Iron Deficiency Anaemia in the Elderly: Investigation of Uptake and Outcomes in an Older Iron-Deficiency Anaemia Cohort

Introduction

Iron deficiency anaemia is common in the elderly, but investigations often require invasive tests. We conducted a single centre evaluation of 100 consecutive urgent suspected cancer iron deficiency anaemia (USCIDA) referrals over the age of 80, evaluating outpatient attendance, investigations, clinical outcomes and reasons for not undergoing tests.

Methods

Data was extracted via SQL query from the backend from electronic health record. A retrospective analysis of 100 consecutive USCIDA referrals in patients over the age of 80, referred in 2024, was conducted. Data on demographics, fitness for tests, investigations, diagnosis, and reasons for not undergoing tests were analysed. Statistical analysis was performed with GraphPad Prism.

Results

The median age was 84 years (range 80–98), with 54 males and 46 females. Ethnicity was predominantly white British. Overall, 92% of patients underwent at least one investigation. 75% of patients underwent a gastroscopy, 22% colonoscopy, 5% a flexible sigmoidoscopy and 4% a capsule endoscopy. 52% had a CT colonography and 17% a CT abdomen/pelvis. 4 colorectal cancers and 1 duodenal cancer were found. Frequent non-malignant findings included diverticular disease, hiatus hernia, colonic polyps, gastritis, gastric polyps and angiodysplasia. 24 patients had normal investigations. 8 patients did not undergo investigations as 2 had died before, 3 declined and 3 were deemed unfit, all with higher frailty on the pre investigation WHO score.

Conclusion

This analysis of USCIDA referrals demonstrates that gastrointestinal findings, including a 4% cancer rate, are common. Patients who do not undergo investigations are frail and may benefit from a combined elderly care/gastroenterology assessment.