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.
Similar content being viewed by others
References
Ahmad I, Gibson PR. Management of iron deficiency in patients admitted to hospital: time for a rethink of treatment principles. Intern Med J. 2006;36(6):347–54.
Duh MS, Latypova A, Greenberg P. Impact and treatment of anemia in the elderly: clinical, epidemiological and economic perspectives. Expert Rev Pharmacoecon Outcomes Res. 2006;6(5):577–90.
Shah R, Agarwal AK. Anemia associated with chronic heart failure: current concepts. Clin Interv Aging. 2013;8:111–22.
Patel KV. Epidemiology of anemia in older adults. Semin Hematol. 2008;45(4):210–7.
Balducci L, Ershler WB, Krantz S. Anaemia in the elderly; clinical findings and impact on health. Crit Rev Oncol Hematol. 2006;58(2):156–65.
Baker H. Nutrition in the elderly: hypovitaminosis and its implications. Geriatrics. 2007;62(8):22–6.
Dmitrieva O, de Lusignan S, Macdougall IC, et al. Association of anaemia in primary care patients with chronic kidney disease: cross sectional study of quality improvement in chronic kidney disease (QICKD) trial data. BMC Nephrol. 2013;14:24.
Artz AS. Anemia and the frail elderly. Semin Hematol. 2008;45(4):261–6.
Yang Y, Li H, Li B, et al. Efficacy and safety of iron supplementation for the elderly patients undergoing hip or knee surgery: a meta-analysis of randomized controlled trials. J Surg Res. 2011;171(2):e201–7.
Parker MJ. Iron supplementation for anemia after hip fracture surgery: a randomized trial of 300 patients. J Bone Joint Surg Am. 2010;92:265–9.
Rimon E, Kagansky N, Kagansky M, et al. Are we giving too much iron? Low-dose iron therapy is effective in octogenarians. Am J Med. 2005;118(10):1142–7.
Hörl WH, Ertl G. Anaemia and the heart. Eur J Clin Invest. 2005;35(3 Suppl 3):20–5.
Lam SK, Quah TC. Iron deficiency: a diagnostic problem. J Singapore Paediatr Soc. 1991;33(3–4):133–9.
Pang WW, Schrier SL. Anemia in the elderly. Curr Opin Hematol. 2012;19(3):133–40.
Nagaraju SP, Cohn A, Akbari A, et al. Heme iron polypeptide for the treatment of iron deficiency anemia in non-dialysis chronic kidney disease patients: a randomized controlled trial. BMC Nephrol. 2013;14:64.
Salles N. Basic mechanisms of the aging gastrointestinal tract. Dig Dis. 2007;25(2):112–7.
Hamzat H, Sun H, Ford JC, et al. Inappropriate prescribing of proton pump inhibitors in older patients: effects of an educational strategy. Drugs Aging. 2012;29(8):681–90.
Andres E, Federici L, Serraj K, et al. Update of nutrient-deficiency anemia in elderly patients. Eur J Intern Med. 2008;19:488–93.
den Elzen WPJ, Gussekloo J. Anaemia in older persons. Neth J Med. 2011;69(6):260–7.
Barraclough KA, Brown F, Hawley CM, et al. A randomized controlled trial of oral heme iron polypeptide versus oral iron supplementation for the treatment of anaemia in peritoneal dialysis patients: HEMATOCRIT trial. Nephrol Dial Transplant. 2012;27(11):4146–53.
Ferrari P, Nicolini A, Manca ML, et al. Treatment of mild non-chemotherapy-induced iron deficiency anemia in cancer patients: comparison between oral ferrous bisglycinate chelate and ferrous sulfate. Biomed Pharmacother. 2012;66(6):414–8.
Mimura EC, Bregano JW, Dichi JB, et al. Comparison of ferrous sulfate and ferrous glycinate chelate for the treatment of iron deficiency anemia in gastrectomized patients. Nutrition. 2008;24(7–8):663–8.
Van Wyck DB, Roppolo M, Martinez CO, et al. A randomized, controlled trial comparing IV iron sucrose to oral iron in anemic patients with nondialysis-dependent CKD. Kidney Int. 2005;68(6):2846–56.
Beck-Da-Silva L, Piardi D, Soder S, et al. IRON-HF study: A randomized trial to assess the effects of iron in heart failure patients with anemia. Int J Cardiol. 2013;168(4):3439–42.
Balducci L. Epidemiology of anemia in the elderly: information on diagnostic evaluation. J Am Geriatr Soc. 2003;51(3 Suppl):S2–9.
Balducci L, Beghe C. Anemia, fatigue, and aging. Ann Longterm Care. 2005;13(7):18–23.
Garcia-Arias MT, Villarino Rodriguez A, Garcia-Linares MC, et al. Iron, folate and vitamins B12 & C dietary intake of an elderly institutionalized population in Leon. Spain. Nutr Hosp. 2003;18(4):222–5.
Okuyama M, Ikeda K, Shibata T. Preoperative iron supplementation and intraoperative transfusion during colorectal cancer surgery. Surg Today. 2005;35(1):36–40.
Quinn M, Drummond RJ, Ross F, et al. Short course pre-operative ferrous sulphate supplementation: is it worthwhile in patients with colorectal cancer? Ann R Coll Surg Engl. 2010;92(7):569–72.
