Gary was always exhausted and felt run down. In a recent interview with The New York Times, he said he would feel tired, have trouble breathing, and just didn’t feel well in general. He felt cold even when it was warm outside and often appeared pale with dark circles under his eyes.
His health issue was clear. As a retired nurse-anesthetist, he was aware that he had anemia, which means he had too few red blood cells. In his situation, this was due to a genetic condition that caused him to suffer from frequent nosebleeds, which in turn lowered his hemoglobin levels —the protein in red blood cells that carries oxygen throughout the body.
When he talked to doctors about his chronic fatigue, many were unsure how to help him. Some suggested that he take iron tablets, which are typically the first treatment for anemia.
However, like many adults of a certain age, he found it difficult to take four to six tablets every day, and in many cases, they didn’t provide much relief – some people taking iron experience bad constipation or stomach cramps – Gary said he felt “nauseated all the time.”
After nearly 15 years of suffering, he discovered a solution.
Dr. Michael Auerbach, a specialist in blood disorders and cancer, recommended that Gary receive iron through an IV instead of taking it orally.
Now, at 78 years old, he receives an hour-long iron infusion when his hemoglobin levels and other indicators indicate he needs it, which is usually about three times a year. He compares it to filling up a gas tank, saying, “I feel great” afterward as his symptoms improve.
Gary’s experience highlights how often an issue like anemia is overlooked. Although it’s quite common, affecting nearly one in four people worldwide, it can seriously affect older adults’ quality of life. According to the Mayo Clinic, typical symptoms are feeling tired and weak, having pale skin, and experiencing cold hands and feet. But more serious symptoms can include cognitive impairment, decreased physical ability and a higher chance of falling and breaking bones. In addition, anemia can make existing health issues worse like heart failure, chronic kidney disease and COPD, which doctors often relate to getting older.
“People say, ‘I feel weak, but everybody my age feels weak,’” Dr. William Ershler, a hematologist and researcher, told The Times.
He points out that although hemoglobin levels are usually noted in patients’ records from routine blood tests, doctors often overlook the signs.
Recent reporting from The Times indicates that anemia affects 12.5% of individuals over 60, and this percentage increases with age, according to the latest data from the CDC.
However, this might actually be an underestimate.
In a study published in the Journal of the American Geriatrics Society, Dr. Ershler and his team examined the electronic health records of nearly 2,000 patients aged 65 and older at Inova, a large healthcare system in Northern Virginia, where he recently retired.
They found that the rate of anemia was significantly higher than reported: about one in five patients had anemia, with hemoglobin levels below the normal range set by the World Health Organization.
Surprisingly, only about a third of these patients had their anemia clearly noted in their medical records.
Dr. George Kuchel, a geriatrician at the University of Connecticut, noted that anemia “deserves our attention, but it doesn’t always get it,” and he was not surprised by these results.
One reason for this oversight is that anemia can have many causes, some of which are easier to treat than others. In about a third of cases, it’s due to nutritional deficiencies – most commonly a lack of iron, but it can also result from a deficiency in vitamin B12 or folate (also known as folic acid in its synthetic form). As a result, older adults may experience reduced appetites or struggle to shop for groceries and prepare meals. Additionally, anemia can also occur due to blood loss from ulcers, polyps, diabetes, and other sources of internal bleeding.
Iron tablets, which can be purchased without a prescription, are inexpensive. But intravenous iron infusion, which is being prescribed more often, can cost between $350 and $2,400 for each infusion, depending on the type, according to GoodRx.
Some patients may only require one dose, while others may need ongoing treatment. Medicare typically pays for it if tablets are difficult to take or not effective.
Surgery can also cause a lack of iron in the body. The National Institutes of Health explains that this can happen because of several reasons: losing blood during the surgery, the body not absorbing enough iron from food, and changes in how the body processes iron due to inflammation.
Additionally, anemia is sometimes caused by long-term health issues such as heart disease, kidney failure, problems with bone marrow, or inflammatory bowel diseases.
“These people don’t lack iron, but they’re not able to process it to make red blood cells,” Kuchel explained. He says that since iron supplements won’t help, doctors will try to focus on treating the underlying health issues causing the anemia.
Moreover, Kuchel noted that another important point to consider is that losing iron can be an early sign of colon or stomach cancer. Still, in about a third of the patients, the cause of their anemia remains frustratingly unclear. “We’ve done everything, and we have no idea what’s causing it,” he said.
The Final Takeaway
Understanding anemia and its causes can prevent complications down the road, especially as we age. Doctors say it can lead to falls and worsen chronic conditions like heart, lung, kidney and liver diseases. Severe anemia may result in serious issues like heart attacks or strokes.
By inquiring about our hemoglobin and iron levels or reviewing our medical records via a patient portal, we can have more meaningful discussions with healthcare providers and explore the right options to enhance our quality of life.
Instead of dismissing fatigue or other symptoms as simply a consequence of getting older, we might find they could be signs of a treatable condition.
