Handouts: Anemia & Aging

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Glossary
Bone marrow: Soft, spongy tissue found in bone cavities; responsible for production and storage of most blood cells, as well as storage of iron

Diabetes: Disease which causes your body to either not make enough insulin (type1) or not use insulin the right way (type2)

Erythropoietin: Hormone that regulates red blood cell production

Hematocrit: Percentage of red blood cells in a blood sample

Hemoglobin: Protein carried by red blood cells that transports and delivers oxygen throughout your body

Idiopathic anemia of aging: Anemia without an obvious cause

Inflammation: Your body’s response to injury or irritation; often associated with pain, redness, heat, and/or swelling

What is anemia?
Anemia is a below-normal level of hemoglobin* or hematocrit*. Hemoglobin is the protein in red blood cells that carries oxygen to all parts of the body. Anemia can be a temporary condition, a consequence of other health conditions, or it can be a chronic problem. People with mild anemia may not have any symptoms or may have only mild symptoms. People with severe anemia may have problems carrying out routine activities and can feel tired or experience shortness of breath with activity.1

How common is anemia in older adults?
The frequency of anemia varies depending on age, sex, and overall health. For older adults, aged 65 years and over, around 10-11% have anemia.2 For older adults residing in a nursing-home, about 50% have anemia.3

What causes anemia in older adults?
There are many causes of anemia in older adults. Some common causes include:

Iron deficiency anemia in older adults usually results from slow blood loss over time. Bleeding is most often caused by stomach ulcers, abnormal blood vessels, or a more serious problem such as colon cancer. Occasionally, iron deficiency can occur by not eating enough iron-rich foods or when your body isn’t absorbing the iron in your diet.

Chronic inflammatory diseases, chronic infections, and kidney disease are frequently associated with anemia. This may include conditions such as rheumatoid arthritis, cancer and chronic kidney disease. If the underlying condition can be effectively treated, the anemia often improves. These chronic diseases are probably the most common cause of anemia in older adults.3-4

A cause cannot be determined in about 20-36% of anemia cases in older adults.5-7 This is called idiopathic anemia of aging or unexplained anemia in the elderly. Anemia without an obvious cause is unique to older adults. There may be many reasons why older people get idiopathic anemia, but some doctors believe it is due to mild or unrecognized chronic conditions.

What are the effects of untreated anemia in older adults?
Elderly people with anemia are 40% more likely to have problems that keep them from being independent. These problems include poor balance and not being able to walk long distances,8making them prone to falls, heart trouble, depression, and loss of memory and concentration.1,9-11 Anemia has been associated with decreased life expectancy of older adults.12 As early as age 65, people with kidney disease, diabetes, and/or heart failure are more likely to die if they have anemia.13 Anemia can also make certain medical conditions worse: one more reason its recognition and treatment are especially important. While managing anemia may be life saving in some circumstances, treatment has not proven to guarantee a longer lifespan.

How do I know if I have anemia?
The best way to determine if you have anemia is to discuss your blood counts and changes in hemoglobin and hematocrit with your doctor. Symptoms usually develop when anemia is moderate to severe, and can include fatigue, weakness, pale skin, chest pain, dizziness, irritability, numbness or coldness in your hands and feet, trouble breathing, a fast heartbeat, and headache. The misconception that these symptoms are a normal part of aging, may lead to a delay in the diagnosis of anemia in the elderly. But neither these symptoms, nor anemia, are a natural part of aging and both should receive meticulous medical attention.

What treatments are available to help me?
For iron deficiency anemia, iron supplements are necessary, but it is critical to identify and treat the underlying cause. Red blood transfusions can treat anemia, but they are usually reserved for severe cases because of the risks and costs of blood transfusions. Approved medications include a manmade form of erythropoietin which stimulates red blood cell growth in the bone marrow. These medications are given as injections in the vein or under the skin. They are usually used for anemia due to chronic kidney disease or anemia in cancer patients receiving chemotherapy. Close communication with your doctor will help him or her provide the treatment that is best for you based on what is causing the anemia.

*Normal Lab Values: Normal hemoglobin >12 g/dL for women, >13 g/dL for men; normal hematocrit >36% for women, >39% for men.

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References

  1. [Cited source redacted; replace with a supporting citation.]
  2. Guralnik JM, et al. Blood. 2004;104(8):2263-2268.
  3. Robinson B, et al. J Am Geriatr Soc. 2007;55(10):1566-1570.
  4. Artz AS, et al. J Am Geriatr Soc. 2004;52(3):423-427.
  5. Joosten E, et al. Gerontology. 1992;38:111-117.
  6. Anía B, et al. J Am Geriatr Soc. 1997;45:825-831.
  7. Ershler W. J Am Geriatr Soc. 2003;51(suppl):S18-S22.
  8. Penninx B, et al. Am J Med. 2003;115:104-110.
  9. Herndon J, et al. J Am Geriatr Soc. 1997;45:739-743.
  10. Lipschitz D. J Am Geriatr Soc. 2003;51(suppl):S10-S13.
  11. Katz I, et al. J Geriatr Psychiatry Neurol. 1993;6:161-169.
  12. Izaks G, et al. JAMA. 1999;281:1714-1717.
  13. Collins A, et al. Adv Stud Med. 2003;3(3C);S14-S17.

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