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Sites of vitamin B 12 absorption and causes of deficiency Abbreviations: B = vitamin B 12 ; HCl = hydrochloric acid; I = intrinsic factor; P = animal protein; PPI = proton pump inhibitor; R = protein; TC = transcobalamin Adapted from Reference 29, with permission from Prof E Andrès 

Sites of vitamin B 12 absorption and causes of deficiency Abbreviations: B = vitamin B 12 ; HCl = hydrochloric acid; I = intrinsic factor; P = animal protein; PPI = proton pump inhibitor; R = protein; TC = transcobalamin Adapted from Reference 29, with permission from Prof E Andrès 

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Vitamin B12 deficiency is common among the elderly. Elderly people are particularly at risk of vitamin B12 deficiency because of the high prevalence of atrophic gastritis–associated food-cobalamin (vitamin B12) malabsorption, and the increasing prevalence of pernicious anaemia with advancing age. The deficiency most often goes unrecognised because...

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... vitamin B 12 deficiency can be seen even among the elderly consuming meat and animal proteins and this is because of malabsorption. Vitamin B 12 in animal food is bound to a protein, and after ingestion, it is broken down in the stomach by pepsin and hydrochloric acid to release free vitamin B 12 (Fig 1 29 ). The free vitamin B 12 is then bound to R-protein (transcobalamin I) found in saliva and gastric juice. ...

