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Iron deficiency anaemia in severe frailty — SCE Geriatric Medicine MCQ

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HardAnaemia/haematologyIron deficiency anaemia in severe frailtySCE Geriatric Medicine

A 91-year-old with CFS 8, moderate dementia, Hb 82 g/L, ferritin 9 micrograms/L and positive FIT becomes severely distressed by hospital visits. She has consistently said she would not accept surgery or chemotherapy. Which investigation strategy is proportionate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Clarify goals and offer symptom-focused iron treatment rather than automatic colonoscopy

Explanation lettering: C = shown as A · A = shown as C

A is correct: investigation is proportionate only when its result could lead to an intervention the patient would accept and benefit from; symptom-focused iron may best match her goals. B still creates preparation, transport and incidental-finding burdens without changing the treatment ceiling. C adds anaesthetic risk to an investigation whose result would not alter accepted care. D substitutes a different test without solving that decision problem. E creates surveillance burden and assumes severe frailty will reverse.

Reference: BGS: investigating iron deficiency in older people with anaemia: https://www.bgs.org.uk/investigating-for-iron-deficiency-in-elderly-patients-with-anaemia