Anaemia is common in older individuals and, because of
its association with various negative outcomes, adequate
diagnosis and treatment is important. The present review
focuses on prominent factors included in diagnostic and
therapeutic algorithms for anaemia. Although pernicious anaemia is associated with severe vitamin B12 deficiency, evidence of an association between subnormal vitamin B12 and anaemia in older persons
in the general population is limited and inconclusive.
Accumulating evidence suggests that clinicians should at
least reconsider the risks of a low vitamin B12 level before starting vitamin B12 supplementation in older individuals. Although clinicians may be reluctant to measure ferritin in older individuals due to its acute phase properties, such measurements are important in older persons with anaemia, especially in those with signs of inflammation. While a severe age-related decline in renal function may lead to a blunted erythropoietin response and anaemia, elevated erythropoietin levels are associated with increased
mortality. More studies are needed to identify the clinical
relevance and therapeutic implications of low and high
erythropoietin levels in older persons. In contrast to other age-related diseases, telomere length is not associated with anaemia in older individuals in the general population. In conclusion, many issues regarding the aetiology of anaemia in old age remain unresolved. Because current guidelines on anaemia are based on the classic notions of the aetiology of anaemia, they may need to be revised for the highest age groups.