Geriatric Anemia; An Overview of Symptoms, Causes, Diagnosis and Treatment

In the United States, 40 – 60% of geriatric patients suffer from anemia with a significant number of deaths attributed to the condition. With females more likely to suffer than males, anemia can be debilitating, inhibit daily living activities and lead to misdiagnosis in the elderly patient. Understanding the cause and origin of anemia in the elderly, anemia symptoms, diagnosis and treatment, will provide caregivers, adult children and physicians the tools necessary to assess and provide the appropriate care and guidance to the elderly patient.

Anemia in the elderly can be caused by a variety of factors including genetics, vitamin deficiencies, iron deficiency and disease. The most common cause of anemia in the geriatric patient is attributed to chronic disease, including inflammatory disease, malignancy and chronic infection. Only second to chronic disease, geriatric anemia is also attributed to decreased nutritional value, specifically lack of folate and cobalamin (vitamin B12). Additionally, It is important to note that many cases of geriatric anemia have no underlying cause; approximately 15%.

Hemoglobin, found naturally within the body and located in the red blood cells, provide the body with oxygen. To do this, red blood cells must be rich in iron. Produced in the bone marrow, iron promotes red blood cell production which, in turn, transports oxygen throughout the body thus providing the patient with energy and a mental feeling of alertness. When in an anemic state, blood laboratory tests will reveal the body contains too few red blood cells as the body may be destroying the cells at a rate greater than production or the cells simply are not producing due to a lack of iron. In elderly patients suffering from bone marrow related disease, anemia is a significant issue and often contributes to death.

Symptoms of anemia are varied and may include weakness, pale skin, frequent headache pain, dizziness, low body temperature and chest pain. In some cases, cognitive deficit or slowness may be present. Unfortunately, in some geriatric patients, these symptoms may be difficult to describe by the individual, especially in those who have lost speech ability. Of additional concern is the tendency of the medical community to misdiagnosis anemia as an unrelated condition or attribute anemia symptoms to a consequence of aging. By doing so, the physician may lose an opportunity to diagnose a chronic disease while in its early stages, ie. gastrointestinal bleeding.

To diagnose geriatric anemia, the physician may order a variety of laboratory tests. However, if the elderly patient was ill within a two week period prior to the testing, the laboratory results may be difficult to interpret and could lead to false positive or false negative result. The two test combination most commonly seen, in diagnosing geriatric anemia, includes hemoglobin and hematocrit levels. Testing is simple as blood is drawn by venipuncture; through the arm. In addition to standard blood work, the physician may consider testing for chronic infection, including renal and hepatic related diseases.

Once diagnosed with geriatric anemia, the physician will recommend a variety of treatment options. The first line of defense being increased dietary nutritional value including limited cow’s milk, avoiding juice intake and increasing intake of iron fortified cereal. In patients with anemia induced by chronic disease, the administration of iron supplements or iron therapy is of no benefit. As a result, the physician may, instead, consider administration of erythropoietin, three times daily. What is important to note is that these treatment options are affordable and may provide a significant improvement in the daily living activities of the geriatric anemia sufferer.

Without treatment, the geriatric patient will have limited daily living activities and may often miss the opportunity to obtain diagnosis of a more chronic health condition or disease. Studies have shown anemic patients suffer from decreased mental activity, suffer from increased fear, anguish, fatigue, anxiety in addition to the standard physical symptoms of fatigue, lethargy, paleness and chest pain. A patient exhibiting these symptoms may not be anemic. However, if the symptoms persist, a battery of tests should be completed, including intelligence testing, to determine if anemia is present and, in some cases, an underlying chronic, geriatric based disease, has developed.

With age, most individuals begin to lose physical and mental health. Understanding the signs and syptoms of anemia will provide the geriatric patient with the tools and resources to identify signs of general aging versus sympoms associated with disease. Treatment to relieve the anemia symptoms and improve red blood cell health, in addition to more extensive testing into an underly chronic disease complication should be discussed with the physician. When faced with anemia type symptoms, a consultation, with laboratory testing, is highly recommended and may lead to a more prolonged and improved life.

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