De Silva AD, Tsironi E, Feakins RM, et al. Efficacy and tolerability of oral iron therapy in inflammatory bowel disease: a prospective, comparative trial. Aliment Pharmacol Ther. 2005;22(11–12):1097–105.
Khalil A, Goodhand JR, Wahed M, et al. Efficacy and tolerability of intravenous iron dextran and oral iron in inflammatory bowel disease: a case-matched study in clinical practice. Eur J Gastroenterol Hepatol. 2011;23(11):1029–35.
Weatherall M, Maling TJ. Oral iron therapy for anaemia after orthopaedic surgery: randomized clinical trial. ANZ J Surg. 2004;74(12):1049–51.
Zauber NP, Zauber AG, Gordon FJ, et al. Iron supplementation after femoral head replacement for patients with normal iron stores. J Am Med Assoc. 1992;267(4):525–7.
Rimon E, Kagansky N, Kagansky M, et al. Are we giving too much iron? Low-dose iron therapy is effective in octogenarians. Am J Med. 2005;118(10):1142–7.
Andrews CM, Lane DW, Bradley JG. Iron pre-load for major joint replacement. Transfus Med. 1997;7:281–6.
Lindgren S, Wikman O, Befrits R, et al. Intravenous iron sucrose is superior to oral iron sulphate for correcting anaemia and restoring iron stores in IBD patients: a randomized, controlled, evaluator-blind, multicentre study. Scand J Gastroenterol. 2009;44(7):838–45.
Prasad N, Rajamani V, Hullin D, et al. Post-operative anaemia in femoral neck fracture patients: does it need treatment? A single blinded prospective randomised controlled trial. Injury. 2009;40(10):1073–6.
Sutton PM, Cresswell T, Livesey JP, et al. Treatment of anaemia after joint replacement: a double-blind, randomised, controlled trial of ferrous sulphate versus placebo. J Bone Joint Surg Br. 2004;86(1):31–3.
Avorn A. Including elderly people in clinical trials. BMJ. 1997;315(7115):1033–4.
Cook J. Diagnosis and management of iron-deficiency anaemia. Best Pract Res Clin Haematol. 2005;18:319–32.
Litton E, Xiao J, Ho KM. Safety and efficacy of intravenous iron therapy in reducing requirement for allogeneic blood transfusion: systematic review and meta-analysis of randomised clinical trials. BMJ. 2013;347:f4822.
Auerbach M, Ballard H. Clinical use of intravenous iron: administration, efficacy, and safety. Hematology Am Soc Hematol Educ Program. 2010;2010:338–47.
Mcintyre LA. Intravenous iron therapy for treatment of anaemia. BMJ. 2013;347:f5378.
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
Corresponding author
Appendix: Search strategy: MEDLINE and EMBASE (OVID)
Appendix: Search strategy: MEDLINE and EMBASE (OVID)
-
1.
iron.mp. [mp=ti, ab, ot, nm, hw, kf, px, rx, ui, an, sh, tn, dm, mf, dv, kw]
-
2.
ferrous*.mp. [mp=ti, ab, ot, nm, hw, kf, px, rx, ui, an, sh, tn, dm, mf, dv, kw]
-
3.
supplement.mp. [mp=ti, ab, ot, nm, hw, kf, px, rx, ui, an, sh, tn, dm, mf, dv, kw]
-
4.
haemoglobin.mp. [mp=ti, ab, ot, nm, hw, kf, px, rx, ui, an, sh, tn, dm, mf, dv, kw]
-
5.
hemoglobin.mp. [mp=ti, ab, ot, nm, hw, kf, px, rx, ui, an, sh, tn, dm, mf, dv, kw]
-
6.
anaemia.mp. [mp=ti, ab, ot, nm, hw, kf, px, rx, ui, an, sh, tn, dm, mf, dv, kw]
-
7.
anemia.mp. [mp=ti, ab, ot, nm, hw, kf, px, rx, ui, an, sh, tn, dm, mf, dv, kw]
-
8.
aged.mp. [mp=ti, ab, ot, nm, hw, kf, px, rx, ui, an, sh, tn, dm, mf, dv, kw]
-
9.
old*.mp. [mp=ti, ab, ot, nm, hw, kf, px, rx, ui, an, sh, tn, dm, mf, dv, kw]
-
10.
elderly.mp. [mp=ti, ab, ot, nm, hw, kf, px, rx, ui, an, sh, tn, dm, mf, dv, kw]
-
11.
geriatrics.mp. [mp=ti, ab, ot, nm, hw, kf, px, rx, ui, an, sh, tn, dm, mf, dv, kw]
-
12.
1 or 2 or 3
-
13.
4 or 5 or 6 or 7
-
14.
8 or 9 or 10 or 11
-
15.
12 and 13 and 14
-
16.
limit 15 to abstracts
-
17.
limit 16 to “all aged (65 and over)”
-
18.
limit 17 to humans
-
19.
limit 18 to english language
-
20.
limit 19 to human
-
21.
limit 20 to aged <65+ years>
-
22.
limit 21 to humans
-
23.
limit 22 to english
-
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.
limit 24 to humans
-
26.
remove duplicates from 25
Rights and permissions
About this article
Cite this article
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
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40266-015-0241-5