Anemia In Older Adults: Causes, Symptoms, And Treatment

Anemia is common in adults over the age of 65. Its prevalence increases with age, making anemia an essential health issue in this age group.¹

Learn what anemia is, the signs and symptoms to look out for, and the treatment options you have.

What is anemia?

Anemia is a condition that occurs when you have a lower count of healthy red blood cells or lower hemoglobin levels than your body needs for the red blood cells to function properly.

Red blood cells are essential for transporting oxygen from the lungs to the rest of the body.

Hemoglobin is the iron-rich protein found inside red blood cells. It’s responsible for carrying the oxygen to be delivered through the blood to the rest of the body’s tissues.

Without enough normal red blood cells that function as they should, or with lower levels of hemoglobin inside the cells, your body won’t get enough oxygen. You might experience symptoms like headache, fatigue, pale skin, shortness of breath, fast heartbeat, and dizziness as a result.

Acquired anemia can be treated in most cases. Treatment will depend on the type of anemia you have and its underlying cause.

Common signs and symptoms of anemia

Mild anemia may not cause symptoms, but as the anemia progresses, symptoms will start appearing.

Symptoms that are specific to anemia often develop over time. However, you may experience sudden symptoms that range from mild to severe depending on the underlying cause of your anemia.

General symptoms of different types of anemia include the following:

• Dizziness and fainting

• Weakness and tiredness

• Headache

• Chills

• Shortness of breath

• Fast, slow, or irregular heartbeat

• Hair loss

• Brittle nails

• Pale skin

Talk to your doctor if you develop any of these symptoms. They can take steps to identify the type of anemia and its cause and begin treatment promptly to avoid complications.

If untreated, anemia will progress to cause serious cardiovascular and lung issues. It can also affect the immune system, making you more susceptible to infections.

What causes anemia in older adults?

Causes of anemia in older adults can be broken down broadly into three categories:²

1. Nutritional deficiency (insufficient iron, vitamin B12, or vitamin B9/folate)

2. Anemia of chronic disease

3. Unexplained anemia

Each category is not necessarily the sole cause of anemia in any particular case. In many older individuals, the cause of anemia is multifactorial. This means various elements may co-exist and contribute independently to the person developing anemia.

Nutritional deficiency anemia

Anemia in older adults can be caused by the following nutritional deficiencies:

Iron deficiency anemia

Iron deficiency is the most frequent nutritional cause of anemia.

Iron is a critical component of hemoglobin inside the red blood cells. Without it, they cannot transport oxygen effectively to the organs, causing anemia symptoms.

Causes of iron deficiency anemia

• Gastrointestinal issues — Chronic stomach and intestinal problems causing blood loss and iron malabsorption are the most frequent causes of iron deficiency anemia in older adults. Conditions such as inflammation of the stomach or intestine, ulcers, inflammatory bowel disease (IBS), cancer, and non-cancerous tumors become more prevalent with age.

Additionally, some medications frequently used by older adults to treat chronic conditions — such as antithrombotic therapies for cardiovascular disease and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen for arthritis — can induce or increase gastrointestinal bleeding.

• Insufficient dietary iron intake —Your body usually relies on what you eat to get iron. However, if you don’t eat iron-rich foods, your body may not get enough iron.

• Your body can’t absorb iron efficiently — Absorption issues may result from medical conditions such as celiac disease, atrophic gastritis, Helicobacter pylori infection, or Crohn’s disease. Gastrointestinal surgeries, such as bariatric surgeries or surgeries to remove tumors, can also limit nutrient absorption, including iron.

Symptoms of iron deficiency anemia

Signs and symptoms of iron deficiency anemia include problems concentrating or thinking, dizziness, headaches, restless leg syndrome, and unusual fatigue.

Vitamin B12 and folate deficiency anemia

Insufficient levels of vitamin B12 (cobalamin) and/or vitamin B9 (folate) can cause anemia in older adults.

