Anemia is a disorder in which the number of red blood cells or the hemoglobin concentration in red blood cells is lower than normal. 

Hemoglobin is needed to carry oxygen. If you have too few red blood cells or not enough hemoglobin, there will be a decrease in the blood’s ability to carry oxygen to the tissues of the body.  

Anemia can be temporary or long-term, ranging from mild to severe. 

Anemic patients may appear pale, feel cold, fatigue, tire quickly, have weakness, dizziness, or lightheadedness, impaired balance and increased risk of falling, develop rapid heartbeats, and become short of breath. 

Anemia is associated with decreased walking speed or the ability to get up from a chair, impaired mental abilities such as thinking, memory, and learning (cognitive performance), depressive symptoms, and diminished quality of life. 

Anemia is a common condition in older people, although it is not caused by normal aging. 

It has many causes, some of which you can control. For example, in the elderly, a poor diet can lead to anemia.

Anemia is more common in women than men, but from age 65, it occurs more often in men. It is diagnosed in about 20% of men and 15% of women over 80.

Types of anemia

iron deficiency

Iron is one of the main building blocks for producing red blood cells. Iron levels in the body may be too low if your body does not absorb iron from your food, if you do not eat enough iron-containing foods, or if you bleed and lose iron faster than you expect. You can consume it. Low iron is a prevalent cause of a low red blood cell count.

Anemia associated with chronic diseases

Anemia associated with chronic diseases is the result of chronic inflammation caused by ongoing infections, tissue damage, various forms of arthritis, benign or malignant tumors, or a variety of chronic medical conditions.  

Pernicious anemia

It occurs when you don’t have enough vitamin B12 or folic acid. 

hemolytic anemia

This type of anemia occurs when a disease destroys your red blood cells.

The causes

The three main reasons why anemia can occur are described below. In the elderly, anemia is often the result of several conditions simultaneously. These conditions may include the following:

  • Decreased red blood cell production caused by:
    • Bone marrow function problems
    • Chronic diseases or inflammation, such as cancer or infections
    • Hormonal problems
    • kidney disease
    • Malnutrition and dietary deficiencies of iron, vitamin B12, or folic acid (folate)
    • Hereditary disorders
    • Medications
    • Alcohol addiction
  • Blood loss due to:
    • stomach irritation caused by drugs, alcohol, or an ulcer
    • polyps or tumors in the intestines
    • kidney stones or tumors
    • cancer
    • surgery 
  • Increased destruction of red blood cells caused by:
    • Medications
    • A hereditary disorder
    • A disease of your immune system
    • Heart valve problems (which damage your red blood cells)
    • A tumor
    • Infections


Symptoms of anemia may include

  • Fatigue
  • weakness
  • Shortness of breath
  • Dizziness
  • Pale skin color
  • Be cold
  • Behavioral changes, such as lack of interest, confusion, agitation, or depression
  • If you have heart disease and anemia, you may notice increased chest pain or swelling in your ankles.

Diagnosis and tests

The cause(s) of anemia in the elderly can be challenging to diagnose. Many conditions can cause anemia in older people, and several can co-occur. 

Even with a thorough evaluation, in 20% of cases, the underlying cause of anemia is not found. If you have symptoms of anemia, your healthcare professional will perform a complete history and physical exam and take a blood sample for a total blood count.

Anemia is diagnosed if the amount of hemoglobin (the part of the blood cell that carries oxygen) is lower than usual (less than 13 g/dL in men and less than 12 g/dL in women ). Your healthcare professional may also test your blood to measure your iron, vitamin B12, and folate levels and recommend special blood tests to determine how well your body stores and uses iron.

Your healthcare professional may perform additional tests to determine if you have any underlying disease or problems, such as ulcers or polyps, which could be causing chronic internal bleeding. These tests may include the following:

  • Additional blood tests
  • X-rays
  • endoscopy.
  • Bone marrow biopsy.

Care and treatment of anemia

Treatment for anemia will depend on the type you have been diagnosed with.

If you are diagnosed with iron deficiency anemia, your healthcare professional may prescribe oral iron supplements (usually ferrous sulfate or ferrous gluconate). Treatment may need to continue for six months or more. A typical treatment schedule is 325 mg ferrous sulfate 1-2 times daily, 1 hour before or 2 hours after a meal. Orange juice or oral vitamin C supplements can help you absorb iron. Antacids, H2 receptor blockers, proton pump inhibitors, calcium supplements, and some antibiotics (tetracycline, quinolones) can interfere with iron absorption.

Oral iron supplements’ most common side effects are indigestion, nausea and vomiting, constipation, diarrhea, and dark stools. If you experience uncomfortable side effects, your healthcare professional may suggest a lower dosage or frequency, or you can try a different formulation. There is no significant difference between oral iron preparations, but one preparation may be better tolerated than another by an individual patient. Liquid iron drops may be better absorbed, but their side effects are similar to those of iron tablets.

Suppose you are diagnosed with anemia due to vitamin B12 or folate deficiency. In that case, your healthcare provider may prescribe periodic injections or oral supplements of vitamin B12 or folic acid (the synthetic version of folate).

If you have hemolytic anemia, your healthcare provider might prescribe steroids or even recommend surgery to remove your spleen if it’s enlarged.

Anemia caused by kidney disease or chemotherapy may require injection treatments (called erythropoietin-stimulating agents) to increase the production of red blood cells in the bone marrow.

You may need a blood transfusion if your blood count is meager or you have severe anemia symptoms.

Lifestyle and management

Some types of anemia can be managed with a healthy, balanced diet rich in iron, vitamin B12, folic acid, and vitamin C, which helps your body absorb iron. Because meat is a primary source of some of these nutrients, strict vegetarians should have periodic blood tests and discuss the need for supplements with their healthcare provider.  

  • Iron is found in red meat, poultry, and fish (like salmon, tuna, and shrimp). Other iron-rich foods include beans, lentils, dark green leafy vegetables, dried fruits, nuts, soy, and iron-fortified cereals and bread.
  • Folate is found in fortified cereals, meat, spinach, beans, citrus fruits and juices, cantaloupe, papaya, and bananas.
  • Vitamin B12   is most abundant in meat, fish, dairy products, and fortified cereals.
  • Vitamin C   is found in citrus fruits, melons, berries, bell peppers, broccoli, Brussels sprouts, and kale.