title: Systematic review and meta-analysis: what is the evidence for oral iron supplementation in treating anaemia in elderly people?
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.
  
  
  METHODS
  MEDLINE, EMBASE and The Cochrane Library databases were searched from inception to 23 January 2014.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Medicine for the Elderly, Ward 102, Aberdeen Royal Infirmary, NHS Grampian, Foresterhill Road, Aberdeen, AB, 25 2ZN, UK, huisiantay@nhs.net.
authors: Hui Sian
authors: HS
authors: Tay
authors: Roy L
authors: RL
authors: Soiza
mesh_terms: D000368:Aged; D000740:Anemia / Q000188:drug therapy*; D018798:Anemia, Iron-Deficiency / Q000188:drug therapy*; D019587:Dietary Supplements; D005296:Ferrous Compounds / Q000008:administration & dosage; D006801:Humans; D007501:Iron / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic
chemical_list: D005296:Ferrous Compounds; C020748:ferrous sulfate; D007501:Iron
references: Nutrition. 2008 Jul-Aug;24(7-8):663-8
references: 18499399
references: Aliment Pharmacol Ther. 2005 Dec;22(11-12):1097-105
references: 16305723
references: BMJ. 2013 Aug 15;347:f4822
references: 23950195
references: Neth J Med. 2011 Jun;69(6):260-7
references: 21868809
references: BMC Nephrol. 2013 Mar 20;14:64
references: 23514036
references: Curr Opin Hematol. 2012 May;19(3):133-40
references: 22495692
references: BMJ. 2013 Sep 03;347:f5378
references: 24002811
references: Clin Interv Aging. 2013;8:111-22
references: 23403618
references: Nutr Hosp. 2003 Jul-Aug;18(4):222-5
references: 12884479
references: Hematology Am Soc Hematol Educ Program. 2010;2010:338-47
references: 21239816
references: Semin Hematol. 2008 Oct;45(4):261-6
references: 18809097
references: Best Pract Res Clin Haematol. 2005 Jun;18(2):319-32
references: 15737893
references: J Surg Res. 2011 Dec;171(2):e201-7
references: 21962806
references: BMC Nephrol. 2013 Jan 25;14:24
references: 23351270
references: J Am Geriatr Soc. 2003 Mar;51(3 Suppl):S2-9
references: 12588565
references: Crit Rev Oncol Hematol. 2006 May;58(2):156-65
references: 16387511
references: BMJ. 1997 Oct 25;315(7115):1033-4
references: 9366725
references: J Singapore Paediatr Soc. 1991;33(3-4):133-9
references: 1812329
references: Nephrol Dial Transplant. 2012 Nov;27(11):4146-53
references: 22962411
references: ANZ J Surg. 2004 Dec;74(12):1049-51
references: 15574145
references: Semin Hematol. 2008 Oct;45(4):210-7
references: 18809090
references: Eur J Gastroenterol Hepatol. 2011 Nov;23(11):1029-35
references: 21857526
references: Intern Med J. 2006 Jun;36(6):347-54
references: 16732859
references: Biomed Pharmacother. 2012 Sep;66(6):414-8
references: 22795809
references: Ann R Coll Surg Engl. 2010 Oct;92(7):569-72
references: 20573311
references: Transfus Med. 1997 Dec;7(4):281-6
references: 9510925
references: Surg Today. 2005;35(1):36-40
references: 15622462
references: Geriatrics. 2007 Aug;62(8):22-6
references: 17668961
references: Dig Dis. 2007;25(2):112-7
references: 17468545
references: JAMA. 1992 Jan 22-29;267(4):525-7
references: 1729575
references: Injury. 2009 Oct;40(10):1073-6
references: 19524906
references: Eur J Intern Med. 2008 Nov;19(7):488-93
references: 19013375
references: J Bone Joint Surg Br. 2004 Jan;86(1):31-3
references: 14765861
references: J Bone Joint Surg Am. 2010 Feb;92(2):265-9
references: 20124051
references: Expert Rev Pharmacoecon Outcomes Res. 2006 Oct;6(5):577-90
references: 20528504
references: Drugs Aging. 2012 Aug 1;29(8):681-90
references: 22775478
references: Scand J Gastroenterol. 2009;44(7):838-45
references: 19330567
references: Kidney Int. 2005 Dec;68(6):2846-56
references: 16316362
references: Int J Cardiol. 2013 Oct 9;168(4):3439-42
references: 23680589
references: Am J Med. 2005 Oct;118(10):1142-7
references: 16194646
references: Eur J Clin Invest. 2005 Dec;35 Suppl 3:20-5
references: 16281954