Unexplained Anemia of Aging

Etiology, Health Consequences, and Diagnostic Criteria

Jack Guralnik MD, PhD; William Ershler MD; Andrew Artz MD; Alejandro Lazo-Langner MD; Jeremy Walston MD; Marco Pahor MD; Luigi Ferrucci MD, PhD; William J. Evans PhD


J Am Geriatr Soc. 2022;70(3):891-899. 

In This Article

Anemia is Associated With Morbidity and Mortality

Anemia is not only more common in older people but is also more likely to be associated with harm. A recent study[19] in a large cohort of 138,670 subjects demonstrated that in individuals older than 60 years, anemia was associated with elevated mortality and poorer quality of life (QOL), whereas in individuals aged 60 or younger, anemia had no effect on mortality and a very limited impact on health-related quality of life. In that study, lower QOL resulted from lower physical function subscales. After adjusting for age, sex, type II diabetes, and comorbidity in a population of 17,030 community-dwelling men and women over 66 years of age, anemia was associated with increased risks of all-cause hospitalization (HR = 2.16, confidence interval [CI] 1.88–2.48) and death (HR: 4.29, CI 3.55–5.12).[20] Consistent with this, in men and women over the age of 65, anemia is associated with a higher risk of various poor health outcomes, including poor functional capacity, poor QOL,[21] depression,[22] sarcopenia, and poor muscle quality.[23] Similarly, data from the EPESE cohort[24] of older Americans demonstrated that after controlling for age, sex, cognitive status, blood creatinine, and comorbid conditions, individuals with anemia had more disabilities, and poorer functional status than people without anemia. Decline in performance with lower hemoglobin was also observed in people with hemoglobin levels above the WHO clinical threshold for anemia. Of course, factors other than age can exacerbate the risk of anemia; prevalence in older black men and women is substantially greater than that of the general population,[25] with black women 80–85 years old having a prevalence that is 6.4 times greater than the population average.

For older individuals with comorbid disease, the deleterious effects associated with anemia are similarly clear. For example, among patients >75 years old with stable angina, anemia is associated with elevated rates of death (34% increase for every 1 g/dl decrease in Hb, p < 0.01), increased cardiac death (28% increase for every 1 g/dl decrease in Hb, p < 0.01), and increased major adverse clinical events (23% increase for Hb <13.3 g/dl).[2]