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Let’s not ignore anemia in older people

Let’s not ignore anemia in older people

Many people feel tired and listless in the twilight of their lives because of low blood hemoglobin levels but are rarely treated for it

Anaemia in elderly

If an aged parent or elderly person in the family looks pale all the time, feels fatigued or complains of frequent headaches, the reason may not be advancing age alone. These could be a sign of anemia; the causes range from a mild deficiency to a serious condition that may need immediate attention.

World Health Organisation estimates point out that 12–50 per cent of individuals over the age of 65 may be suffering from anemia with the numbers going up with increasing age. The prevalence is highest among old people in nursing homes. In senior citizens over the age of 85, anemia may be found to be as high as 80 per cent. Regular health check-ups and blood tests will ensure that low hemoglobin levels do not go unnoticed for long, and help pick up any underlying condition, so that prompt treatment may be provided.

How does anemia occur?

Anemia is a condition where the body does not produce adequate red blood cells (RBCs) to carry oxygen to the tissues. Most of the RBCs in the body are manufactured in the bone marrow, which is the soft tissue present inside the bones.

Anemia is diagnosed by checking the RBC count or the amount of hemoglobin in the blood. Hemoglobin is the protein inside the RBCs that transports oxygen. Doctors consider hemoglobin levels of less than 12 g/dL in women and less than 13g/dL in men to be indicative of anemia.

Symptoms of anemia   

  • Fatigue and lack of energy
  • Overall weakness and listlessness
  • Irritability and lack of concentration
  • Headaches
  • Dizzy spells
  • Paleness of skin
  • Shortness of breath

Causes for anemia in elderly citizens

  • Iron deficiency
  • Vitamin B12 and folic acid deficiency
  • Peptic ulcers
  • Hookworm infection
  • Myelodysplastic syndrome
  • Chronic kidney disease
  • Colon polyps and colon cancer

“The most common cause of anemia in the elderly is iron and vitamin B12 deficiency, which is easily treatable by iron and B12 supplementation. An elderly person who is on a predominantly vegetarian diet is more likely to have a B12 deficiency. In some older persons, anemia may be caused by an untreated ulcer or a cancerous growth, which causes internal bleeding,” says Dr Steve Paul Manjaly, consultant geriatrician at Apollo Hospitals, Bengaluru.

“Underlying colon polyps (small growth in the colon) or colon cancer could be a reason for low hemoglobin levels, so it is important to do a colonoscopy to rule out the condition. Myelodysplastic syndrome, a disorder where the bone marrow does not function properly can cause anemia in elderly people,” he adds.

Anemia is often considered to be an inevitable part of the ageing process. But experts say this is not true. A hemoglobin level less than 10 g/dL is not normal and must be evaluated for possible deficiencies or a chronic condition. Extremely low levels of hemoglobin also increase the risk of heart failure.

“In chronic diabetes patients, there is always a risk of kidney disease. Healthy kidneys produce a hormone ‘erythropoietin’ that helps the bone marrow to make RBCs. That’s why, when a blood test shows a low RBC count, a proper evaluation must be done to check for chronic kidney disease,” says Dr Manjaly.

Tips to prevent anemia in elderly

  • Maintain a good diet that includes leafy green vegetables, fruits and whole grains that provide important nutrients — iron, vitamins and minerals.
  • Go for regular health check-ups and do blood tests every three to six months even if you are feeling well, to rule out an underlying condition.
  • Avoid smoking and alcohol consumption.
  • Focus on staying fit and doing regular physical activity, as this will give you an idea of your energy levels and whether you are feeling tired easily.
  • Be aware of your health needs and do not ignore symptoms like fatigue and shortness of breath. Consult a doctor whenever necessary.

Treatment for anemia 

Doctors may advise oral iron medications or iron supplements given through the intravenous route for mild to moderate iron-deficiency anemia.

In case of vitamin B12 deficiency, supplements in the form of oral medicines or B12 injections may be necessary.

“Bone marrow stimulation therapy may be recommended for elderly persons diagnosed with anemia caused by chronic kidney disease or myelodysplastic syndrome. Patients with dangerously low levels of hemoglobin may need a blood transfusion,” says Dr Manjaly.

In case of stomach ulcers or cancerous growth, appropriate medication and therapy are recommended.

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