Iron deficiency anemia is a condition in which the body does not have enough healthy red blood cells due to a shortage of iron. It is common among older adults, with possible causes including nutritional deficiencies, blood loss, taking certain medications, and poor absorption.
The body uses iron in the production of red blood cells (RBCs), which transport oxygen around the body. Without sufficient iron, a person may not be able to produce enough healthy RBCs to satisfy the body’s needs. The result may be iron deficiency anemia, which can cause symptoms such as fatigue, weakness, and shortness of breath.
A person typically receives iron from their diet. However, a dietary deficiency or the body’s inability to use iron correctly can lead to iron deficiency anemia. This condition is common among older adults due to multiple contributing factors that can affect how the body gets or uses dietary iron.
In this article, we discuss the prevalence of iron deficiency anemia in older adults and explain how to treat and manage the condition.
Other evidence notes that anemia is most frequent in older age, potentially affecting about 17% of the population over the age of 65 years. Research also suggests that iron deficiency anemia, specifically, accounts for about one-third of anemia cases in older adults.
Although some cases of iron deficiency anemia may be mild, anemia in older adults can contribute to a number of adverse outcomes, including longer hospital stays and even mortality. As a result, doctors will work to diagnose and treat even mild cases of anemia.
Multiple underlying factors can play a role in iron deficiency anemia, more than one of which may contribute to a person’s diagnosis. These can include:
Lower dietary intake of iron may cause symptoms if the body does not get enough iron to replenish healthy RBCs. People who follow certain diets, such as vegans, or those who do not consciously eat enough iron-rich foods may have an increased risk of anemia.
Other vitamin deficiencies
Even with a diet high in iron, a person lacking other important vitamins may still be at risk of developing iron deficiency anemia. Deficiencies in B vitamins — such as vitamin B12 or vitamin B9, which is also called folic acid or folate — are also quite common and may affect iron absorption.
If the body cannot use iron properly — for example, due to a gastrointestinal disorder — even a high intake of iron may not be sufficient to balance iron levels. Health issues that affect iron absorption may, therefore, cause iron deficiency anemia as a secondary issue.
Erythropoietin (EPO) is a hormone that the kidneys produce. EPO helps stimulate the production and repair of RBCs. Conditions that could affect EPO levels may also lead to iron deficiency anemia. These conditions include those affecting the kidneys and hormone-related disorders.
Bleeding may cause a person to lose enough healthy RBCs that they develop anemia. External bleeding may occur as the skin ages and becomes thinner, making cuts and scrapes more likely. These cuts and scrapes may also take longer to heal.
Conditions that cause internal bleeding, such as ulcers or issues in the stomach or intestines, may reduce the number of healthy RBCs in the body and lead to iron deficiency anemia. Trauma or injury can also sometimes cause hidden internal bleeding, leading to blood loss.
Some medications or combinations of medications may also increase the risk of internal bleeding, particularly with prolonged use. People in medical care who need regular testing may undergo very frequent blood draws, which could contribute to the issue.
Altogether, bleeding may be a contributing factor to RBC loss and anemia in many people. Research from 2018 notes that bleeding from medications and underlying conditions is the most frequent cause of iron deficiency anemia in older people.
Several medications can potentially alter the RBC count. Medications that affect the kidneys or hormones may cause imbalances in key compounds and impair the creation of RBCs.
Medications that affect digestive absorption may make it difficult for the body to process iron or other important vitamins, such as B vitamins. Some drugs, including chemotherapy drugs, can affect the bone marrow, which is responsible for making healthy RBCs. Combinations of some drugs may also have unknown effects that could alter how the body makes or uses RBCs.
It is advisable for people to check the possible side effects of a drug and discuss the possibility of a drug causing symptoms of iron deficiency anemia with a doctor.
H. pylori infection
Some infections may cause issues with how the body uses iron. Research from 2019 notes that Helicobacter pylori infections are common in aging populations, affecting up to 50% of those aged over 60 years. Complications from H. pylori infections can include anemia.
Chronic conditions may cause various issues in the body, potentially affecting RBCs or other systems involved in making or using RBCs. Some examples include:
- conditions in the intestines or stomach
- liver disease
- kidney disease
Doctors will consider possible underlying conditions when making a diagnosis.
Some conditions may cause chronic inflammation in the body. Depending on the type and area of the inflammation, it may interfere with bodily functions, such as making RBCs. Anyone with a chronic inflammatory condition or other issue leading to long lasting inflammation may wish to consider contacting a doctor to discuss their risk.
The symptoms of anemia vary among individuals, but some common symptoms include:
- rapid heartbeat
- shortness of breath
- chest pain
People with light skin tones may also notice their skin becoming paler or slightly yellow.
A complete blood count (CBC) test can help measure the different types of blood cells and other components of the blood, such as hemoglobin, which is a protein that carries oxygen. A low hemoglobin count may indicate a low RBC count and anemia.
Doctors may also administer a packed cell volume (PCV) test to measure hematocrit levels. The hematocrit level is the percentage of RBCs in the blood. A PCV test may help show that a person has too few RBCs, which may indicate anemia.
In addition to blood tests, doctors may use follow-up tests to check for other important factors related to anemia. They may perform a C-reactive protein test to look for inflammation markers or a reticulocyte count to evaluate bone marrow production. In addition, they may check for:
- sufficient levels of B vitamins
- kidney function
- abnormalities in the gastrointestinal tract
- blood in the urine or stool
- H. pylori infection
Doctors may recommend different methods for treating anemia depending on its underlying cause and severity. The treatment can vary in each case, as multiple factors may be contributing to the condition.
If an underlying condition is responsible for anemia, the doctor will look to treat this condition. This may resolve the anemia or help them find any other underlying causes.
If the doctor suspects that a medication or combination of medications is causing anemia, they may recommend alternative drugs, if available. Alternatively, they might suggest other ways to manage anemia until the person can get off the medication.
A person with iron deficiency anemia will need to ensure that they get sufficient iron and other key nutrients in their diet.
Tips for doing this include:
- eating more iron-rich foods, such as dark leafy greens, animal products, and beans
- consuming foods high in vitamin C and vitamins B9 and B12 to help improve iron absorption
- limiting the intake of foods that may block iron absorption, such as dairy or foods high in phytic acid
- taking iron supplements with food to reduce the harsh feeling on the stomach
Any older adults who are experiencing symptoms that may indicate iron deficiency anemia, such as fatigue and shortness of breath, should consider contacting a doctor for a diagnosis.
Individuals with underlying conditions that can affect iron absorption may wish to discuss with their doctor how to reduce their risk of iron deficiency.
Iron deficiency anemia is common in older populations, and multiple factors can play a role in its development. Potential causes of iron deficiency anemia in this age group include blood loss, nutritional deficiencies, medications, underlying conditions, and malabsorption.
Individuals experiencing symptoms of iron deficiency anemia should consider contacting a doctor for a diagnosis. The doctor should be able to advise how to increase dietary iron intake or treat underlying conditions that may affect iron absorption.