Anemia in the elderly is a common health issue among the elderly population, with iron deficiency anemia (IDA) accounting for approximately 30%–50% of cases. It is mainly associated with factors such as declined digestive and absorptive functions in elderly patients, iron absorption disorders caused by chronic diseases (e.g., chronic kidney disease, inflammatory diseases), malnutrition, or chronic blood loss (e.g., occult gastrointestinal bleeding). As an important type of oral iron supplement, ferrous gluconate demonstrates significant clinical value in the treatment of iron deficiency anemia in the elderly due to its safety, tolerability, and efficacy adaptability. Its value is specifically reflected in four dimensions: targeted efficacy, safety advantages, medication convenience, and the improvement of the overall health of elderly patients.
In terms of targeted efficacy, ferrous gluconate can accurately address the core pathological mechanism of iron deficiency anemia in the elderly—insufficient hemoglobin synthesis caused by iron deficiency. After entering the human body, it dissociates into divalent iron ions in the gastrointestinal tract, which are absorbed through iron transporters in the small intestinal mucosa. Subsequently, these iron ions participate in the synthesis of hemoglobin, myoglobin, and various iron-containing enzymes (e.g., cytochrome enzymes, peroxidases). Given the relatively weak digestive and absorptive capacity of elderly patients, although the bioavailability of ferrous gluconate is slightly lower than that of ferrous sulfate, it can still effectively increase serum ferritin levels and hemoglobin concentration by adjusting the dosage appropriately (e.g., supplementing 60–120 mg of elemental iron daily). Clinical studies have shown that after elderly patients with iron deficiency anemia take ferrous gluconate continuously for 8–12 weeks, their hemoglobin levels can increase by an average of 20–30 g/L, and serum ferritin can rise from less than 15 μg/L (the diagnostic criterion for iron deficiency) to more than 30 μg/L. Most patients can meet the anemia correction standards (hemoglobin ≥ 120 g/L for men and ≥ 110 g/L for women). At the same time, it significantly improves the "iron deficiency-related symptoms" associated with elderly patients, such as fatigue, dizziness, decreased exercise tolerance, and memory loss caused by anemia. These symptoms can be significantly relieved after 4–6 weeks of medication, helping elderly patients regain their ability to perform daily activities.
In terms of safety and tolerability, ferrous gluconate is one of the preferred iron supplements with "low gastrointestinal irritation" for the treatment of anemia in the elderly, and this advantage is particularly crucial for elderly patients. The gastrointestinal mucosal barrier function of elderly patients is weakened, making them more sensitive to the irritation of traditional iron supplements (e.g., ferrous sulfate). They are prone to adverse reactions such as nausea, vomiting, abdominal pain, constipation, or diarrhea, which lead to poor medication adherence. In contrast, ferrous gluconate has a more stable chemical structure and dissociates slowly in the gastrointestinal tract, significantly reducing direct irritation to the gastric mucosa. Clinical data show that the incidence of gastrointestinal adverse reactions of ferrous gluconate is only 8%–15%, much lower than the 25%–40% of ferrous sulfate, and most adverse reactions are mild and tolerable for patients. In addition, elderly patients often have multiple underlying diseases (e.g., hypertension, diabetes, coronary heart disease) and take multiple medications (e.g., antihypertensive drugs, hypoglycemic drugs, antiplatelet drugs). Ferrous gluconate has few interactions with most commonly used drugs in the elderly—only needing to be taken 2–3 hours apart from tetracycline antibiotics, thyroxine, and calcium supplements (to avoid affecting absorption). It has high safety when used in combination with other drugs, without the need for frequent adjustment of medication regimens, thus reducing the medication risks for elderly patients.
From the perspective of medication convenience and adherence, the dosage form design and flexible dosage adjustment of ferrous gluconate are suitable for the medication needs of elderly patients. Currently, the commonly used clinical dosage forms include tablets, capsules, and oral liquid preparations (e.g., syrups, drops). Among them, oral liquid preparations are more friendly to elderly patients with declined swallowing function (especially those with cerebrovascular diseases or edentulism), avoiding medication aspiration or missed doses caused by swallowing difficulties. Tablets/capsules can be "split for administration" (supported by some dosage forms), facilitating dosage adjustment according to the patient’s weight and the severity of anemia (e.g., 0.3 g once a day for patients with mild anemia; 0.3 g twice a day for patients with moderate anemia). There is no need for a strictly fixed dosage, which improves the flexibility of medication. Meanwhile, the administration requirements of this drug are relatively lenient—although it is recommended to take it on an empty stomach to improve absorption, elderly patients with gastrointestinal sensitivity can take it half an hour after meals (this only slightly reduces bioavailability without affecting the overall efficacy). This further reduces medication restrictions and helps elderly patients adhere to long-term treatment (iron deficiency anemia requires continuous iron supplementation for 3–6 months after anemia correction to replenish iron reserves, necessitating long-term medication).
In terms of long-term benefits for the overall health of elderly patients, ferrous gluconate can indirectly improve the prognosis of underlying diseases and the quality of life of elderly patients by correcting anemia. If anemia in the elderly is not corrected for a long time, it will cause hypoxia in the body, increase the cardiac load, and raise the risk of heart failure and arrhythmia. At the same time, it will reduce the body’s immune function and increase the incidence of infections (e.g., respiratory tract infections, urinary tract infections). After effectively correcting anemia through iron supplementation, ferrous gluconate can improve oxygen supply to the body, reduce the compensatory work of the heart, and lower the risk of acute events in elderly patients with cardiovascular diseases (e.g., reduced frequency of angina pectoris attacks). Meanwhile, after anemia correction, the immune function of elderly patients (e.g., lymphocyte count, phagocyte activity) can be partially restored, and the incidence of infections decreases by approximately 20%–30%. In addition, long-term anemia is likely to cause psychological problems such as depression and anxiety in elderly patients. By improving anemia-related symptoms, ferrous gluconate helps patients resume social activities and self-care abilities, which also has a positive effect on improving their mental health. Ultimately, a positive cycle of "anemia correction - symptom relief - overall health improvement" is achieved.
Ferrous gluconate has core advantages of "reliable efficacy, low gastrointestinal irritation, convenient medication, and high safety" in the treatment of iron deficiency anemia in the elderly. It can not only effectively correct anemia and improve symptoms but also adapt to the physiological characteristics and medication needs of elderly patients, significantly enhancing treatment adherence and overall health benefits. It is an important clinical choice that combines "efficacy and safety" for the treatment of iron deficiency anemia in the elderly.
