**3. Clinical features**

In elderly, anemia is ignored frequently in spite of obvious evidence that due to decreased Hb levels physiologic functions may worsen in the patients [28]. It has been noticed that there are 75% chances of negligence of symptoms by the patients [29, 30]. Also no related positive finding could be recognized on general physical examinations as there are insufficient signs on physical examination that are specific for mild to moderate anemia [3, 31, 32]. However signs and symptoms vary from weakness, irritability, alopecia, xerostomia and depression especially in iron deficiency anemia (IDA). The restless leg syndrome seen in elderly is also commonly take place with iron deficiency [33–35]. Many studies searched in literature verified that anemia is an independent risk factor for rise in morbidity and mortality along with decreased quality of life in older persons [18, 28, 36–38].

### **4. Etiopathogenesis**

Geriatric anemia to a certain extent may be due to unrevealed underlying diseases or due to reduced bone marrow functional reserve or adaptation to reduced lean body mass with diminished oxygen requirements or escaped erythropoietin secretions. There is plenty of substantiation that hematopoietic stem cells undergo some qualitative changes with age hence resulting in reduced proliferative and regenerative capacity. It has been realized that anemia at older age is rising with the possibly of changes in diagnostics and demographics. Though this also have been emphasized by authors that anemia in the elderly do has a treatable cause [18, 39, 40]. The etiopathogenesis of anemia in geriatric age group is multifaceted and varying from nutritional deficiencies to inflammatory progressions resulting in immunodeficiency. Other causes may be from bone marrow failure syndromes to chronic kidney disease. In general causes of anemia were found to be anemia of chronic disease (ACD) associated with co morbidities, deficiency anemia constituting iron deficiency, vit B 12 deficiency, folate deficiency and others and unexplained anemia. While considering the underlying diseases, anemia in elderly is also seen associated with *H. pylori* and twice prevalent in people with chronic kidney disease (CKD), withprevalence of anemia increasing with stage of CKD [22, 33, 41, 42]. Under normal circumstances, increased plasma and stored iron levels activate Hepcidin production, a hormone released by liver which in turn inhibits

#### *Geriatric Anemia DOI: http://dx.doi.org/10.5772/intechopen.95540*

dietary iron absorption. Anemia due to iron deficiencies can occur due to low iron content in diet, decreased iron uptake by intestine or excessive bleeding, and compensated by increased erythropoiesis. IDA seemed to be associated with obesity, gastritis and peptic ulcer, esophagitis, Crohn's disease, celiac disease etc. Although, polymedication was considered independent risk factor for anemia, a 12–35% higher chance of anemia was seen in aspirin users alone. Other drugs like corticosteroids and anti-acids were also seen associated with IDA [43, 44]. Screening for under nutrition should be included in assessment of anemia in geriatric patients as low serum albumin levels are found as independent risk factors for anemia in geriatric patients [44, 45]. The association of deficient serum vitamin D levels with anemia is not considered significant as hypoalbuminemia is measured likely to be confounding factor. At the same time as considering the sociodemographic profile as a causative factor, geriatric anemia was significantly seen associated with high socioeconomic status followed by employment and chronic diseases [45, 46]. Another aspect discussed by Freedman ML and associate suggested that low values in elderly especially in men is a physiologic phenomenon or values of anemia need to be revised in this age group is not known [31, 47].
