Your father has been napping more, gets winded walking to the mailbox, and looks paler than usual. He says he's just old. At his checkup, a blood test shows anemia, and the doctor wants more tests. You wonder how worried to be.
Anemia is common in older adults and usually treatable, but it's important to find the cause. Here's what families should know.
What anemia is
Anemia is a condition in which the blood has fewer healthy red blood cells or less hemoglobin than normal. Hemoglobin is an iron-rich protein that gives blood its red color and carries oxygen from the lungs to the rest of the body1. When there isn't enough, the body's tissues get less oxygen, which can make a person feel tired or weak2.
Mild anemia is a common and treatable condition that can develop in anyone2. In older adults, even mild anemia can affect energy, thinking and physical function, and it may point to an underlying health problem worth finding.
Signs and symptoms
Anemia can make you feel tired, cold, dizzy and irritable1. Other signs include shortness of breath, especially with activity, pale skin, a fast or irregular heartbeat, headaches, cold hands and feet, and trouble concentrating. In older adults, symptoms can be subtle and develop slowly, so they're easy to blame on age.
Anemia can also worsen other conditions. It can make heart failure symptoms worse, contribute to confusion, and raise the risk of falls through dizziness and weakness. See dizziness in the elderly and fall prevention for the elderly.
Common causes in older adults
| Cause | Notes |
|---|---|
| Iron deficiency | The most common cause; may come from slow bleeding or poor intake |
| Vitamin B12 or folate deficiency | Poor absorption or diet; can also cause nerve and memory problems |
| Chronic kidney disease | Kidneys make less of a hormone that signals red cell production |
| Chronic inflammation or illness | Infections, arthritis, cancer |
| Bleeding | Stomach or bowel bleeding, sometimes from medicines |
| Bone marrow problems | Less common; may need a specialist |
The most common cause of anemia is not having enough iron1. Anemia may also be a sign of a more serious condition, such as bleeding in the stomach, inflammation from an infection, kidney disease, cancer, or autoimmune diseases2. In some older adults, no clear cause is found, and the doctor may simply monitor blood counts over time.
Iron deficiency
The body needs iron to make hemoglobin1. In older adults, low iron often comes from slow blood loss, such as from the stomach or bowel, rather than from diet alone. Blood thinners, aspirin and anti-inflammatory pain relievers like ibuprofen can raise the risk of stomach bleeding. That's why doctors often look for a source of bleeding, which may include tests of the stool or a colonoscopy or upper endoscopy, depending on your parent's health and wishes.
Poor appetite and limited diets can also lower iron. See when an elderly parent isn't eating.
Vitamin B12 and folate
People who don't get enough iron or certain vitamins are at higher risk for anemia2. Vitamin B12 deficiency is common in older adults because the stomach absorbs it less well with age, and some medicines, including some for acid reflux and diabetes, can lower B12. Low B12 can also cause numbness or tingling, balance problems, and memory or mood changes, so it's worth checking in anyone with new confusion. See early signs of dementia for why doctors check B12 when memory changes.
Kidney disease and chronic illness
Healthy kidneys make a hormone that tells the body to produce red blood cells. When kidneys don't work well, anemia often follows. See kidney failure in the elderly. Long-term conditions such as rheumatoid arthritis, infections, heart failure and cancer can also cause anemia by affecting how the body uses iron and makes red cells.
Medicines and treatments
People who take certain medicines or treatments are at higher risk of anemia2. Blood thinners and anti-inflammatory drugs can cause bleeding; some medicines reduce absorption of iron or B12; and cancer treatments can affect the bone marrow. Bring a full medicine list, including over-the-counter drugs and supplements, to the doctor. See polypharmacy in the elderly.
How anemia is diagnosed
A complete blood count, or CBC, measures hemoglobin and red blood cells. If anemia is found, the doctor may check iron levels, vitamin B12 and folate, kidney function, and markers of inflammation. The size and shape of red cells give clues about the cause. Depending on the results, the doctor may look for bleeding or refer your parent to a blood specialist, called a hematologist.
