Systematic review and meta-analysis: what is the evidence for oral iron supplementation in treating anaemia in elderly people?

Abstract

Background: Oral iron supplementation is used widely in older people despite observational studies suggesting it is ineffective.

Objective: The aim of this systematic review was to determine if oral iron therapy is effective in elderly people with iron deficiency anaemia.

Data sources: MEDLINE, EMBASE and The Cochrane Library databases were searched from inception to 23 January 2014.

Study selection: Randomised controlled trials comparing oral iron with no iron supplementation or placebo and measuring the change in haemoglobin levels in elderly patients with anaemia were included. Titles and abstracts were reviewed and publications were screened by both authors independently to exclude articles that did not satisfy the inclusion criteria.

Study appraisal and synthesis: Risk of bias was systematically assessed independently by both authors using the Cochrane risk of bias tool. Data on the increase in haemoglobin level after therapy was either collected from original publications or by contacting the corresponding authors. Length of hospitalisation, mortality and adverse effect data were also analysed.

Results: A total of 6,163 citations were screened, but only three studies (a total of 440 participants with a mean age ranging between 70 and 83 years) met the inclusion criteria. Meta-analysis showed oral iron supplementation increased haemoglobin levels more than placebo or no treatment after 4-6 weeks of treatment (mean difference 0.35 g/dL, 95 % CI 0.12-0.59, p = 0.003). There were no statistically significant differences in adverse effects, length of hospitalisation or mortality.

Limitations: Only one of the three studies was specific to older people and all studies involved patients in orthopaedic settings. The mean age of participants was different, and the dosage and frequency of ferrous sulphate differed.

Conclusion: Oral iron raises haemoglobin levels in elderly people with iron deficiency anaemia by 0.35 g/dL after 4-6 weeks, but it is unclear if this results in tangible health benefits.