Constant fatigue in the elderly is not always aging

The example of 78-year-old Gary Sergott, a former anesthesiology nurse from Maryland, illustrates this problem. For 15 years, he suffered from chronic anemia caused by a hereditary disease that caused him to experience nosebleeds almost daily and decreased levels of hemoglobin, a protein that carries oxygen in the blood. Despite the obvious symptoms, doctors for a long time limited themselves to prescribing standard iron-containing pills, which caused Sergott severe nausea and did not bring improvements.

The decision came only after contacting hematologist Michael Auerbach, who suggested injecting iron intravenously. Now the patient receives infusions about three times a year and feels well again. His case highlights an important problem: anemia is often overlooked, but it can significantly reduce the quality of life and cause dangerous complications, from falls and fractures to heart attacks and stroke.

According to the National Health and Nutrition Examination Survey (NHANES), anemia affects about 12.5% of people over the age of 60, and this figure increases with age. However, the actual spread of the disease may be higher. In a study published in the Journal of the American Geriatrics Society, hematologist William Erschler and his colleagues analyzed data from nearly 2,000 patients over the age of 65 and found that about 20% had low hemoglobin concentrations. However, only a third of them had anemia officially recorded in their medical records.

The causes of anemia in the elderly are diverse. In one third of patients, it develops due to a lack of nutrients: most often iron, but also vitamin B12 or folic acid. This can be caused by poor appetite, problems with cooking, or eating after surgery. For example, 83-year-old Mary Dagold had anemia for a long time after three abdominal surgeries in 2019 and was accompanied by severe fatigue and cognitive impairment. Intravenous iron injections every five weeks helped her return to a full life and even to water aerobics.

However, it’s not always a matter of iron deficiency. In chronic diseases such as heart, kidney, and inflammatory bowel diseases, the body may lose its ability to effectively use iron to form red blood cells. In such cases, it is important to treat the underlying disease, and not just increase iron levels.