Treatment
Treatment depends on the cause. For some types of mild to moderate anemia, iron supplements, vitamins, or medicines that help the body make more red blood cells may be needed2. B12 may be given as pills, a nasal spray or shots. Treating the underlying condition, such as stopping a source of bleeding or managing kidney disease, is often the key. For severe anemia, iron may be given through a vein, or a blood transfusion may be needed.
Ask the doctor what's causing your parent's anemia, how it will be treated, how soon they might feel better, and when blood will be rechecked.
Taking iron safely
Don't start iron pills without testing, since iron isn't right for every kind of anemia and too much can be harmful. If the doctor prescribes iron, ask how and when to take it. Iron can cause constipation, nausea and dark stools. Taking it with food may ease stomach upset, though it can reduce absorption; some doctors suggest every-other-day dosing. Iron can interfere with some medicines, such as thyroid pills and certain antibiotics, so space them apart as the pharmacist advises. See constipation in the elderly if iron causes problems.
Food sources
Foods rich in iron include red meat, poultry, fish, beans, lentils, tofu, spinach and iron-fortified cereals. Vitamin C from citrus, tomatoes or peppers helps the body absorb iron from plant foods. B12 is found in meat, fish, eggs, dairy and fortified foods. Diet alone usually can't fix moderate anemia, but it helps. If your parent has trouble shopping or cooking, home-delivered meals may help; see SNAP for seniors.
When to call the doctor
Call the doctor for new or worsening tiredness, shortness of breath, dizziness or fainting, chest pain, a racing heart, black or bloody stools, or vomiting blood. Chest pain, fainting or heavy bleeding need emergency care. If your parent is on a blood thinner, know the signs of bleeding and keep the doctor's number handy.
Living with anemia
While anemia is being treated, your parent may tire easily. Help them pace activities, rest between tasks, and get up slowly to prevent dizziness. Keep the home warm, since anemia can make people feel cold, and keep a sweater or blanket nearby. Ask family and friends to help with errands and chores while energy is low, so your parent can save strength for what matters most to them. Encourage regular meals. As treatment works, energy often improves within weeks, but it can take months for blood counts to return to normal.
Care planning
For some older adults, finding the cause of anemia means invasive tests. A frail parent may prefer a simpler approach. Talk with the doctor about the benefits and burdens of each test, and include your parent's goals. Make sure someone has authority to make health decisions if your parent can't; see power of attorney.
Is anemia just part of aging?
Anemia becomes more common with age, but it is not a normal part of getting older. A low blood count is a sign that something is affecting how the body makes, uses or loses red blood cells. Even when the cause turns out to be simple, like low iron from a limited diet, treating it can improve energy, strength and quality of life. If a doctor finds anemia and doesn't explain the cause or a plan, it's fair to ask what comes next.
Keep a copy of your parent's blood test results over time. Seeing whether hemoglobin is slowly drifting down or suddenly dropped helps the doctor decide how urgently to look for a cause.
Preparing for the appointment
Before the visit, write down your parent's symptoms and when they started, any changes in stool color, recent falls or bleeding, and what they typically eat in a day. Bring every medicine and supplement, including aspirin and pain relievers. Questions to ask: What type of anemia is this? What's causing it? Do we need more tests, and what do they involve? What treatment do you recommend, and what side effects should we watch for? When will you recheck blood work? Should any current medicines change? Going with your parent helps, especially if they tire easily or have memory problems; see the Medicare annual wellness visit for keeping regular checkups on track.
An example
Linda's mother, 84, was tired all the time. Blood tests showed iron-deficiency anemia. Her doctor noticed she'd been taking ibuprofen daily for arthritis and ordered tests that found a small stomach ulcer. She stopped the ibuprofen, started a stomach medicine and iron pills, and switched to a safer pain plan. Two months later, her energy was back and her blood count was nearly normal. This is an illustration; the cause and treatment of anemia vary.
