Anemia in Seniors: What to Look for and How to Treat It

Decades ago when my grandmother was alive and living with my family, a public health nurse would come to the house once a month and give her a vitamin B12 shot. While I remember this well, it didn’t register with me at that young age how vital this injection was for Grandma. Once I started writing about health issues, I began to understand the seriousness of her condition. It seems that Grandma had pernicious anemia, which is not uncommon in elderly people.

A number of things can cause anemia in seniors, such as chronic disease, iron deficiency, B12 deficiency (like my grandmother), bleeding, and more. It is important to be aware of the signs and symptoms of anemia to make sure it can be medically treated as quickly as possible.

For more information on this condition, I contacted Carole Eldridge, DNP, RN, CNE, NEA-BC, Vice President of Post-Licensure & Graduate Programs at the Chamberlain College of Nursing, and asked her to educate us, as caregivers, about anemia in seniors. Below, Carole shares the knowledge we need to keep watch over our loved ones (and ourselves) as we age.

AgingCare: What exactly is anemia?

Carole: When someone is anemic, the number of red cells in their blood or the amount of hemoglobin in these cells is lower than it should be. This condition is diagnosed by measuring the amount of each through a simple blood test. Anemia can occur due to a loss of blood, insufficient or faulty production of red blood cells (RBCs), or the destruction of these cells.

Hemoglobin is a protein in RBCs that carries oxygen to all the tissues in the body, making it an essential component of health and life. If the hemoglobin level is below 12 grams per deciliter of blood in a woman, and 13 grams per deciliter in a man, that person may be said to be anemic.

AgingCare: What are the signs that we should look for if we suspect anemia in our loved one?

Carole: When older people notice that they are tired or a little weaker than they used to be, they often attribute it to general aging. Sometimes that is a correct assumption. However, common symptoms of “old age,” such as fatigue, weakness, dizziness, irritability, pale skin and shortness of breath, often point to more serious (and treatable) illnesses. These signs should always indicate that a loved one needs to be evaluated by a healthcare provider.

AgingCare: What causes low RBC and hemoglobin levels, and how does it develop?

Carole: Anemia can either be acute, with a sudden and severe onset, or it can be chronic, developing slowly over a long period of time. This difference in the two types reflects the cause of the anemia, and the treatment will be different depending on the cause. Sometimes a cause can’t be found, but even then, anemia can often be treated with good results.

Approximately 13 percent of people older than 70 are anemic. In about 70 percent of these cases, the cause can be identified. The two most common are chronic disease (30-45 percent) and iron deficiency (15-30 percent). Between 5 and 10 percent of cases are due to deficiencies in vitamin B12 or folate. Some of the many possible chronic diseases associated with anemia include ulcers, liver or kidney disease, hypothyroidism, inflammation of the stomach or intestines, and cancer.

It is helpful to think of anemia as a symptom of another underlying condition rather than the primary concern. This is especially true in seniors, who often have multiple health issues. In severe cases of anemia, the heart can become damaged from working harder to circulate enough oxygen throughout the body, but the main threat and target for treatment is still the patient’s underlying health conditions.

AgingCare: What are the implications of overlooking the symptoms and not receiving treatment?

Carole: It is important to detect and treat this as quickly as possible. Anemic seniors are twice as likely to lose some of their physical abilities and experience functional decline as those who are not anemic. Furthermore, studies have found a 150 percent increase in the risk of hospitalization for older people with anemia and a 200 percent higher risk of their admission to a nursing home. Even borderline anemia makes a significant difference. Mildly anemic elders experience 1.5 times the risk of losing physical abilities as those without.

AgingCare: How is anemia due to a nutritional deficiency treated?

Carole: Iron deficiency, vitamin B12 deficiency, and folate deficiency can be relatively easily identified and treated. Addressing nutritional issues can make an enormous difference in the way a senior feels and functions and may prevent the loss of physical abilities that could result in hospitalization or placement in a nursing home. Simple blood tests are used to diagnose these deficiencies and then dietary supplements are typically prescribed.

