Journal Article

P370 Acceptability and outcome of investigating iron deficiency anaemia in the elderly

Johnson, Jessica, Riley, Stuart, Maynard, Alec, Hebden, John, Dacosta, David

2021

Overview

IntroductionThe investigation of iron deficiency anaemia (IDA) in the over 80-year-olds presents a unique challenge due to co-morbidity, uncertain prognosis and differing attitudes to acceptability of invasive investigation. We evaluated the investigations accepted and the subsequent outcomes for elderly patients.MethodsWe prospectively collected consecutive GP referrals of IDA patients aged 80+ between 2015 and 2018 seen by a single gastroenterologist. The options of invasive investigation (bidirectional endoscopy), non-invasive investigation (CTC – CT pneumocolon; CT long oral prep; CT TAP – CT thorax, abdomen, pelvis), or no investigation, were discussed and offered in a standardised manner.Results173 patients (64.7% female, 80–95 yrs) were seen. 28 (16.2%) declined all investigations, while 39 (22.5%) underwent bidirectional endoscopy. Investigations accepted and performed were: OGD 93 (53.7%), colonoscopy 40 (23.1%), CTC 52 (30%), CT long oral prep 47 (27.2%), and CT TAP 34 (19.7%). Carcinoma was identified in 21 (14.5%) patients who underwent investigations - 19 (13.1%) were gastrointestinal (GI) cancers (16 colorectal, 3 gastric), one metastatic. Two patients with GI malignancy were also diagnosed with myeloma. The 2 non-GI cancers were metastatic renal cell carcinoma and hepatocellular carcinoma. There were significant differences in investigations undertaken between the elderly (80–84 yrs) and very elderly (85+yrs) as shown in the table 1.Abstract P370 Table 1 AGE GROUP n= number 80– 84 (n= 99) 85+ (n= 74) χ 2 comparison of age group Declined all investigations 9 (9%) 19 (26%) P<0.01 Bidirectional endoscopy 37 (37%) 2 (3%) P<0.00001 Colonoscopy 38 (38%) 2 (3%) P<0.00001 OGD 62 (63%) 31 (42%) P<0.01 CTC 28 (28%) 24 (32%) P=0.55 CT long oral prep 21 (21%) 26 (35%) P<0.05 CT TAP 13 (13%) 20 (27%) P<0.03 Of the 17 potentially operable GI cancers, 9 procedures with curative intent were performed (8 hemicolectomy, 1 transanal resection). Two of these were in patients aged 85+. 1 subject, aged 89, was offered curative surgery but declined. Outcomes from surgery were very positive, with 8/9 patients undergoing surgery still alive (median follow up 984 days, range 454–2151). The single death occurred 1247 days post-clinic. This compared with on-going survival of 2/8 patients who did not undergo surgery (421 and 701 days), with a median survival of 495 days (range 93–1562) for those who died.ConclusionsThe over 80-year-olds with IDA are a heterogeneous group. Overall 16% of patients declined all investigations, though this rose to 26% in those aged over 85. Non-invasive tests were much more likely to be undertaken in the 85+ age group, with only 3% having ‘gold standard’ bidirectional endoscopy. Half of patients with potentially curable GI cancers discovered underwent surgery, with 8/9 alive at a mean follow-up of 2.5 years.

• Publisher: BMJ Publishing Group LTD
• Subject: Age / Age groups / Anemia / Colon / Colonoscopy / Colorectal cancer / Endoscopy / Hepatocellular carcinoma / Iron / Iron deficiency / Kidney cancer / Liver cancer / Malignancy / Medical prognosis / Metastases / Metastasis / Morbidity / Myeloma / Nutrient deficiency / Pelvis / Renal cell carcinoma / Surgery