Diagnostic choices and clinical outcomes in octogenarians and nonagenarians with iron-deficiency anemia in the Netherlands.

OBJECTIVES: To evaluate current clinical practice for octogenarians with iron-deficiency anemia (IDA) by assessing referral patterns, diagnostic choices, clinical consequences of omission of endoscopy, and risks and benefits of IDA-related surgery. DESIGN: Chart review. SETTING: A regional hospital-based laboratory in the Netherlands between January 2008 and December 2010. PARTICIPANTS: All individuals aged 80 and older with newly ascertained IDA. MEASUREMENTS: IDA was defined as a hemoglobin level of 11.1 g/dL or less and a ferritin level of 25 µg/L or less. RESULTS: Four hundred seventy-one participants were newly diagnosed with IDA during the study period (median age 85.4), 276 of whom (59%) did not undergo any diagnostic procedures for IDA. A cause of anemia was identified during the initial examination in 50% of the 205 investigated participants, including nine (4%) upper and 37 (18%) lower gastrointestinal malignancies. Another 24 malignancies were identified during follow-up, of which 16 were in the gastrointestinal tract, primarily in participants for whom the initial diagnostic examination was limited or omitted. Perioperative mortality was 15% in individuals with colon cancer. Median survival for participants with colon cancer was 2.2 years, and the survival benefit of surgery over supportive care was not apparent until 1.3 years after ascertainment of IDA. CONCLUSION: The omission of endoscopy for IDA and the omission of surgery for colon cancer occur frequently in octogenarians and seem appropriate in the presence of significant comorbidity and in cases in which there is limited life expectancy. Further research is needed to determine which baseline factors should guide decision-making to optimize treatment outcomes and quality of life.

Patients and families desire a patient to be told the diagnosis of dementia: a survey by questionnaire on a Dutch memory clinic.

BACKGROUND: Controversy exists as to whether dementia patients should be told their diagnosis. OBJECTIVE: This study examined as to whether, both patients with subdued memory impairment and their accompanying relatives want a diagnosis of dementia or somatic disease disclosed to the referred patient. METHOD: Fifty consecutive out-patients referred to a memory clinic and their accompanying relatives filled in a questionnaire regarding their views on telling the diagnosis to the patient in case of a somatic disease and in case of a dementia. An ordinal scoring system was used (not important 1; little important 2; important 3 and very important 4). RESULTS: Forty-six (92%) questionnaires were completed. All the patients and their accompanying relatives thought it was at least important that physicians should tell the patient their diagnosis in case of a somatic disease, and 96% of the patients, 100% of the spouse and 94% of the non-spouse accompanying relatives stated the same in case of a dementia. All the spouses and most of the accompanying relatives showed similar desires for a dementia or somatic diagnosis. CONCLUSION: In The Netherlands, out-patients with subdued memory impairment, mostly suffering from a dementing illness, wish to be informed of their diagnosis, therefore should not automatically be considered incompetent.