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

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A number of things can cause anemia in seniors, such as chronic disease, iron deficiency, vitamin B12 deficiency and bleeding. While this may not seem like a serious health issue, studies have found that anemic seniors are more likely to lose physical abilities, experience functional decline, be hospitalized and be admitted to nursing homes compared to seniors without the condition. Even borderline anemia can contribute to these health outcomes, therefore, it is important for caregivers to be aware of the signs and symptoms to ensure it is detected and treated in a timely manner.

What Is Anemia?

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. Anemia can occur due to a loss of blood, insufficient or faulty production of red blood cells (RBCs), or the destruction of these cells. This condition is diagnosed by measuring the amount of each through a simple blood test.

“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,” explains Carole Eldridge, DNP, RN, CNE, NEA-BC, Vice President of Post-Licensure & Graduate Programs at the Chamberlain College of Nursing. “If the hemoglobin level is below 12 grams per deciliter of blood in a woman, or 13.5 grams per deciliter in a man, that person may be said to be anemic.”

Signs of Anemia

When older people notice that they are tired or a little weaker than they used to be, they often attribute it to general aging. Eldridge says that this assumption is sometimes correct, but 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,” she asserts.

Causes of Anemia

Anemia can either be acute, with a sudden and severe onset, or it can be chronic, developing slowly over a long period of time. The difference in onset can shed light on the cause of the anemia, and also helps to determine which course of treatment will be most effective. In some cases, a clear cause can’t be found, but even then, anemia can often be treated with good results.

According to the American Society of Hematology, approximately 10 percent of Americans over age 65 are anemic. The two most common causes are chronic diseases (such as ulcers, liver or kidney disease, hypothyroidism, inflammation of the stomach or intestines, and cancer) and iron deficiency. Deficiencies in vitamin B12 or folate are not as common.

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,” Eldridge says. 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. “It is helpful to think of anemia as a symptom of another underlying condition rather than the primary concern,” Eldridge advises.

Iron Deficiency Anemia

While they are less common causes of anemia in the elderly, iron deficiency, vitamin B12 deficiency and folate deficiency can be 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,” Eldridge encourages. 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 it typically affects younger individuals. Eldridge states that when it occurs in seniors, it is usually due to limited iron 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,” she urges. 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 Eldridge says that injections are usually the most effective treatment. 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.

Treatments for Anemia Caused By Chronic Diseases

When anemia is caused by a chronic disease, naturally, the best thing to do is treat the underlying condition. This is also known as “anemia of chronic disease” or ACD. Patients with ACD 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,” Eldridge speculates. “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. Other conditions can also be culprits. “Chronic kidney disease is one specific example, and there are helpful drugs available that stimulate the bone marrow to produce more red blood cells,” suggests Eldridge. 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 or repair abnormal blood vessels, tumors, or heart valves.

“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,” Eldridge recommends.

Carol Bradley Bursack

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Over the span of two decades, author, columnist, consultant and speaker Carol Bradley Bursack cared for a neighbor and six elderly family members. Her experiences inspired her to pen, "Minding Our Elders: Caregivers Share Their Personal Stories," a portable support group book for caregivers.

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