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Systematic Review and Meta-Analysis: What Is the Evidence for Oral Iron Supplementation in Treating Anaemia in Elderly People?

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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.

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Acknowledgements

Hui Sian Tay and Roy L. Soiza have no conflicts of interest to declare. No sources of funding were used to assist in the conduct of this study or in the preparation of this paper.

Author information

Authors and Affiliations

  1. Department of Medicine for the Elderly, Ward 102, Aberdeen Royal Infirmary, NHS Grampian, Foresterhill Road, Aberdeen, AB, 25 2ZN, UK

    Hui Sian Tay & Roy L. Soiza

  2. Health Services Research Unit, University of Aberdeen, Aberdeen, UK

    Roy L. Soiza

Authors
  1. Hui Sian Tay
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  2. Roy L. Soiza
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Corresponding author

Correspondence to Hui Sian Tay.

Appendix: Search strategy: MEDLINE and EMBASE (OVID)

Appendix: Search strategy: MEDLINE and EMBASE (OVID)

  1. 1.

    iron.mp. [mp=ti, ab, ot, nm, hw, kf, px, rx, ui, an, sh, tn, dm, mf, dv, kw]

  2. 2.

    ferrous*.mp. [mp=ti, ab, ot, nm, hw, kf, px, rx, ui, an, sh, tn, dm, mf, dv, kw]

  3. 3.

    supplement.mp. [mp=ti, ab, ot, nm, hw, kf, px, rx, ui, an, sh, tn, dm, mf, dv, kw]

  4. 4.

    haemoglobin.mp. [mp=ti, ab, ot, nm, hw, kf, px, rx, ui, an, sh, tn, dm, mf, dv, kw]

  5. 5.

    hemoglobin.mp. [mp=ti, ab, ot, nm, hw, kf, px, rx, ui, an, sh, tn, dm, mf, dv, kw]

  6. 6.

    anaemia.mp. [mp=ti, ab, ot, nm, hw, kf, px, rx, ui, an, sh, tn, dm, mf, dv, kw]

  7. 7.

    anemia.mp. [mp=ti, ab, ot, nm, hw, kf, px, rx, ui, an, sh, tn, dm, mf, dv, kw]

  8. 8.

    aged.mp. [mp=ti, ab, ot, nm, hw, kf, px, rx, ui, an, sh, tn, dm, mf, dv, kw]

  9. 9.

    old*.mp. [mp=ti, ab, ot, nm, hw, kf, px, rx, ui, an, sh, tn, dm, mf, dv, kw]

  10. 10.

    elderly.mp. [mp=ti, ab, ot, nm, hw, kf, px, rx, ui, an, sh, tn, dm, mf, dv, kw]

  11. 11.

    geriatrics.mp. [mp=ti, ab, ot, nm, hw, kf, px, rx, ui, an, sh, tn, dm, mf, dv, kw]

  12. 12.

    1 or 2 or 3

  13. 13.

    4 or 5 or 6 or 7

  14. 14.

    8 or 9 or 10 or 11

  15. 15.

    12 and 13 and 14

  16. 16.

    limit 15 to abstracts

  17. 17.

    limit 16 to “all aged (65 and over)”

  18. 18.

    limit 17 to humans

  19. 19.

    limit 18 to english language

  20. 20.

    limit 19 to human

  21. 21.

    limit 20 to aged <65+ years>

  22. 22.

    limit 21 to humans

  23. 23.

    limit 22 to english

  24. 24.

    limit 23 to (clinical trial, all or clinical trial or comparative study or consensus development conference or consensus development conference, nih or controlled clinical trial or evaluation studies or government publications or guideline or letter or meta analysis or multicenter study or observational study or pragmatic clinical trial or “review” or validation studies)

  25. 25.

    limit 24 to humans

  26. 26.

    remove duplicates from 25

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Tay, H.S., Soiza, R.L. Systematic Review and Meta-Analysis: What Is the Evidence for Oral Iron Supplementation in Treating Anaemia in Elderly People?. Drugs Aging 32, 149–158 (2015). https://doi.org/10.1007/s40266-015-0241-5

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