Investigating Iron Deficiency Anaemia in the Elderly

Iron deficiency anaemia (IDA) is often attributed to gastrointestinal (GI) blood loss and warrants thorough investigation. In elderly, endoscopy carries increased risk, especially in those with multiple comorbidities and poor functional status. This study aimed to evaluate the outcomes of elderly patients with IDA, identify underlying causes, and assess one-year mortality.

Patients ≥75 years referred to gastroenterology for investigation of IDA were recruited. Demographics, comorbidities, antiplatelet/antithrombotic use, investigations performed, and one-year mortality were recorded.

92 patients were recruited. Mean patient age was 81.2 years (SD: +/- 4.02) with a female preponderance (70.7%). Mean Charlson Comorbidity Index (CCI) was 5.96 (SD +/- 1.93). Frailty precluded any investigation in 13% of patients. 26% underwent upper and lower GI assessment (14% had bidirectional endoscopy and 12% had oesophagogastroduodenoscopy (OGD) + computed tomography (CT) colonography). Malignancy was diagnosed in 6.5%. Overall, one-year mortality rate was 28% (CCI mean score: 6.7). Mortality was statistically significantly higher for patients living in care homes (p=0.03). Higher CCI was associated with increased risk of one-year mortality, and each additional CCI point increased odds of dying within one year by 40% (OR = 1.40, 95% CI: 1.10-1.79, p=0.007).

Elderly patients referred for investigation of IDA frequently have a high CCI score, making endoscopy a high-risk procedure. A high CCI score and living in a care home are independent risk factors for one-year mortality. Alternative strategies including trans-nasal endoscopy and CT colonography, should be considered as first-line tests to balance diagnostic yield, prognosis and procedural safety.