Anemia in the elderly: a consequence of aging?

INTRODUCTION: Anemia in the elderly is a common finding that is associated with a poorer quality of life, worse outcomes, and increased mortality. While this entity is frequently overlooked, there is often an underlying cause that is correctable. Areas covered: In this review, we shed light on the prevalence of anemia in the elderly population, review the most common causes, particularly iron deficiency anemia and anemia of chronic disease, and describe the available treatment modalities. When a clear etiology for the anemia is ruled-out, the term unexplained anemia may be utilized; while still an under-explored field, one of the underlying pathophysiological mechanisms appears to be associated with an age-related inflammatory process. Expert commentary: Treating anemia secondary to nutritional deficiencies can be straightforward, but the management of the other types of anemia is not always the case. Treating anemia of chronic disease and anemia of chronic kidney disease may be limited by elevated levels of hepcidin and new promising treatments are still in pre-clinical and clinical trial phases. Caution should be employed when using erythropoiesis stimulating agents due to safety concerns, and when prescribing blood transfusion therapy, both of which lack the specific guidelines for use in the elderly.