Low iron is the most well-known cause of anemia, but typically affects younger individuals. When it occurs in seniors, it is usually due to limited absorption in the intestines or gastrointestinal bleeding.

Someone with iron deficiency anemia may be prescribed iron supplements, and it is crucial to follow the healthcare provider’s instructions regarding supplementation. Too much iron intake can cause vomiting, diarrhea, headache, irritability, fatigue, and even heart and joint damage. Even in proper doses, iron supplements can still cause constipation, nausea, diarrhea, and stomach pain.

These side effects may be lessened by taking the pills with food. Iron and calcium supplements should not be taken together, since calcium interferes with the absorption of iron. Timed-release iron supplements are not usually recommended, because absorption is best in the upper part of the digestive tract. Taking these pills with a little orange juice or in conjunction with a vitamin C supplement may help promote absorption as well. Another easy fix may be adding more iron-rich foods to a loved one’s diet. Red meat, egg yolks, nuts, seafood, beans, and whole grains are all healthy sources of this mineral.

Seniors sometimes lose the ability to absorb vitamin B12 from their food. Deficiencies of vitamin B12 may be treated with oral supplements, but injections are usually the most effective treatment. Depending on the severity of the deficiency, these injections may be needed periodically for life. To increase the amount of this vitamin in the diet, seniors should eat beef, poultry, fish, liver, oysters, clams, milk, cheese and eggs.

Folate deficiencies can be helped with a diet that includes plenty of raw or lightly cooked green, leafy vegetables, cruciferous vegetables (broccoli, Brussels sprouts, and cauliflower), fresh fruits, dairy products, and whole grains. A healthcare provider might prescribe a folic acid supplement, which is a form of folate.

AgingCare: How are other types treated?

Carole: When it is caused by a chronic disease, naturally, the best thing to do is treat the underlying condition. This type is also known as “anemia of chronic disease” or ACD, and patients often have adequate iron and nutrients in the body, but they are not being used efficiently in the formation of new red blood cells. Although the reason for this impaired ability to use iron is not known, some experts believe it to be a part of the body’s immune response to prevent bacterial growth and further harm. This is part of why iron supplementation is not an effective treatment for ACD.

Infections, inflammation, hormonal imbalances and malignancy are a few main causes of ACD.
Chronic kidney disease is one specific example, and there are helpful drugs available that stimulate the bone marrow to produce more red blood cells. Another is chronic lymphocytic leukemia (CLL), a type of slow-growing cancer that some seniors live with for years before experiencing noticeable symptoms. Other conditions, such as tuberculosis, diabetes, endocarditis, chronic urinary tract infections (UTIs), osteoarthritis, hepatitis, lupus, pressure ulcers, myeloma and lymphoma can also be culprits. Specific methods of treatment depend entirely on the individual’s overall health and comorbid conditions.

There are other forms of anemia that are less common and require serious medical intervention. Treatment might include steroids, blood transfusions, or even surgery to remove an enlarged spleen, repair abnormal blood vessels, tumors, or heart valves among other things.

Certain medications can also contribute to anemia. This is especially true for older individuals who typically take multiple prescriptions. Numerous medications can have a synergistic effect and cause side effects to have a greater impact on the body. Examples of these medications include ACE inhibitors, angiotensin-receptor blockers (ARBs), and certain antibiotics and anticonvulsants. Cancer treatments like radiation and chemotherapy can also damage bone marrow, where red blood cells are created.

The key to dealing with anemia is always to discover the root cause when possible and then to work with a healthcare provider to treat both the cause and the symptoms.

AgingCare: Thank you, Carole, for answering our questions about anemia and helping us know what to look for. As caregivers, this information is invaluable.

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Anemia in Seniors: What to Look for and How to Treat It