Iron plays a crucial role in various physiological processes, including oxygen transport, DNA synthesis, and electron transport. In the elderly population, maintaining appropriate iron levels is essential, yet it presents unique challenges due to age-related changes in metabolism, dietary intake, and the prevalence of chronic diseases.

Iron Deficiency in the Elderly
Iron deficiency anemia (IDA) is relatively common among older adults, often resulting from inadequate dietary intake, chronic inflammation, or gastrointestinal malabsorption. Symptoms such as fatigue, decreased physical performance, and increased risk of falls can significantly impact the quality of life. Diagnosing IDA in the elderly is complex, as inflammation can elevate serum ferritin levels, masking true iron deficiency. Therefore, a comprehensive assessment, including evaluating dietary habits and potential sources of blood loss, is essential.

Iron Overload and Its Implications
Conversely, excessive iron accumulation can be detrimental, particularly in the aging brain. Studies have shown that aging is associated with increased iron levels in the brain cortex, leading to oxidative stress and potential neurodegeneration. This accumulation is partly due to elevated hepcidin levels, which decrease iron export from cells, resulting in intracellular iron buildup. Therefore, indiscriminate iron supplementation without confirmed deficiency may pose risks, emphasizing the need for careful evaluation before initiating therapy.

Recommendations for Managing Iron Levels in Older Adults
Regular Monitoring: Routine screening for anemia and iron status should be part of geriatric care, especially for those with symptoms suggestive of iron imbalance.

Tailored Supplementation:

For diagnosed iron deficiency, low-dose iron supplementation has been found effective and is associated with fewer adverse effects compared to higher doses. Options include half of a 300-mg ferrous gluconate tablet per day or 2.5 mL of ferrous sulfate syrup daily. It’s crucial to avoid unnecessary supplementation to prevent potential iron overload.

Dietary Considerations:

Encourage a balanced diet rich in iron-containing foods, such as lean meats, beans, and fortified cereals, while being mindful of factors that affect iron absorption. For instance, vitamin C enhances iron absorption, whereas certain compounds in tea and coffee can inhibit it.

Address Underlying Causes:

Investigate and manage potential sources of chronic blood loss or malabsorption, such as gastrointestinal disorders, to prevent recurrent iron deficiency.

In summary, maintaining optimal iron balance in the elderly requires a nuanced approach that considers the risks of both deficiency and overload. Personalized care, guided by thorough assessment and regular monitoring, is essential to promote healthy aging and prevent complications associated with iron imbalance.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10525335/
https://pubmed.ncbi.nlm.nih.gov/37683986/
https://pubmed.ncbi.nlm.nih.gov/35302431/