Anemia and the elderly: is it physiology or pathology?

There is currently a controversy of whether elderly people (over age 65) have an age-related physiologic decline in red cell parameters. If this is so, a new normal range might be established for geriatric patients, as has been suggested by others. However, since anemia is often the first sign of severe illness in a patient, new normal values might include a danger of overlooking patients with true anemia secondary to an underlying disease. In this article we shall review what is known about red cell parameters in elderly patients and attempt to answer the questions of whether new geriatric norms should be established.