Fatigue: Is It Aging or Anemia?

As we age into our 60s and beyond, it’s tempting to chalk up episodes of fatigue to the aging process. You reach a certain vintage and your body simply begins to lose energy.

But William Ershler, MD, believes that many seniors — and their doctors — are overlooking another possible cause for fatigue: anemia.

U.S. National Health and Nutrition survey data indicates that some 12.5 percent of Americans over 60 may suffer from anemia, but a recent study Ershler coauthored suggests the numbers could be much higher in some populations. And anemia goes undiagnosed in a significant portion of seniors — even when their blood tests reveal low hemoglobin levels.

“The patients come to the clinic and get the blood tests, and nothing happens, particularly if the anemia is mild,” says Ershler.

When he and his research team reviewed the health records of 1,992 seniors, they found that about 20 percent had hemoglobin levels below the World Health Organization’s threshold for anemia: 13 grams per deciliter for men; 12 for nonpregnant women. But only about a third of them had been diagnosed with the condition.

“Anemia goes undiagnosed in a significant portion of seniors —
even when their blood tests reveal low hemoglobin levels.”

The lack of attention to that marker may be partly due to anemia’s many potential causes. These include a lack of iron or another nutritional deficiency; blood loss from the internal bleeding of ulcers and polyps; iron-­sapping surgical procedures; and heart disease, kidney failure, inflammatory bowel diseases, and other chronic illnesses.

Treating an iron deficiency with supplements or infusions is often effective, but for up to 40 percent of older patients with anemia, nothing seems to work. “We’ve done ­everything, and we have no idea what’s causing it,” George Kuchel, MD, a University of Connecticut ­geriatrician, tells The New York Times.

That shouldn’t deter seniors from asking their doctors to pay attention when their hemoglobin levels are low, he adds. “If it’s really outside the normal boundaries, or it’s changed compared to a year ago, you need to ask questions.”

(For more on iron deficiencies, see “Everything You Need to Know About Iron“.)