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

Objectives: Oral iron supplementation is used widely despite observational studies suggesting it is ineffective. Therefore, this systematic review determined if oral iron therapy is effective in elderly people with iron deficiency anaemia. Methods: The systematic review was based on Cochrane Collaboration methods. MEDLINE, Embase and the Cochrane library were searched from inception up to 23rd January 2014. Only randomised controlled trials comparing oral iron with no iron supplementation or placebo and measuring the change in haemoglobin levels in elderly anaemic people were included. Length of hospitalisation, mortality and adverse effect data were also analysed. Results: 6163 titles were screened but only three studies (total 440 participants, mean age 70-83 years old) met the inclusion criteria, all in an orthopaedics setting. Just one showed oral iron supplementation significantly raised haemoglobin level. However, meta-analysis showed oral iron supplementation increased haemoglobin levels more than placebo or no treatment after 4-6 weeks of treatment (weighted mean difference 0.35 g/dL, 95% CI 0.12-0.59, p = 0.003). There were no significant differences in adverse effects, length of hospitalisation or mortality. Conclusions: Oral iron raises haemoglobin levels in elderly people with post-operative anaemia by about 0.35 g/dL after 4-6 weeks. However, only 3 studies in an orthopaedics setting met inclusion criteria. It remains unclear if the widespread practice of prescribing oral iron supplements results in tangible health benefits for older people.