[Prevalence and etiology of anemia in an institutionalized geriatric population].

OBJECTIVE: Anemia is a common problem in the elderly, but its etiology in this age group is not well known, nor is its correlation with the mental and functional states. The objectives of the present study were to determine the prevalence of anemia in a large institutionalized geriatric population, to diagnose the etiology, and to analyze the correlation of anemia with the nutritional, mental and functional status. METHODS: The study was performed in a 970 bed multilevel geriatric complex, from which 481 residents were randomly chosen. Their mean age was 81.4 +/- 8.7 years, and 46 of these residents were independent, 162 frail, and 273 nursing home patients. RESULTS: High prevalence of anemia (31.4%) was found, but, in more than half of the cases, the anemia was mild. The most common diagnosis was anemia of chronic disorders (65.6%), followed by anemia of chronic renal failure (13.2%). Anemia primarily due to iron, vitamin B12 or folate deficiency was found to be only 4%. In 15.9% of these cases the main cause of anemia could not be resolved. No correlation with the nutritional or cognitive states was found, but the functional state was highly and significantly inversely correlated with the presence of anemia. CONCLUSIONS: Anemia in institutionalized elderly is mostly the consequence of other chronic diseases. Further studies are required to determine whether a low functional state is an independent risk factor for anemia in old age.

[Multifocal skin cancer with very severe destruction of the face in a patient refusing medical treatment].

We report a case of multifocal skin cancer of the face, in a 64 years old farmer who had refused medical treatment for about 12 years. Destruction of the entire face, including nose and eyes, was unusually extensive and severe, resulting in significant functional impairment and a fatal outcome. There are no legal means to enforce treatment upon a non-cooperative patient, regardless of the consequences, and there are no reliable ways available to the health insurer or the employers to enforce use of protective measures by individuals at risk.