public Health. 29(3):584-9.

PEDRO MR, BARBA CV. 2001. Nutritional issues and status

of older persons of the Philippines: the IUNS, CRONOS

and other studies. J Nutr Health Aging. 5(2): 92-6.

PENNIX BW, PAHOR M, WOODMAN RC, GURALNIK

JM. 2006. Anemia in old age is associated with

increased mortality and hospitalization. J Gerontol A

Biol Sci Med Sci 61(5):474-9.

PHILIPPINE CENSUS. 2007. Available at: http://www.

census.gov.ph/data/sectordata/2007/region%203.

pdf.2006:61:474-479.

RUGGIERO C, METTER E, CHERRUBINI A, et al.2007. White cell count and cardiovascular mortality

white blood cell count and mortality in the Baltimore

study of aging. J An Coll Cardiol 2007: 49:1841-1850.

SALIVE M, CORNONI-HUNTLEY J, GURALNIK

J, PHILIPPS C, WALLACE R, OSTFELD A.

1992. Anemia and hemoglobin levels in older

persons:relationship with age, gender, and healthy

status. J Am Geriatr Soc 40:489-96.

SHAKYA B, RAI SK, SINGH A, SHRESTHA A. 2006.

Intestinal parasitosis among the elderly people in

Kathmandu Valley. Nepal Med. Coll. J. 8: 243-247.

SPIVAK J. 2006. Anemia in the elderly: a growing

health concern. Accessed from: www.medscape.com/

viewarticle/522647.

WEISS S, SEGAL M, SPARROW D, WAGER C. 1995.

Relation of FEV1 , and peripheral blood leukocyte

count to total morbidity; the normal ageing study. Am

J Epidemiol 42:493-498.

WEISKOFF D, WEINBERGER B, GRUBECK-

LOEBENSTEIN B. 2009. The aging of the immune

system. Transpl Int 22(11):1041-50.

[WHO] World Health Organization.1968. Nutritional

anaemia: Report of a WHO scientific group. World

Health Organ Tech Rep Ser 405:5-37.

WORLD POPULATION PROSPECTS: The 2006

Revision . Available at: http://ww w.un.org/

esalpopulation/publications/wpp2006/FS_ageing.pdf

Date Accessed: Feb. 13, 2010

ZAKAI N, KATZ R, HIRSCH C. 2005. A prospective

study of anemia status, hemoglobin concentration and

mortality in an elderly cohort: the cardiovascular health

study. Arch Intern Med. 165:2214-2220. Accessed

February 14, 2010.

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