Preventing Anemia in Older People - Types of Anemia, Causes and, Management

Introduction:

Anemia is an independent risk factor for increased mortality and morbidity and decreased quality of life in community-dwelling older persons. An increase in functional deterioration is associated with a decrease in hemoglobin concentration in an inverse and linear manner. There are several different types of anemia, but the most common among older people are iron deficiency anemia and anemia of chronic disease. Most cases of anemia are mild, with 2.8 percent of women and 1.6 percent of men having hemoglobin levels less than 11 grams per deciliter.

What Are the Types of Anemia?

The types of anemia are-

• Iron deficiency anemia.

• Vitamin deficiency anemia.

• Anemia of inflammation.

• Aplastic anemia.

• Anemias associated with bone marrow disease.

• Hemolytic anemias.

• Sickle cell anemia.

What Are the Causes of Anemia in Older People?

The most common cause of anemia in older people is as follows-

• Chronic inflammation.

• Chronic kidney disease.

• Nutrient deficiency.

• Undiagnosed malignant diseases.

How Does Anemia Present in Elderly Persons?

Anemia often has an insidious onset in elderly persons. Slower onset of anemia can be well tolerated, with symptoms developing as compensatory mechanisms fail. An older person can present with dyspnea, fatigue, and confusion. As anemia worsens, pre-existing cardiac diseases often become more symptomatic as hemoglobin level decreases. A few signs on physical examination, specific for mild or moderate anemia. Hence it is important to have a high index of suspicion when an older person presents with even subtle symptoms of decline.

What Is Iron Deficiency Anemia?

Iron deficiency anemia is when the body does not have enough healthy red blood cells due to a shortage of iron. Although some cases of iron deficiency anemia may be mild, anemia in the older population can contribute to several adverse outcomes, such as longer hospital stays and even mortality. Multiple factors that contribute to iron deficiency anemia are-

• Low iron intake.

• Vitamin deficiencies.

• Malabsorption.

• Low erythropoietin.

• Bleeding.

• Certain medications.

• Helicobacter pylori infection.

• Chronic diseases like kidney disease, liver disease, cancer, etc.

• Inflammatory conditions.

What Are the Symptoms of Iron Deficiency Anemia?

The symptoms of iron deficiency anemia are-

• Fatigue.

• Weakness.

• Rapid heartbeat.

• Shortness of breath.

• Headaches.

• Chest pain.

How Is Iron Deficiency Anemia Treated?

The first step in iron deficiency anemia is to treat the underlying cause. A doctor may treat the person with supplementary iron in the form of medicines, dietary iron, or intravenous iron to increase iron levels.

• Eating more iron-rich foods. The doctor may suggest some dietary changes, which are as follows-

• Consuming foods high in vitamin C, vitamins B9 and B12 to help improve iron absorption.

• Limiting intaking foods that may block iron absorption, such as dairy or foods high in phytic acid.

What Is Anemia of Chronic Disease?

Anemia of chronic disease is found in people with certain long-term medical conditions that also involve inflammation. It is also known as anemia of inflammation. Elderly people are more at risk for anemia of chronic disease than other types of anemia. It is because older people have more chronic diseases that are caused by inflammation. Some of the chronic diseases that put older people at risk of developing anemia of chronic disease and blood loss include-

• Heart failure.

• Obesity.

• Chronic kidney disease.

• Osteomyelitis.

• Tuberculosis.

• Hepatitis.

• Rheumatoid arthritis.

• Autoimmune and blood disorders.

• Crohn’s disease.

• Ulcerative colitis.

• Diabetes.

• Cancer.

What Are the Symptoms of Anemia of Chronic Disease?

Symptoms of anemia of chronic disease can vary from person to person and are mild to moderate in severity. These symptoms include-

• Fatigue.

• Weakness.

• Shortness of breath.

• Dizziness.

• Irregular heartbeat.

• Headache.

• Cold hands.

• Pale skin.

• Chest pain.

What Are the Treatment Options for Anemia of Chronic Disease?

The main line of treatment for anemia of chronic disease is by treating the underlying chronic condition that is causing inflammation. Anemia in older adults may be the result of a chronic condition. For example, if someone has kidney failure, treatment to improve kidney function may help prevent the anemia from worsening over time.

• Other treatment options for anemia of chronic disease include iron supplements, medications, and sometimes blood transfusions. If the patient’s body is low on iron, which happens in some people with anemia or inflammation, a doctor will recommend iron supplements.

• In rare cases, a doctor may prescribe a medication that can assist the patient’s body in making new red blood cells, which help treat anemia. These medications are called erythropoietin or ‘EPO’ injections that are given subcutaneously.

• In severe cases, the patient may need a red blood cell transfusion to treat anemia of chronic disease. Blood transfusions are used when blood levels are low due to blood loss. Blood is donated and prepared for transfusions. Every unit of blood that is donated is carefully inspected for impurities. Blood transfusions are administered intravenously.

What Are the Diagnostic Tests for Anemia in Older People?

Once anemia is confirmed, a complete blood count test should be done. If bleeding or iron deficiency anemia is suspected clinically, measurement of serum ferritin is also required. The red blood cell size or mean corpuscular volume is used to distinguish microcytic, normocytic, and macrocytic anemias.

How to Prevent Anemia in Older Adults?

The management of anemia in older adults is a clinical challenge, especially when the etiology remains unclear and multiple comorbidities are present. Management and treatment of anemia in older patients require a multidisciplinary approach and detailed investigations of organ function.Anemia in older adults is mild to moderate and sometimes chronic. The following methods should be adopted to help prevent anemia in older adults-

• Eating a healthy and well-maintained diet that includes iron-rich food such as beans, lentils, iron-fortified cereals, lean red meat, etc.

• Drinking plenty of water.

• Avoid coffee and tea during meals, as this can disrupt iron absorption.

• Take medications as prescribed by the physician.

• Regular exercise.

• Maintain proper hygiene.

• Keep track of the symptoms of the anemia.

• Follow-up with the physician should not be missed.

Conclusion:

There are various factors that can cause anemia in older people, but anemia of chronic disease and iron deficiency anemia is the most common among the older population and needs to be treated as they develop severe complications in this age group. By treating the underlying causes and symptoms of the disease, anemia can be prevented, and the elderly can be helped to maintain their lifestyle effectively.