Anemia in Older Adults: What Seniors Need To Know
June 24, 2021 | Preventive Care
What is Anemia?
Anemia is a condition in which the body does not have enough healthy red blood cells to function properly and is caused by red blood cell loss or production problems. Red blood cells provide oxygen to body tissues and are needed for optimal health.
There are many types of anemia, but two of the most common amongst seniors are iron-deficiency anemia and Anemia of Chronic Disease (ACD). According to the American Journal of Hematology, iron deficiency anemia is seen in 24% of those tested 65 years old or older while the World Health Organization reports that the highest prevalence of anemia is in men 85 years and older. The National Heart, Lung and Blood Institute reports that anemia affects more than 3 million Americans.
Iron deficiency anemia is anemia caused by low iron levels. While iron deficiency can occur when you don’t get enough iron in your diet, it can also occur if your body doesn’t absorb the iron you are eating. This can happen in people with celiac disease or after bariatric surgery. The most common cause of iron deficiency anemia is blood loss. This can be overt, with things like bleeding or having blood in your urine. It can also happen over time in small amounts that may not be detected. . Iron is a mineral that makes hemoglobin, an oxygen carrying protein of blood. Your bone marrow needs iron to make hemoglobin and without enough iron, your body can’t produce enough hemoglobin for red blood cells. If you are diagnosed with iron deficiency anemia, it is important to make sure your doctor looks for the cause of the blood loss. Unexplained blood loss can be due to colon cancer or other types of cancer and should not be ignored.
Anemia of chronic disease is anemia found in people with certain long-term (chronic) medical conditions that involve inflammation. It is also referred to as Anemia of Inflammation for this reason. Some people with ACD also have low iron, but not always.
Who’s at Risk?
Elderly populations are more at risk for Anemia of Chronic Disease than other types of anemia because older adults have more chronic diseases caused by inflammation. Anemia of Chronic Disease is more prevalent in seniors since 85% of older adults have at least one chronic condition and 60% have two chronic conditions. In the United States, about 1 million people older than age 65 have anemia of inflammation.
Seniors are more at risk for anemia due to the likelihood of chronic illnesses. Some chronic illnesses that puts seniors at risk to develop anemia of chronic disease and blood loss include:
- Heart failure
- Chronic kidney disease
- Chronic infections like osteomyelitis, tuberculosis, hepatitis B/C, or chronic UTI
- Rheumatoid arthritis
- Autoimmune and blood disorders
- Crohn disease
- Systemic lupus erythematosus
- Ulcerative Colitis
- Cancer, such as colon cancer, lymphoma, and Hodgkin’s
The most common chronic diseases that affect those over 65 years old are cancer and heart failure. Cancer causes inflammation in the body which slows down the production of red blood cells by the bone marrow. Heart failure can cause damage and inflammation to the kidney cells which then reduces the amount of erythropoietin (a hormone that helps make red blood cells) made by the body. Both of these chronic illnesses result in blood loss.
What are the Symptoms of Anemia of Chronic Disease?
Anemia of Chronic Disease displays similar symptoms among people diagnosed. Symptoms of Anemia of Chronic Disease vary from person to person from mild to moderate in severity. The most common symptom of anemia can be no symptoms at all. When the anemia happens over time, many people do not notice any symptoms until it becomes severe. If symptoms do occur, they might include:
- Severe fatigue
- Shortness of breath
- Rapid or irregular heartbeat
- Cold hands or feet
- Pale skin or mouth
- Chest pain
Other chronic illnesses exhibit similar symptoms, so it is important to notify your doctor when these symptoms occur. The importance of regular health checkups are evident to reduce the risk of chronic illnesses and prevent complications from occurring.
What Kind of Tests for Anemia Will My Doctor Perform?
