An estimated 13 percent of people 70 and older are anemic, defined as having a hemoglobin concentration below 12g/dL in women and below 13g/dL in men.

Hemoglobin, a protein in red blood cells, gives blood its color. In many older people, anemia is caused by diseases such as cancer, kidney disease and congestive heart failure. But up to 35 percent of cases can’t be directly linked to an illness.

Impacts "Executive Function"

What is known is that anemia takes a huge toll on quality of life.

The Women’s Health and Aging Study recently uncovered preliminary evidence that mild anemia might be a risk factor for what is known as “executive function impairment” in women ages 70 through 80.

Executive function involves the ability to solve problems, plan, and follow through on important activities.

The results, published in the Journal of the American Geriatrics Society, found that anemic women were four to five times more likely to score poorly in tests that measured executive function than women who didn’t have anemia, despite controlling for factors such as age, education, and disease.

Other recent research, reported in the Journal of Gerontology, found that people 71 and older who had anemia were more likely to die, be hospitalized and spend more time in the hospital during the four-year follow-up.

Researchers aren’t certain if anemia actually causes mental and physical decline or whether it is a byproduct of chronic disease or the aging process. But physicians need to be on the lookout for anemia in older patients.

Symptoms

When hemoglobin levels dip, red blood cells can’t carry enough oxygen throughout your body. As a result, you may feel weak or tired, experience shortness of breath, chest pain, dizziness, cold or numb hands and feet, or have headaches. Your skin may turn pale and you may even have cognitive problems.

One cause of anemia is iron deficiency. You may not be getting enough iron in your diet or your body may be losing blood as a result of an ulcer, a colon polyp or regular aspirin use, for example.

Another possible cause: You may not be getting enough folate (folic acid) or vitamin B-12 (which helps produce red blood cells) from food; or your body may not be absorbing these nutrients.

Other causes include cancer, rheumatoid arthritis and kidney failure; bone marrow disease, certain medications, and autoimmune disorders, such as lupus.

Testing for Anemia

A simple blood test can detect low levels of hemoglobin. Treatment for the condition depends on its severity and cause -- one reason your doctor will order tests to rule out various culprits.

In many instances, treating anemia may be a matter of eating more iron–rich foods (See “What You Can Do”), boosting your folate and B-12 intake, or taking an iron, folic acid (B-9) or B-12 supplement.

The View from Duke

Robin Ali, MD, Pharm D, Geriatric Medicine Fellow, says, "Even though routine screening of older adults for anemia is not recommended, it’s important for a health care provider to evaluate an older person for anemia if he or she complains of weakness, fatigue or shortness of breath with exertion, or experiences cognitive difficulty.

"If you have a condition associated with blood loss such as a kidney disorder or a hematological disorder, of course your physician will already be evaluating you for anemia. Most otherwise healthy people should be able to get the iron they need by eating a balanced diet.

"But if you are at all concerned about your iron intake, talk to your physician. He or she can recommend iron-rich foods and discuss whether or not you need a iron supplement. Although anemia is a common occurrence in the elderly, it should not be considered a ‘normal’ part of aging."