Are You at Risk for Anemia?
According to the American Society of Hematology, almost 10 percent of people age 65 and older have anemia, and more than 20 percent of those age 85 and older are affected. Although the condition is easy to overlook, it can have serious consequences—it correlates with decreased performance on tests of physical function, and increased mortality in the elderly. “It also can be a sign of numerous underlying medical conditions,” says Louis Aledort, MD, PhD, professor of medicine, hematology and medical oncology at Mount Sinai. “If you have any symptoms that may indicate anemia, it is critical that you raise them with your primary care physician, who can refer you to a hematologist if necessary.”
What is Anemia? Anemia is a condition in which there aren’t enough healthy red blood cells to carry sufficient oxygen to the tissues in the body. “Insufficient oxygen prevents the body from generating enough energy to properly fuel all of its systems, resulting in poorer overall functioning,” Dr. Aledort explains.
“Fatigue is the most common symptom of anemia—unfortunately it is also a symptom that many older adults may dismiss as a ‘normal’ part of aging, but if you are suffering from fatigue you should mention this to your doctor,” says Dr. Aledort. “Other symptoms of anemia include shortness of breath, weakness, dizziness, and pale skin.”
Anemia is detected by a blood test that measures hemoglobin (Hgb), a substance in red blood cells that contains iron as well as proteins that transport oxygen. A hemoglobin level in the range of 14-17 grams per deciliter (g/dL) for men, and 12-15 g/dL for women is regarded as normal. Levels lower than 13 g/dL in men and 12 g/dL in women indicate anemia.
Possible Causes Anemia is frequently caused by a deficiency in iron, folate, or vitamin B12. “Iron plays a vital role in the body’s production of hemoglobin, while folate and vitamin B12 are essential for red blood cell formation,” Dr. Aledort says. A B12 deficiency is common in older adults because as we age, the level of acid produced in the stomach falls too low to properly absorb the vitamin from food. Other possible nutrition-related causes of anemia include following a vegetarian or vegan diet—both can cause deficiencies in iron and vitamin B12. “If you are a vegetarian or vegan, consult a registered dietitian to ensure that you are consuming a nutritious diet,” Dr. Aledort advises. “You may need to take a daily multivitamin.”
Undetected blood loss due to gastrointestinal (GI) bleeding is another risk factor for anemia. GI bleeding is a risk in people who regularly take nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil®, Motrin®) and naproxen (Aleve®, Naprosyn®), and in those who take anticoagulants (blood thinners) such as warfarin (Coumadin®). “GI bleeding also may be caused by colorectal cancer. Signs that may red-flag a GI bleed include vomiting blood, and tarry or bloody bowel movements.
Chronic infections (including urinary tract infections) also make you susceptible to anemia, as do certain diseases (including cancer, rheumatoid arthritis, and kidney disease), and gastric conditions that affect the absorption of nutrients from food (like celiac disease, and Crohn’s disease). “Drugs that treat other health conditions also may underpin anemia,” Dr. Aledort adds. Common culprits include anti-seizure drugs, drugs used to treat HIV and hepatitis C, some antibiotics, and drugs that treat gastroesophageal reflux disease, as well as those already mentioned that raise the risk for bleeding.
Treating Anemia In all cases of iron deficiency anemia, an evaluation to rule out GI bleeding must be undertaken. “This type of anemia is treated with iron supplements,” Dr. Aledort says. “However, you should not take iron unless you have been advised to do so by your doctor.” Ensuring that your diet includes iron-rich foods, such as beans, lentils, fortified cereals, enriched grains, and chicken also can help. Red meat also is rich in iron but should be consumed in moderation due to its saturated fat and cholesterol content. As for folate, dark green leafy vegetables, beans, lentils, and fortified cereals are good dietary sources, and folate also can be boosted with folic acid supplements.
As well as anemia, vitamin B12 deficiency can result in neurological symptoms such as memory loss, numbness, tingling, and abnormal gait—studies also associate low B12 with an increased risk for osteoporosis, and fractures of the hip and spine (see our cover article). Fish, poultry, eggs, milk, and soy products are rich in B12—however, Dr. Aledort emphasizes that some older adults cannot absorb sufficient vitamin B12 from food. “These individuals need daily oral supplements or monthly injections of the vitamin,” he notes.
When anemia occurs because of a chronic infection or disease, the primary focus of treatment is on the infection or disease itself. “Treating the underlying cause typically reverses the anemia,” says Dr. Aledort, “but it is vital to accurately diagnose the underlying condition, since some infections and diseases require a complicated treatment regimen, and regular check-ups may be needed to monitor possible treatment side effects.”
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