Blood tests are used to diagnose anemia. At your appointment your doctor will discuss your medical history, including chronic illnesses that may cause anemia. This refers to your past medical history and any surgeries performed. Your doctor will also review prescription medications, doses, and the last time doses were taken. During your visit, your provider will perform a clinical evaluation and collect blood tests.
Blood tests for anemia are simple ways to provide additional information about the inner workings of your body using a minimally invasive technique. The following blood tests are used to determine if you have anemia:
- Complete Blood Count (CBC): measures red blood cells, hemoglobin, hematocrit, white blood cells and platelets. This test is generally collected to review the hemoglobin and hematocrit levels instead of the other categories but can be useful in the overall clinical picture.
- Hemoglobin (Hgb): measures how many grams of this oxygen-carrying protein per deciliter of blood gives clinicians an idea of blood loss.
- Hematocrit (Hct): measures the fraction of blood that is made up of red blood cells and gives clinicians an idea of blood volume.
- Serum iron test: measures how much iron is in your blood and gives clues to whether or not your body is low on iron levels. Iron studies should be obtained to evaluate the possibility of iron-deficiency anemia.
Once these samples are collected and sent to the laboratory to be analyzed, your provider can update your chart and call with the results. You should know the results within a few days. If you are diagnosed with anemia, your doctor may suggest other blood tests to look for a cause. This can include an iron test, but may also include testing for other vitamin deficiencies or signs of inflammation. If you are diagnosed with iron deficiency anemia and you are not up to date on your preventive screening tests, especially for colon cancer, your doctor may recommend that you get other screenings as well. Fortunately, these blood tests are covered by Medicare Advantage.
Treatment Options for Anemia of Chronic Disease
The main treatment for Anemia of Chronic Disease is to treat the underlying chronic condition that causes inflammation. Anemia in seniors may be the result of a chronic condition. For example, if you have kidney failure, treatment to improve your kidney function may help prevent your anemia from worsening over time.
Other treatments for Anemia of Chronic Disease include iron supplements, medications, and even blood transfusions. If your body is low on iron, which happens in some people with anemia of inflammation, your doctor will recommend iron supplements. These are tablets taken by mouth to provide an extra, consistent source of iron.
In rare cases, your doctor may prescribe a medication that assists your body in making new red blood cells, which help treat anemia. These medications are called erythropoietin or “EPO” shots and are given subcutaneously into a meaty part of your body, such as your abdomen. These are not needed for most causes of anemia or unless your anemia becomes severe.
In severe cases, you may need a red blood cell transfusion to treat Anemia of Chronic Disease. Blood transfusions are used when blood levels (hemoglobin and hematocrit) are low, as a result of blood loss. Blood is donated and prepared for the use of transfusions by a “Blood Bank”. Every unit of blood donated is carefully inspected for impurities. Blood transfusions are safe and effective. Blood transfusions are given intravenously (IV) by a healthcare professional.
Anemia of Chronic Disease is affected by chronic illnesses; therefore, it is important to take all medications prescribed to you everyday, if you have a chronic condition. Medication management and being compliant with treatment will reduce flare-ups of anemia. Iora Primary Care encourages you to build and maintain a close relationship with your healthcare provider and feel free to share updates about your condition on a regular basis.
How to Prevent Anemia in Older Adults
Anemia in older adults is often mild to moderate and chronic, which is why following up with your healthcare provider helps prevent anemia and promote overall health. Don’t let follow up appointments slip through the cracks. Here are some long-term general guidelines to prevent anemia:
- Eat a healthy diet that includes iron rich foods such as lean red meats, lentils, beans, and iron-fortified cereals and breads.
- Drink enough water (talk with your doctor if you have kidney or heart problems)
- Avoid coffee and tea with meals as this can disrupt iron absorption
- Take medications as prescribed for other chronic conditions
- Exercise regularly
- Avoid infections by washing your hands frequently
- Visit the dentist twice a year to reduce the risk of infections
- Keep track of your anemia symptoms by writing them down
- Follow up with your Iora Primary Care Doctor