Blood Tests Over 60: What Changes and What to Monitor
Ageing changes how the body handles nutrients, hormones, and metabolic processes — and those changes show up on blood tests. Here is what normally shifts with age and what blood test monitoring is essential after 60.
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Many laboratory reference ranges do not account for age. A 65-year-old and a 25-year-old have the same printed reference range on their lab report — even though the expected physiology is different. Understanding age-related changes prevents over-treatment of normal aging and under-treatment of genuinely concerning trends.
| Test | Expected Age-Related Change | Clinical Significance |
|---|---|---|
| eGFR | Declines approximately 1 mL/min/year after 40 — a 70-year-old with eGFR 60 may be normal for age | Distinguish normal aging from CKD using uACR alongside eGFR |
| Haemoglobin | Mild decline common with age (WHO anaemia threshold applies) | Anaemia in over-60s is never assumed to be "age-related" — always investigate cause |
| Testosterone (men) | Declines ~1% per year from 35; below 300 ng/dL with symptoms = hypogonadism | Consider if symptomatic fatigue, low libido, or muscle loss present |
| TSH | Subclinical hypothyroidism more common; some evidence that a slightly higher TSH (up to 6) may be acceptable in those over 80 | Treat if symptomatic or if TSH is above 10 |
| LDL and triglycerides | Often rise with age due to declining metabolic rate and hormonal changes | Cardiovascular risk assessment determines treatment need |
| Fasting glucose | Rises by approximately 1 mg/dL per decade — insulin resistance increases with age | Screen annually; HbA1c above 5.7% is prediabetes |
| Vitamin B12 | Absorption falls with age due to declining gastric acid and intrinsic factor | B12 deficiency affects up to 20% of over-60s; MMA confirms deficiency |
| Vitamin D | Skin synthesis declines with age; kidneys less efficiently activate vitamin D | Target 40–60 ng/mL; supplement if below 30 |
Most Important Tests Over Age 60
The Anaemia Evaluation in Older Adults
Anaemia is present in approximately 10% of community-dwelling adults over 65. Unlike in younger patients where iron deficiency predominates, anaemia in older adults has many causes: iron deficiency (gastrointestinal blood loss, including colorectal cancer), B12/folate deficiency, anaemia of chronic inflammation, myelodysplastic syndromes, chronic kidney disease, and less commonly haematological malignancy. Anaemia of "old age" is a diagnosis of exclusion — a thorough work-up including MCV, reticulocyte count, ferritin, B12, folate, CRP, eGFR, and LDH is appropriate before accepting that conclusion.
Key Changes in Blood Test Interpretation Over 60
Polypharmacy and Blood Tests
Most adults over 65 take five or more medications. Polypharmacy creates important blood test considerations: ACE inhibitors/ARBs raise potassium and creatinine; diuretics lower potassium and magnesium; metformin depletes B12; PPIs (proton pump inhibitors) impair B12 and magnesium absorption; statins may elevate CK; warfarin requires INR monitoring; and numerous drugs affect thyroid test interpretation. A medication review alongside every blood test panel is essential in older adults.
Medical Disclaimer
This article is for educational purposes only and does not constitute medical advice. Reference ranges, supplement dosages, and nutritional information mentioned are general educational guidance from published research—not personalised recommendations. Do not use this content to self-diagnose or self-treat any condition. Always consult a qualified healthcare provider before making any changes to your health regimen, medications, or supplements.
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