| BackgroundIron deficiency is a common nutritional disorder worldwide, with a prevalence from high to low in pregnant women, preschool children, low birth weight babies, other women, older people, schoolchildren and adult males. China is faced with the most serious challenge in population aging. However, there are few epidemiological data on iron deficiency and iron deficiency anemia among the elderly people. Therefore, it is very important to conduct epidemiological investigations on iron deficiency and iron deficiency anemia among the elderly people, so as to further develop effective prevention and control measures to improve the quality of life of the elderly population, and reduce the burden on society and the family.Since1985, doctors from the Hematology and Oncology Department of Dongzhimen Hospital affiliated to Beijing University of Chinese Medicine have been engaged in researches of the effective prevention and treatment of iron deficiency and iron deficiency anemia. According to TCM theory "spleen is the root of acquired constitution and the source of qi and blood production", the main pathogenesis of iron deficiency anemia is considered as the spleen and stomach deficiency. Based on the etiology and pathogenesis of iron deficiency anemia, it has established the treatment principles to fortify the spleen, harmonize stomach, boost qi and nourish blood", and have developed a "Yizhong Shengxue Capsules (Tablets)"(listed) in the treatment of iron deficiency anemia, which have achieved ideal therapeutic effects. However, in previous studies, more attention are paid to the treatment of iron deficiency anemia, but it lacks in-depth clinical research on effective prevention of iron deficiency and iron deficiency anemia, especially the prevalence of iron deficiency and iron deficiency anemia among the elderly population.Based on the results of our previous clinical studies, epidemiological research methods were adopted according to the requirements defined in the protocol of Beijing Chinese Medicine Science and Technology Project (Project NO. JJ2010-11) to screen iron deficiency and iron deficiency anemia among the population, and to determine the epidemiological data on the incidence among the population, as well as the etiology and the clinical characteristics. According to analysis on the clinical epidemiological data, the self-assessment form was developed specially for elderly population, and it has been further proven through the promotion of scientific knowledge in the community, laying the foundation for the development of the "protocols or expert consensus on prevention and treatment of iron deficiency and iron deficiency anemia with Chinese medicine in elderly population" that embody the characteristics and advantages of Chinese medicine.ObjectivesEpidemiological research methods were adopted to preliminarily screen iron deficiency and iron deficiency anemia among the population, and to determine the epidemiological data on the incidence among the population, as well as the etiology and the clinical characteristics. According to analysis on the clinical epidemiological data, the self-assessment form was developed specially for elderly population, and it has been further proven through the promotion of scientific knowledge in the community, laying the foundation for the development of the "protocols or expert consensus on prevention and treatment of iron deficiency and iron-deficiency anemia with Chinese medicine in elderly population" that embody the characteristics and advantages of Chinese medicine.MethodsA two-phase investigation was conducted in the elderly population over65years, based on multiple centers including Dongzhimen Hospital affiliated to Beijing University of Chinese Medicine, Xinzhong Street Health Service Station, Shizipo Health Service Station and the Ministry of Foreign Affairs Street Health Service Station in Dongcheng District, and China Meteorological Administration Health Service Station in Haidian District.In the first stage, serum ferritin values were collected from the elderly population who came for health check-up, and the iron storage status of the elderly was preliminarily screened to obtain the epidemiological data. In the second stage, through monitoring the peripheral blood hemogram and serum iron levels (serum iron, total iron binding capacity, transferrin saturation), the incidence of iron deficiency anemia among the population was preliminarily screened; moreover, TCM qualitative research methods were used for in-depth investigation on the clinical symptoms of the patients, as well as the predisposing factors of the diseases, which was combined with results of bone marrow examination to determine the incidence in the population, etiology and clinical characteristics to obtain epidemiological data.Results1.The detection rate of iron depletion in elderly people366of5576elderly people met the diagnosis criteria for iron depletion, with a total detection rate of6.56%. Among them,177were male with a detection rate of6.31%, and189were female, with a detection rate of6.82%. The data were analyzed using the x2test, and it showed x2=0.59and P=0.44>0.05, indicating that there is no difference in the detection rate of iron depletion between elderly men and women. Compared with foreign literature:①The detection rate of iron depletion was6.56%in elderly population of Beijing. It is higher than that of the United States, Denmark, Singapore, and lower than that of Chile, the Netherlands.②The detection rate of iron depletion was6.31%in man. It is higher than that of Denmark, the United States, Singapore, lower than that of the Netherlands.Women was6.82%. It is higher than that of Denmark, the Netherlands, Singapore, the United States. The results show that the detection rate of iron depletion in elderly population of Beijing was higher than that of developed countries, lower than that of developing countries. 