ANEMIA IN THE ELDERLY
As a Home Health Care Agency caring for the geriatric population, one of the goals with our blogs is to address common complaints and/or diagnoses that are often seen in our elderly. When we care for our family members at home, it is beneficial to know signs and symptoms of these various diagnoses so we can know if a visit to the doctor's office or even the Emergency Room is needed. In the next few blogs, we will be addressing a common diagnosis seen in our elderly clients - ANEMIA.
Anemia is a common clinical finding in our elderly population. However, anemia should NOT be considered as a normal part of the aging process. The risk of developing anemia increases with age. An average of 6.5% of individuals have anemia at 60-69 years old; this increases to 19.4% at 80-85 years old. The prevalence of anemia increases with age and is highest in elderly men 80-85 years old.
Anemia is defined as a medical condition in which the number or function of red blood cells (RBCs) is not adequate to meet the oxygenation needs of the tissues in our body. In the next few blogs, we will discuss the top common causes of anemia in the elderly, starting with nutrient-deficiency anemia.
SIGNS AND SYMPTOMS OF ANEMIA
New-onset fatigue
Increased weakness
Shortness of breath
Fast or low heart rate
Chest pain
Dizziness
Headache
Cold hands and feet
Black, tarry stools
Pica - an unusual and specific craving to eat non-food items, like dirt, ice, starch, ashes, or clay. Pica is associated with both mineral deficiency (including iron-deficiency anemia) and mental health conditions.
Pagophagia, a craving for ice, is present in about 50% of patients with iron deficiency.
NUTRIENT-DEFICIENCY ANEMIA
IRON DEFICIENCY ANEMIA
Nutrient deficiency anemia includes iron deficiency anemia, Vitamin B12, and folate deficiency. Iron deficiency occurs when the rate that our body uses iron exceeds the rate that our intestine absorbs iron causing our iron stores to become depleted. This may be caused by inadequate nutrition, impaired absorption of iron, or chronic blood loss (such as gastrointestinal bleeding). Our elderly may be at increased risk for decreased iron absorption because of medication side effects, chronic illness and inflammation, dietary iron deficiencies, and malabsorption.
The most common cause of iron-deficiency anemia in the elderly is blood loss from the gastrointestinal tract. Common causes include nonsteroidal anti-inflammatory drug (NSAID) use (see below for complete list of NSAIDs), gastric ulcer, colon cancer, diverticulosis, and vascular malformation (angiodysplasia) of the bowel submucosa (the layer of tissue under the inner lining that makes mucus).
Work-up for anemia may include but is not limited to an upper endoscopy (a scope with a camera that is inserted in the throat allowing the physician to view the esophagus, stomach, and first part of small intestine) and/or colonoscopy (a scope with a camera that is inserted in the rectum to view the large intestine).
LIST OF NSAIDS (Non-Steroidal Anti-Inflammatory Drugs)
Excedrin (Acetaminophen, Aspirin, and Caffeine)
FlurbiprofenIbuprofen (Motrin/Advil)
VITAMIN B-12 DEFICIENCY
Vitamin B12 (also called cobalamin) is needed for DNA synthesis, red blood cell maturation, and for the normal functioning of our neurologic system. The primary natural sources of dietary vitamin B12 are animal products, such as fish and shellfish, beef, poultry, pork, eggs, and dairy products. Fortified cereals also usually contain 100% of the recommended daily value of vitamin B12. Strict vegetarians and particularly vegans, who do not consume animal products, are at an increased risk of inadequate intake of vitamin B12. They may benefit from vitamin B12-fortified foods, oral vitamin B12 supplements, or vitamin B12 injections.
Several medications are associated with increased risk of vitamin B deficiencies. Because of the high rate of elderly patients taking multiple medications and chronic conditions among the elderly, drug-induced vitamin B12 deficiency is a serious concern. During doctor visits, it is a good idea to inform your doctor of all the medications you are taking, especially new medications.
Pernicious anemia is an autoimmune disorder that causes our body to not absorb vitamin B12. The red blood cells are decreased because of impaired intestinal absorption of vitamin B12, caused by autoimmunity against intrinsic factor or gastric parietal cells (which produce intrinsic factor). Intrinsic factor is needed for the absorption of vitamin B12, and decreased production of intrinsic factor leads to reduced absorption of vitamin B12.
Several other conditions are complicated by vitamin B12 deficiency. Atrophic gastritis, a disorder common in elders, can cause intrinsic factor deficiency and pernicious anemia because of the loss of functioning parietal cells in the stomach. Vitamin B12 is absorbed in the distal small bowel (terminal ileum), and those with disease of the terminal ileum (such as Crohn's disease, Whipple disease, celiac disease) are at risk for malabsorption of vitamin B12 and other nutrients.
FOLATE DEFICIENCY
Folate (also known as folic acid or vitamin B9) is a B vitamin necessary for red blood cell production. Folate deficiency typically occurs from inadequate dietary intake or malabsorption. Signs and symptoms of folate deficiency include weakness, fatigue, difficulty concentrating, shortness of breath, and changes seen in the tongue or oral cavity, including a tongue that may be swollen, red, beefy, or shiny, or the presence of oral ulcers. These symptoms develop gradually but typically become more obvious after about four months.
Conditions that can cause folate deficiency include cancers, Crohn's disease, rheumatoid arthritis, medication side effects, alcoholism, and pregnancy and breastfeeding. Less often, folate deficiency may develop in people taking medications like methotrexate, phenytoin, and trimethoprim, which interfere with absorption of folic acid. Methotrexate is often used for rheumatoid arthritis, lupus, psoriasis, and asthma. Dialysis patients are also at risk for folate deficiency, as folate is lost in dialysis fluid.
The elderly may also have difficulty chewing and swallowing certain foods, causing nutrition deficiencies. When cooking for the elderly, food should not be cooked with excessive heat as folate is destroyed by too much heat and dilution.
Body stores of Conditions that can cause folate deficiency include cancers, Crohn's disease, rheumatoid arthritis, medication side effects, alcoholism, and pregnancy and breastfeeding. Less often, folate deficiency may develop in people taking medications like methotrexate, phenytoin, and trimethoprim, which interfere with absorption of folic acid. Methotrexate is often used for rheumatoid arthritis, lupus, psoriasis, and asthma. Dialysis patients are also at risk for folate deficiency, as folate is lost in dialysis fluid.
The elderly may also have difficulty chewing and swallowing certain foods, causing nutrition deficiencies. When cooking for the elderly, food should not be cooked with excessive heat as folate is destroyed by too much heat and dilution.
Body stores of folate range from 500–20,000 mcg. It is necessary for humans to absorb 50–100 mcg of folate daily to replenish losses through bile and urine. Food sources of folate include green vegetables, yeast, liver, beans, whole grains, and wheat bran. Many foods are also fortified with folate, including some breakfast cereals, rice, breads, and pasta. folate range from 500–20,000 mcg. It is necessary for humans to absorb 50–100 mcg of folate daily to replenish losses through bile and urine. Food sources of folate include green vegetables, yeast, liver, beans, whole grains, and wheat bran. Many foods are also fortified with folate, including some breakfast cereals, rice, breads, and pasta.
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