Akash Jaiswal: Anemia in the Elderly – Is It Truly Age Related or a Missed Diagnosis?
Akash Jaiswal, Consultant Geriatric Medicine at Fortis Healthcare, shared a post on LinkedIn:
“Anemia in the Elderly: Just ‘Age-related’ or a Missed Diagnosis?
Geriatric Anemia Series | Part 1
An 82-year-old walks into the OPD with Hb of 9 g/dL which has been slowly decreasing over last one year from 11.
No other active complaints apart from fatigue.
‘Stable for age.’
Already on iron supplements for months.
Anemia is NOT a normal part of aging.
Yes, you may hear the term ‘anemia of ageing.’
But in reality, this is often a diagnosis of exclusion and not a justification to stop evaluating.
Why this matters
Even ‘mild’ anemia in older adults is associated with:
- Increased falls
- Cognitive decline
- Frailty
- Higher hospitalization rates
- Increased mortality
In geriatrics, anemia is not just a number. It is a prognostic marker.
Most cases fall into 3 broad categories:
Nutritional
- Iron
- Vitamin B12
- Folate
Chronic disease / inflammation
- CKD
- Chronic infections
- Malignancy
Bone marrow disorders
- Myelodysplastic syndromes (MDS)
- Hematological malignancies
- Aplastic Anemia
‘Anemia of aging’ as a final diagnosis is only acceptable after a systematic, documented exclusion of the above causes.
It constitute around 1/3rd of cases of Anemia in elderly.
Common mistake I see in practice
‘Empirical iron therapy without diagnosis.’
Meanwhile, the underlying cause remains missed.
When should you pause and think deeper?
- New-onset anemia in an elderly patient
- No clear nutritional deficiency
- Incomplete response to iron/B12
- Associated weight loss or fatigue out of proportion
Clinical takeaway
Every anemia in the elderly deserves an explanation.
Because sometimes, What looks like ‘simple anemia’ is the first clue to something sinister.
Over the coming weeks, I’ll be breaking down key aspects of anemia in the elderly, one clinically relevant topic at a time.
Stay connected.”
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