2.The prevalence rate of anemia in elderly people709of6025elderly people met the diagnosis criteria for anemia, with a total prevalence rate of11.77%. Among them,380were male with a prevalence rate of12.50%, and329were female with a prevalence rate of11.03%. The data were analyzed using the x2test, and it showed x2=3.14and P=0.08>0.05, indicating that there is no difference in the prevalence rate of anemia between elderly men and women. Compared with foreign literature:①The prevalence rate of anemia was11.77%in elderly population of Beijing. It is higher than that of the United States, and lower than that of South Korea, Uganda, the United Kingdom.②The prevalence rate of anemia was12.50%in man. It is higher than that of United States, South Korea, lower than that of Uganda, the United Kingdom; Women was11.03%. It is higher than that of United States, lower than that of South Korea, Uganda, the United Kingdom. The results show that the prevalence rate of anemia in elderly population of Beijing was higher than that of developed countries, lower than that of developing countries.3.The prevalence rate of iron deficiency anemia in elderly people256of6025elderly people had iron deficiency anemia, with a total prevalence rate of4..25%. Among them,144were male with a prevalence rate of4.74%, and112were female with a prevalence rate of3.75%. The data were analyzed using the x2test, and it showed x2=3.57and P=0.06>0.05, indicating that there is no difference in the prevalence rate of iron deficiency anemia between elderly men and women.Compared with foreign literature:①The prevalence rate of iron deficiency anemia was4.25%in elderly population of Beijing. It is similar with that of the Netherlands, the United Kingdom, and higher than that of Singapore, Denmark, the United States, and lower than that of Uganda, Belgium.②The prevalence rate of iron deficiency anemia was4.74%in man. It is higher than that of United States. Women was3.75%. It is higher than that of United States. The results show that the prevalence rate of iron deficiency anemia in elderly population of Beijing was higher than that of developed countries, lower than that of developing countries.4.The causes of iron deficiency anemia in elderly peopleThe survey results have revealed the causes of iron deficiency anemia in elderly population included the following (with a correlation from high to low):gastrointestinal tumors33.98%, gastric and duodenal ulcers24.22%, gastrointestinal dysfunction20.7%, a history of taking aspirin and clopidogrel19.92%, irrational diet structure11.72%, atrophic gastritis10.16%, blood loss in surgery and traumatic bleeding9.77%, chronic diarrhea9.38%, ulcerative colitis9.38%, a previous history of menstrual disorders8.98%.5.The TCM clinical manifestations of iron deficiency anemia in elderly peopleAccording to the theory of four TCM diagnostic methods, an investigation on clinical manifestations of the elderly population was conducted, and it showed that the symptoms and signs occurring in over30%of the population included the following (with an incidence from high to low):①pale tongue and weak pulses (100%). The pale red tongue or pale tongue and thready pulses were more commonly seen in mild anemia, while the pale tongue and silk-like thready pulses were more commonly seen in moderate to severe anemia.②sallow complexion (56.64%). Mild anemia was more commonly presented with a lusterless complexion; while moderate to severe anemia was more commonly presented with a sallow complexion, somber or even pale.③anorexia (48.44%). Mild anemia patients presented with tastelessness in the mouth, while moderate to severe anemia more commonly presented with a decreased appetite, or even no desire for food and drink.④fatigue and lack of strength (44.53%). Mild anemia patients usually showed fatigue after activities, while moderate to severe anemia patients usually felt fatigue in a resting state.⑤memory loss (43.36%). Mild anemia patients presented with forgetfulness, while moderate to severe anemia presented with significant memory loss.⑥dizziness (38.67%). Mild anemia patients had occasional vertigo, while moderate to severe anemia patients were too dizzy to stand.⑦flusteredness and palpitation (33.98%). Mild anemia patients usually had flusteredness and palpitation after activities, while moderate to severe anemia patients usually had flusteredness and palpitation in a resting state.⑧insomnia and profuse dreaming (31.64%). Mild anemia patients had intermittent insomnia, while moderate to severe anemia patients were sleepless overnight.⑨numbness of the limbs (31.25%). Mild anemia patients more commonly had limb paresthesia, while moderate to severe anemia patients more commonly had limb numbness and loss of feeling.ConclusionThe incidence of iron depletion and iron deficiency anemia was respectively6.56%and4.25%in elderly population of Beijing, which was higher than the European and American developed countries, and lower than the developing countries. The relatively lower incidence of iron deficiency in elderly population of Beijing were directly attributed to the good culture literacy of residents, high education level, popularization of scientific knowledge and good nutrition in Beijing. Although the iron deficiency in Beijing area was lower than the national average, it still needs to pay close attention to.The major causes of iron deficiency anemia in elderly population of Beijing were gastrointestinal diseases, especially gastrointestinal cancer being considered as the main cause. Therefore, it is necessary to conduct an early general survey on gastrointestinal tumors among the elderly population, not only for early detection and early treatment of malignant tumors, but also for prevention of iron deficiency anemia.The major TCM clinical manifestations of iron deficiency anemia in elderly population of Beijing were dominated by signs and symptoms of spleen and stomach deficiency. According to their incidence rates, they were classified into two aspects:①Signs of spleen and stomach deficiency including sallow complexion, loss of appetite and loosen stool;②Signs of qi and blood deficiency including pale tongue and thready pulses, fatigue and lack of strength, memory loss, dizziness, flusteredness and palpitation, insomnia and profuse dreaming, numbness of the limbs. Therefore, the treatment designated for the elderly population was to supplement the spleen and stomach, and nourish qi and yin.
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