Iron for older people – the specific needs of older people

In the 17th century, T. Sydenham described chlorosis as a condition associated, amongst other things, with pallor and weakness, although the mechanisms underlying this disease were not yet well understood at the time. It was not until 1832 that P. Blaud introduced iron-containing tablets, which were used for many years to treat this historically documented form of anaemia. Iron, which supports the normal production of red blood cells and haemoglobin, oxygen transport and the reduction of fatigue, appears to be of great importance in the diet of older people.

1. The role of iron
2. Iron requirements in older adults
3. Iron in the elderly person’s diet
4. Vitamin C and iron

The role of iron

Iron contributes to the normal production of red blood cells and haemoglobin; therefore, an adequate intake is important for the processes involved in oxygen transport within the body. This is particularly important for older adults, as symptoms of iron deficiency or iron metabolism disorders can overlap with conditions often attributed to ageing itself, such as weakness, reduced exercise tolerance, drowsiness, impaired concentration, pale skin, or feeling tired more quickly during daily activities.

Iron also plays a role in normal energy metabolism, helps reduce feelings of tiredness and fatigue, and contributes to the proper functioning of the immune system and normal cognitive function. In nutritional practice, however, it is important to exercise caution in older people, as similar symptoms may result from a variety of causes, including vitamin B12 deficiency, folate deficiency, kidney disease, chronic inflammation, gastrointestinal disorders, gastrointestinal bleeding, or the effects of certain medications.

"People following a plant-based diet tend to have lower ferritin levels (most often below normal) compared to those on a mixed diet, as well as a higher incidence of anaemia. This problem particularly affects vegan women, in whom reduced ferritin and haemoglobin levels are observed more frequently than in vegetarian women and men on plant-based diets." Sławomir Ambroziak – Pharmacologist

Iron requirements in older adults

According to the dietary guidelines for the Polish population, the recommended daily intake of iron is 10 mg for women over the age of 51 and 10 mg for adult men. The lower requirement for post-menopausal women compared to younger women is primarily due to the cessation of regular blood loss associated with menstruation.

This does not mean, however, that iron becomes less important in older age. Older people often eat less than younger people, and a reduced food intake can make it difficult to meet requirements for minerals, protein and vitamins. Other factors that may be significant include difficulties with chewing, a reduced intake of meat, a monotonous diet, frequent consumption of fast food and highly processed products, chronic gastrointestinal conditions, the use of medicines that reduce stomach acidity, and co-existing inflammatory conditions. In older adults, unintentional weight loss, loss of appetite, chronic fatigue, reduced physical function and recurrent infections also require particular attention, as they may indicate a broader nutritional problem rather than merely an insufficient iron intake.

Estimated percentage of the Reference Intake (RI) met

Iron in the elderly person’s diet

Sources of iron in the elderly person’s diet include, amongst others, meat and offal, fish, and pulses or cereals, though these should be properly prepared. It is worth considering both the iron content of the food and whether a particular meal is easy to chew, digestible, and suited to the elderly person’s appetite and capabilities. Haem iron, found in animal-based products, is better utilised by the body than non-haem iron, which is predominant in plant-based products. This does not mean that the diet must be based solely on animal products, but with a low appetite and small meal portions, it is worth choosing products with a higher nutritional density.

Vitamin C and iron

The absorption of non-haem iron can be aided by the presence of vitamin C, which is why vegetables and fruits such as peppers, sauerkraut, broccoli or citrus fruits go well with plant-based meals. However, the availability of iron may be reduced by coffee and tea, or large amounts of bran and other sources of fibre. For older people, the texture of food is also important: a paste made from eggs and parsley, tender meat stewed with vegetables, lentil soup, groats with meat or fish, hummus with peppers or porridge with pumpkin seeds and fruit may be easier to incorporate into the diet than large, hard portions of food that require prolonged chewing.

Sources:

• Oyedeji, C. I., Artz, A. S., & Cohen, H. J. (2024). How I treat anemia in older adults. Blood, 143(3), 205–213. https://doi.org/10.1182/blood.2022017626
• Wacka, E., Nicikowski, J., Jarmuzek, P., & Zembron-Lacny, A. (2024). Anemia and Its Connections to Inflammation in Older Adults: A Review. Journal of clinical medicine, 13(7), 2049. https://doi.org/10.3390/jcm13072049
• Tian, Y., Tian, Y., Yuan, Z., Zeng, Y., Wang, S., Fan, X., Yang, D., & Yang, M. (2022). Iron Metabolism in Aging and Age-Related Diseases. International journal of molecular sciences, 23(7), 3612. https://doi.org/10.3390/ijms23073612