Abstract
Background: Anaemia, defined as insufficient haemoglobin to meet the body’s demands, is common in older adults. It is especially common in frail older adults, affecting over 50% of nursing home residents. In the elderly, anaemia is linked to increased falls, impaired cognition, reduced muscle strength, and poor quality of life. New iron deficiency anaemia (IDA) in those over 60 is a red-flag symptom that warrants urgent investigation for GI malignancy.
Methods: This quality-improvement project used the Plan, Do, Study, Act (PDSA) framework in three audit cycles, including care of the elderly inpatients (n=72) admitted at North Middlesex University Hospital (NMUH) for over 24 hours. Exclusion criteria were those with known GI malignancy or prior GI investigation within 12 months. The project assessed adherence to minimum recommended serum investigations for anaemia in older adults. Interventions included a departmental teaching session, a ‘COE anaemia bundle’ blood request form, and educational posters.
Results: The recommended first-line investigations include B12, folate, and ferritin due to the multifactorial nature of anaemia in the elderly. Prior to intervention, 27% had no further investigations, and less than 50% had all recommended tests. 63% of the cohort was anaemic. Following interventions, fewer patients had no further investigations however the number who had all recommended remained static at ~50%.
Conclusion: Without complete investigations, patients are unlikely to receive optimal treatment. Anaemia management in frail elderly patients is vital but it is challenging to complete meaningful interventions in clinical areas staffed by rotational workforces. Further strategies and ongoing audits are needed to ensure best practices.