Anemia in older adults

Research shows that anemia in the older adult is a common problem as the prevalence of the disease
increases with each decade of life once individuals reach age 70 (Beghe, Wilson, & Ershler, 2004; Bhat,
Kirmani, & Raw, 2008; Guralnik, Ershler, Schrier, & Picozzi, 2005). From 2000 to 2004, anemia was the
cause of death for about 10% of Americans age 65 and older, or over 3.6 million persons (National
Center for Health Statistics [NCHS], 2007). With the size of the aging population expected to more than
double, reaching 71.5 million by 2030 (MetLife Mature Market Institute, 2008), the prevalence of
anemia is likely to increase substantially in the near future. Anemia in the older adult has been reported
to have reached crisis levels as anemia is associated with changes in the quality of life, decreased
cognition and functional ability, and an increased risk for falls, infections, morbidity, and mortality (Bhat
et al., 2008; Guralnik et al., 2005). The prevalence, etiology, classification, and diagnosis of anemia in
older adults are reviewed and collaborative interventions identified for its management.

Most adults with iron deficiency have excess blood loss from the gastrointestinal (GI) tract (Guralnik et
al., 1994; Ioannou, Spector, Scott, & Rockey, 2002). Chronic blood loss can occur due to bleeding ulcers,
hemorrhoids, cancer, intestinal lesions, and polyps. A prospective study considered hospitalized iron-
deficient (serum ferritin less than 50 mg/L) patients, age 70 and older, with or without anemia (defined
as hemoglobin <13 g/dL for men, <12 g/dL for women) (Joosten et al., 1999). Of 151 persons in the
study, 97 (about 64%) had both anemia and iron deficiency. Of this group, about 50% (with or without
anemia) had bleeding upper GI lesions. However, the majority (60%) of patients with the lesions had no
GI symptoms masking the etiology of the anemia. Two other studies (Ioannou et al., 2002; Rockey &
Cello, 1993) reported similar results as colon cancer and premalignant tumors were common among
patients with iron deficiency anemia (IDA). The researchers recommended that among iron-deficient
older adults, with or without low hemoglobin, endoscopic studies may be of diagnostic value to find the
underlying etiology (Ioannou et al., 2002; Joosten et al., 1999).