Anaemia iron deficiency living in older adults

Overview

Anaemia is a condition where your body does not have enough healthy red blood cells to carry oxygen around your body. Iron-deficiency anaemia is the most common type. It happens when you don't have enough iron to make the red blood cells you need. This can make you feel tired, weak, and short of breath.

Yes, iron deficiency anaemia is common in people over 65. Studies suggest that about 1 in 8 older adults may have some form of anaemia, and iron deficiency is one of the main causes.

It affects older adults, especially those with chronic illnesses, those who take certain medicines long-term, or those who have had stomach or bowel surgery. Women who have gone through menopause are also at risk, but men and women both need to be aware as they get older.

Symptoms

Common symptoms

• Feeling very tired, weak, or lacking energy
• Shortness of breath, especially when physically active
• Pale skin, gums, or nail beds
• Cold hands and feet
• Dizziness or lightheadedness
• Brittle or spoon-shaped nails
• Cravings for non-food items like ice, dirt, or starch (pica)
• Restless legs syndrome

Symptoms in children

• This article focuses on older adults. For children, symptoms may include poor appetite, slow growth, and frequent infections.

Symptoms in older adults

• Fatigue that is worse than usual for their age
• Confusion or memory problems (sometimes mistaken for dementia)
• Worsening of heart failure or angina (chest pain)
• Feeling faint or falling more often
• Difficulty getting out of breath with simple tasks like dressing or walking

Causes

Main causes

• Blood loss – most common cause in older adults. This can be from the stomach or intestines, for example from ulcers, polyps, or taking anti-inflammatory painkillers (like ibuprofen) regularly.
• Not enough iron in your diet – a diet that lacks iron-rich foods such as red meat, dark leafy greens, beans, or fortified cereals.
• Poor absorption of iron – conditions like coeliac disease or after surgery on the stomach or small intestine can make it hard for your body to absorb iron from food.

Risk factors

• Age over 65
• Long-term use of medicines that can cause bleeding, such as aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)
• Chronic illnesses like chronic kidney disease, heart failure, or inflammatory bowel disease
• Previous gastrointestinal surgery
• Diet low in iron (vegetarians or vegans without careful planning)
• Frequent blood tests or blood donations

When to see a doctor

See a doctor urgently if:

• If you have chest pain, shortness of breath that is new or getting worse, or if you feel like you might pass out.

Book a routine appointment if:

• If you have been feeling more tired than usual for several weeks, or if you notice any of the other common symptoms such as pale skin, dizziness, or brittle nails.
• If you see blood in your stool or have persistent heartburn or stomach pain.

Diagnosis

Your doctor will ask about your symptoms, your diet, and any medicines you take. They will also perform a physical exam and order blood tests to check your red blood cells and iron levels.

Tests that may be done

• Full blood count (FBC) – to check the number and size of your red blood cells
• Serum ferritin – a measure of your body's iron stores
• Serum iron and total iron binding capacity (TIBC) – to see how much iron is in your blood and how well your body can use it
• Sometimes, tests to look for sources of blood loss, such as a stool test for hidden blood, or an endoscopy (a camera test of the stomach or bowel)

What to expect at your appointment

The blood test is quick and done at your GP surgery or a clinic. Results usually come back in a few days. If your iron is low, your doctor will discuss the possible causes and treatment plan with you. They may refer you to a specialist if they need to investigate further.

Treatment

Treatment for iron deficiency anaemia focuses on fixing the low iron levels and addressing any underlying cause. This usually involves increasing your iron intake and sometimes taking iron supplements. For older adults, it is especially important to find and treat the cause, which may be a problem like a bleeding ulcer.

Self-care at home

• Eat more iron-rich foods such as lean red meat, liver (in moderation – too much vitamin A can be harmful), dark green leafy vegetables (like spinach and kale), beans, lentils, dried fruit, and fortified cereals.
• Eat foods that help your body absorb iron, such as those high in vitamin C (oranges, strawberries, bell peppers) – for example, have a glass of orange juice with your meals.
• Avoid drinking tea or coffee with meals, as these can reduce iron absorption.
• Check with your doctor before taking any over-the-counter iron supplements, as too much iron can be harmful.

Medical treatments

If your iron levels are very low or you cannot get enough from diet alone, your doctor may recommend iron supplements. These come as tablets, capsules, or liquid. The dose and type will be chosen based on your needs and any side effects you might experience. Sometimes, if the cause is ongoing blood loss, treatment for that condition (such as medication for an ulcer) will be the main focus. In severe cases where supplements are not well tolerated or are not working, your doctor may consider giving iron through a drip into a vein (intravenous iron). This is done in a hospital or clinic setting.

When is surgery considered?

Surgery is not usually needed for iron deficiency anaemia itself. However, if the cause is something like a bleeding polyp or a tumour in the bowel, surgery may be required to remove it. Your specialist will discuss this with you if needed.

Living with this condition

Living with iron deficiency anaemia can be challenging because of fatigue and weakness, but most people start to feel better within a few weeks of treatment. It helps to pace yourself – plan rest breaks during the day and ask for help with heavy tasks. Keep track of your energy levels and adjust your activities accordingly.

Lifestyle tips

• Get enough sleep – aim for 7 to 9 hours per night.
• Stay hydrated – drink plenty of water throughout the day.
• Avoid smoking and limit alcohol, as these can worsen symptoms.
• Keep your home safe to prevent falls – remove tripping hazards, use good lighting, and wear sturdy shoes.

Diet and exercise

Eat a balanced diet that includes iron-rich foods and vitamin C to help absorption. Gentle exercise, like short walks or chair exercises, can boost your energy and improve circulation. Listen to your body and do not push yourself when you feel very tired. Talk to your doctor before starting a new exercise routine.

Mental health and emotional wellbeing

Feeling tired all the time can be frustrating and may affect your mood. Some people feel down or anxious. It is normal to feel this way. Talk to your doctor or a trusted family member about how you are feeling. They can help you find support, such as a counsellor or support group.

Prevention

Some cases of iron deficiency anaemia can be prevented by eating a diet rich in iron and having regular health checks, especially if you have a condition that raises your risk. However, not all cases are preventable – for example, if the cause is a hidden bleeding problem, it may not be found until it causes symptoms.

Vaccines

No vaccines are available to prevent iron deficiency anaemia.

Screening programmes

Routine screening for anaemia is not recommended for all older adults, but your doctor may check your blood if you have symptoms or risk factors. If you take medicines that can cause bleeding, your doctor may monitor your blood count regularly.

Complications

If left untreated

• Severe fatigue that makes daily activities difficult
• Heart problems – the heart has to work harder to pump oxygen, which can lead to an enlarged heart, heart failure, or irregular heartbeat
• Increased risk of falls due to dizziness and weakness
• Cognitive decline – confusion or memory issues may get worse
• Infections – your immune system may be weaker

Long-term outlook

The outlook for iron deficiency anaemia is very good once the cause is identified and treated. Most people feel much better within weeks of starting treatment. Even if the cause is something more serious, like colon cancer, catching it early gives the best chance for successful treatment. With proper care, you can manage your iron levels and maintain a good quality of life.

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