Anemia is common in the elderly and its impact on various important health outcomes has recently been clearly demonstrated. Although a causal relationship has not yet been demonstrated, adequate diagnosis and treatment are important. Because of ongoing changes in demographics an increasing number of anemic elderly patients is to be expected. Despite this, many issues regarding the aetiology and the management of anemia in older persons remain unresolved. The present review will focus on aspects specific to the causes of anemia in the elderly and suggests an algorithm for the management of this very common condition. Clearly evidence based guidelines on anemia in this highest age group need to be developed. Treatment options for patients with myelodysplastic syndromes are also discussed.