With insufficient levels of either or both of these vitamins, your body produces unhealthy and very large red blood cells (megaloblastic anemia). These cells are unable to carry oxygen to the body’s tissues properly and may also die prematurely. These nutrients are also essential for making white blood cells and platelets.

Causes of vitamin B12 or folate deficiency

• Gastrointestinal issues — The same issues that affect iron absorption may also affect the absorption of vitamin B12 and folate.³

• Insufficient dietary intake — This is particularly in the case of vitamin B12 deficiency and those following a strict plant-based diet who don’t take supplements. Vitamin B12 can only be found in animal products. You should take vitamin B12 supplements and consume fortified foods if you are following a vegan diet.

• Long-term alcoholism — Chronic alcohol consumption over a long period impacts the absorption of many vitamins and minerals.

• Using certain drugs — Some drugs can increase your risk of developing anemia, including the seizure medication phenytoin and the edema medication triamterene.

Symptoms of megaloblastic anemia

Symptoms vary from person to person and often develop slowly over time. These may include fatigue, pale skin, shortness of breath, fast or irregular heartbeat, feeling dizzy and/or lightheaded, muscle weakness, muscle aches and pains, and trouble breathing.

Some people develop gastrointestinal symptoms, including loss of appetite, a sore, swollen, and smooth tongue, nausea, jaundice, and diarrhea.

Vitamin B12 deficiency is associated with neurological complications. Some people report a tingling feeling or numbness in their hands or feet. Vision loss, problems with balance or gait, confusion, depression, anxiety, and memory loss can also result from this deficiency.⁴

If you notice any of these symptoms, speak to your doctor as soon as possible.

Anemia of chronic disease

Chronic disease is one of the most common causes of anemia in older adults.⁵

Long-term medical conditions such as autoimmune diseases, chronic kidney disease (CKD), and cancer can cause anemia in this age group. Other medical conditions that can cause anemia of chronic disease include bone infection (osteomyelitis), Crohn’s disease, HIV/AIDS, hepatitis B, and hepatitis C.

In anemia of chronic inflammatory disease (anemia of inflammation), you may have an increased or normal amount of iron in your body tissues but a low amount in your blood. Inflammation caused by the underlying condition may prevent your body from using the available iron to generate enough healthy red blood cells. This results in anemia.

Anemia caused by CKD occurs mainly as a result of impaired erythropoietin (EPO) production. EPO is a hormone produced by the kidneys. It’s responsible for stimulating the bone marrow to produce red blood cells. When kidney problems impact the secretion of this hormone, fewer red blood cells are produced and anemia occurs.⁶

Cancer treatment, including chemotherapy and radiation, can also affect the bone marrow’s production of blood cells.

Blood disorders

Several blood disorders that are more prevalent in older adults can cause anemia, including thrombotic thrombocytopenic purpura (TTP), leukemia, and myelodysplastic syndromes.

TTP is a life-threatening blood disorder that requires urgent medical attention. It causes many blood clots to form in the small blood vessels, which can block blood flow to vital organs such as the heart, lung, and brain. This condition can also cause red blood cells to break down, leading to hemolytic anemia.⁷

Myelodysplastic syndromes comprise a group of blood cancers. The condition prevents immature blood cells from growing or becoming healthy. As a result, the immature cells fail to work correctly. They either die in the bone marrow or shortly after entering the blood. This leaves less room for healthy red blood cells to form in the bone marrow, causing anemia.

Myelodysplastic syndromes are not among the most common causes of anemia in older adults. However, they cause anemia more commonly in older adults than in younger people.⁸

Unexplained anemia in older adults

In general, the older you get, the higher your risk of anemia. This could be as a result of various factors.

However, in some cases, no causes are found — even after a thorough investigation, including bone marrow analysis. In these cases, the anemia is known as unexplained or idiopathic anemia.

