In the United States, about one-third of all anemias among older adults are due to dietary deficiencies in iron, vitamin B12 and or folate (folic acid). About one-half of all anemias among older adults are due to chronic medical conditions, and about one-fifth of all anemias remain unexplained even with thorough evaluation. 

The three major reasons why anemia can happen are described below. In older people, anemia is often the result of more than one condition occurring at the same time. These conditions can include:

  • Decreased red blood cell production caused by:
    • Problems with bone marrow function
    • Chronic diseases or inflammation, such as cancer or infections
    • Hormone problems
    • Kidney disease
    • Malnutrition and dietary deficiencies in iron, vitamin B12, or folic acid (folate)
    • Hereditary disorders
    • Medications
    • Alcohol dependency
  • Loss of blood from:
    • stomach irritation from medications, alcohol, or an ulcer
    • polyps or tumors in the bowels
    • kidney stones or tumors
    • cancers
    • surgery 
  • Increased destruction of red blood cells caused by:
    • Medications
    • A hereditary disorder
    • A disease of your immune system
    • Heart valve problems (which damage your red blood cells)
    • A tumor
    • Infections

Here are the most common causes of anemia in older adults. 

Iron-deficiency Anemia

A common cause of iron-deficiency anemia is chronic blood loss, usually from the gastrointestinal tract. This kind of "silent" internal bleeding can be caused by bleeding ulcers or polyps, cancer, or chronic irritation of the lining of the gastrointestinal tract. Often, this blood loss is invisible to the naked eye, and your healthcare provider may do a simple test, called a fecal occult blood test, to find it.

Anemia of Chronic Disease

Anemia of chronic disease can result from chronic inflammation caused by ongoing infections, tissue damage, various forms of arthritis, benign or malignant tumors, or a variety of chronic medical conditions. These conditions cause inflammation inside your body and prevent your bone marrow from working as well as it should.

Anemia of B12 and Folate Deficiencies

Vitamin B12 and folate (folic acid) are two vitamins important for red blood cell production. Vitamin B12 deficiency is more common with advancing age, particularly in women over the age of 60 and adults with autoimmune thyroid disease. Signs and symptoms include:

  • General body weakness
  • Pale skin
  • Changes in the nervous system (some signs of this include a clumsy walk, or numbness and tingling in the arms and legs)
  • Behavioral changes or confusion

Folate deficiency can result from poor nutrition, certain medications, or diseases affecting absorption from the gut.  

Hemolytic Anemia

Anemia caused by red blood cell destruction is called hemolytic anemia. Problems with your immune system are often to blame. Cancers, such as non-Hodgkin's lymphoma or chronic lymphocytic leukemia, also destroy red blood cells. Hemolytic anemia can also be caused by medications or infections, or by an immune system disease like rheumatoid arthritis or lupus.


Last Updated July 2020