Prevalence of anaemia in older persons: systematic review

Background: Ageing populations will impact on healthcare provision, especially since extra years are not necessarily spent in good health. It is important to identify and understand the significance of common medical problems in older people. Anaemia may be one such problem. We report on the prevalence of anaemia in cohorts of elderly people in the general population. The presence of anaemia is associated with a worse prognosis for both morbidity and mortality. Methods: Electronic searching and reference lists of published reports were used to identify studies that reported on prevalence of anaemia in cohorts of at least 100 individuals predominantly aged 65 years and over living in developed countries, together with criteria used to define anaemia. Studies of anaemia prevalence in specific disease groups or published before 1980 were excluded. Prevalence data for the entire cohort, for men and women separately and for differing age bands were extracted. Results: Forty-five studies contributed data. Thirty-four studies (n=85,409) used WHO criteria to define anaemia. The weighted mean prevalence was 17% (3-50%) overall, and 12% (3-25%) in studies based in the community (27, n=69,975), 47% (31-50%) in nursing homes (3, n=1481), and 40% (40-72%) in hospital admissions (4, n=13,953). Anaemia prevalence increased with age, was slightly higher in men than women, and was higher in black people than white. Most individuals classified as anaemic using WHO criteria were only mildly anaemic. Conclusion: Anaemia, as defined by WHO criteria, is common in older people living in the community and particularly common in nursing home residents and hospital admissions. Predicted demographic changes underline the need to understand more about anaemia in older people

Improving surgical outcomes in renal cell carcinoma involving the inferior vena cava

Radical nephrectomy with tumor thrombectomy remains the mainstay of treatment in renal cell carcinoma with inferior vena cava extension. Despite the rapid improvements experienced in perioperative care in recent years, this intervention still often results in significant morbidity and mortality. A deeper understanding of salient features of this complex operation provides a valuable insight into the clinical mechanisms underlying the variations observed in surgical outcomes. The 'operation profile' serves not only as a basis for making an adequate prognostic assessment, but also creates a platform from which 'innovative' strategies for improving quality and safety can be made. The present review aims to set a 'profile' for radical nephrectomy and tumor thrombectomy, and to propose a number of strategies that may reduce the complication rates of this intervention