Some research suggests that with age and the natural decline of kidney function, without having any kidney disease, the kidneys may not be able to produce as much EPO to stimulate the bone marrow to produce red blood cells as they used to.⁹

The natural decline of testosterone and estrogen production could also be a factor. These hormones play a role in the process of red blood cell formation and production.

How is anemia diagnosed?

Visit your doctor for evaluation if you think you have anemia.  They will likely ask about your medical history, diet, and family history of anemia (some types of anemia can be genetically inherited, like iron-refractory iron deficiency anemia).

Your doctor may also conduct a physical exam to look for anemia symptoms, such as brittle nails or pale skin, or neurological and cognition issues in the case of vitamin B12 deficiency anemia. They may recommend seeing a hematologist (an expert in blood diseases) if you have anemia.

Tests that may be used for diagnosis include the following:

• Complete blood count (CBC)

• Ferritin test

• Kidney function tests

• Liver functions tests

• Vitamin B12 level tests

• Vitamin B9 (folate) tests

• Bone marrow analysis

These tests will help ascertain whether you have anemia and what’s causing it. 

Other possible diagnostic tests may include the following:

• Genetic tests identify changes in the genes that control red blood cell formation.

• Urine tests examine the level of protein in your urine (proteinuria). Albumin is a protein that leaks into the urine more when you have kidney issues, which could be the underlying cause of your anemia. Urine tests can also identify if there’s any bleeding in the urinary tract.

• An endoscopy investigates bleeding in the upper small intestine, stomach, and esophagus.

• A colonoscopy can identify colon abnormalities such as bleeding or tumors.

Treating anemia in older adults

Anemia treatment depends on the underlying cause. If your anemia is caused by a health condition or by other medications, your doctor may adjust your treatment to manage or stop your anemia.

Other possible treatments for anemia include the following:

• Your doctor can prescribe drugs to boost red blood cell production in your bone marrow.

• Immunosuppressive prescription medicines can be used to manage anemia caused by an autoimmune disease.

• In iron deficiency anemia, your doctor may prescribe iron supplements to increase the iron supply in your body. They may also recommend consuming an iron-rich diet with foods like fish, chicken, liver, baked beans, dried lentils, spinach, and kale.

• If you have vitamin B12 deficiency anemia, your doctor may recommend vitamin B12 supplements or shots.

• A blood transfusion can replace blood lost through injury, internal bleeding, or surgery. A transfusion may also be necessary if your body is not making blood properly.A bone marrow transplant replaces dysfunctional blood-forming stem cells with healthy ones. High doses of chemotherapy or radiotherapy may destroy stem cells in the bone marrow. Then, a bone marrow transplant aims to restore these cells.

Your doctor will tailor the treatment depending on the cause and your specific health needs.

Can you prevent anemia?

Whether your anemia is preventable depends on its cause. Some types of anemia result from unchangeable factors, like genetics. Such anemias cannot be prevented. However, some anemias are caused by manageable factors, like eating habits and treatable conditions.

How serious is anemia in older adults?

In older adults, any degree of anemia greatly contributes to symptoms and mortality. It also has adverse effects on quality of life because it has several serious consequences.

Anemia is related to higher rates of heart and blood vessel (cardiovascular) disease, increased risk of falls and bone fractures, poorer physical performance, and cognitive impairment (difficulty remembering, learning, concentrating, and making decisions).¹⁰ ¹¹

Who is at risk of developing anemia as an older adult?

The risk of anemia increases as you age. Poor diet, intestinal disorders, chronic diseases, certain medications, infections, and underlying health conditions may increase your chance of developing the condition. Talk to your doctor to learn how to manage your situation.

The lowdown

Anemia is common in older adults, and the associated risks also increase with age. The condition means you have fewer properly functioning red blood cells in your body than you need, leading to symptoms like headache, dizziness, shortness of breath, fatigue, and irregular heartbeat.

There are several causes of anemia in this age group, but iron deficiency and chronic disease are the most common. The treatment your doctor recommends will depend on what is causing your anemia.