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... There is limited evidence with other vitamins such as C, E, B 6 and B 12 . Despite the high prevalence of vitamin B 12 deficiency in asymptomatic older people, there is no formal recommendation for screening [45]. The relationship between the intake of these supplements and frailty has been studied in some observational studies [46]. ...
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... Strict vegetarians are even more vulnerable to vitamin B12 deficiency, as they limit their consumption of meat products [2]. The frequency of vitamin B12 deficiency among vegetarians was approximately 62%, while 25 to 86%, 21 to 41%, and 11 to 90% were evaluated in pregnant women, children, adolescents, and elderly, respectively [3]. Therefore, the issue needs to be taken seriously to reduce the number of people suffering from vitamin B12 deficiency. ...
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... Cardiovascular diseases, presence of infection in body, burns and injuries, surgical interventions, sedentary life and stress c a u s e h i g h C -re a c t i v e p ro t e i n ( C R P ) l e v e l s ; postoperative period, chronic diseases, insufficient nutrition of vitamins and minerals such as folic acid, B 12 and iron may cause low blood hemoglobin level and hematocrit ratios in elderly. [9][10][11][12][13][14] Assessing the nutritional status of elderly who are vulnerable to malnutrition helps to identify the factors and risks that affect malnutrition by identifying the risk factors for malnutrition or by accelerating the identification of malnourished elderly and helping to resolve problems that arise in the early period of nutrition. 15,16 Therefore, the aim of this study was to evaluate the nutritional status of elderly receiving home health care by MNA-SF and to investigate the relationship between them and some biochemical parameters (hemoglobin, hematocrit, CRP, creatinine) routinely evaluated by the hospital. ...
... In addition, the diet does not contain enough protein; diabetes and liver diseases, surgical interventions, and the presence of infections can cause an increase in urea levels; malnutrition, sarcopenia and advanced age can lead to a decrease in creatinine level in elderly. [9][10][11][12][13][14][37][38][39][40] The biochemical parameters such as albumin, which is an important indicator of nutritional status that will contribute to research, are not routinely evaluated by the hospital; inability to measure body weight/ height because most elderly were bedridden; were limitations of this research. ...
... Methylmalonic acid is emerging as a toxic metabolite with important biological consequences outside of the methylmalonic academia. Methylmalonic acid is elevated during aging [30,31], which, at least in some cases, is caused by decreased vitamin B12 absorption and metabolism with aging [32][33][34]. The elevation of MMA in elderly people with deficiencies in B12 is associated with and may play causative roles in neuropsychiatric symptoms and macrocytic anemia [35]. ...
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... The prevalence of vitamin B12 deficiency in adults over 60 years of age is reported as 5-20%. The elderly are the group most at risk of vitamin B12 deficiency [11]. In a study of patients who underwent coronary artery bypass surgery, it was emphasized that cobalamin deficiency may be associated with an increased risk of delirium. ...
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... The risk of vitamin B-12 deficiency among the elderly increased because of the high prevalence of atrophic gastritisassociated foodcobalamin (vitamin B-12) malabsorption and the increasing prevalence of pernicious anemia with advancing age (Wong, 2015). Deficiency of the B vitamins (folate, vitamin B-6, and vitamin B-12) may play a role in the pathogenesis of cognitive impairment in the elderly through hyperhomocysteinemia (Parnetti et al., 1997). ...
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Introduction: Vitamin B-12 deficiency is a frequent condition in the elderly population. High homocysteine levels, which can contribute to arterial damage and blood clots in blood vessels, usually indicate a deficiency in vitamin B-12. Different studies have shown an association of raised total homocysteine with incident Alzheimer's disease. This study aimed to evaluate the association between vitamin B-12 levels and the risk of Alzheimer's disease (AD). Methods: A case-control study with a sample size of 90 was conducted at Tertiary hospital, Kathmandu. The participants who visited the psychiatric outpatient department from 2019 onward at Tertiary hospital, Kathmandu, were recruited. The Mini-Mental State Examination (MMSE) was administered to the participants by a trained medical doctor. The medical doctor used the MMSE scores to classify the participants into two groups: the healthy control group and the AD group. Results: The AD group had higher percentages of hypertension (20.9%), diabetes (13.6%), smoking habit (27.3%), vitamin B-12 deficiency (22.7%), and alcohol consumption (13.8%) relative to the control group. Among these features, a significant association was found between alcohol and vitamin B-12 status and between systolic blood pressure and MMSE score. Conclusion: This study concluded that there is an association between low levels of vitamin B-12 and the risk of AD. Further studies are needed to determine the cause-effect.
... This was observed, for example, in the Netherlands and Germany, where mean vitamin B12 intakes were above the recommendations, but status appeared to be inadequate [48]. We identified the elderly as a particularly vulnerable population in terms of vitamin B12 intake and status; this problem was highlighted also in numerous studies in other regions [25,[91][92][93][94][95][96][97][98][99]. Depending on the diagnostic method and cut-offs, international deficiency rates among the elderly population were reported somewhere between 6% and 43%, with higher deficiency prevalence observed in developing countries [26,90,100,101]. ...
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... Similarly, age was associated with increased odds of falls and mortalities in elderly patients with CDA. Advancing age tends to increase the prevalence of atrophic gastritis resulting into malabsorption of dietary cobalamin, which results into pernicious anemia and CDA [39]. By using proper diagnostic criteria and testing methodology, the prevalence of cobalamin deficiency (defined by a serum cobalamin level < or = 300 pg/mL and levels of serum methyl malonic acid and/or homocysteine elevated to > 3 standard deviation (SD)) has been reported to be as high as 14.5% with advancing age [40]. ...
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... 26,62 Vitamin B12 deficiency can result in haematological, neuropsychiatric and digestive disorders. 63 Haematopoietic changes such as skin pallor, low energy, low exercise tolerance, shortness of breath and palpitations are primary indicators in the diagnosis of vitamin B12 deficiency, as the signs are more apparent when compared to neurological disorders. 64 Neuropsychiatric symptoms associated with vitamin B12 deficiency include paraesthesia, gait abnormalities, autonomic dysfunction, depression, psychosis and confusion. ...
... 65 Conversely, neurological symptoms may be present despite serum vitamin B12 being over 150 pmol/L. 63 It is important to note that vitamin B12 deficiency is often linked to folate deficiency. 65 This 'co-deficient' state is associated with an increased risk of hyperhomocysteinemia, and cardiovascular disease. ...
... Common clinical presentations are usually a combination of low serum vitamin B12 with elevated serum homocysteine and/or serum/urine methylmalonic acid (MMA). 63 Serum vitamin B12 of >200 pmol/L is considered the normal range of serum vitamin B12. 69 However, local laboratory guidelines should be referred to for accurate reference of vitamin B12 to inform diagnosis of deficiency. ...
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Background Chronic health conditions and polypharmacy are common among the older population and associated with increased risks of adverse events, medicine-interactions, geriatric syndromes, falls and mortality. Poor nutrition is also common in older people. Causal associations between medication use and older people's nutrient status is seldom discussed. Objectives The objectives of this review were to summarise the literature reporting associations between medicines commonly prescribed to older adults and nutrient deficiencies, and to discuss the clinical implications and management. Methods Medicine information resources (n = 5) were searched for information about nutrient deficiencies associated with common medicines used by older people and listed within the top 50 medicines prescribed by volume on the Australian Pharmaceutical Benefits Scheme. This was followed by a search for clinical studies published on PubMed from inception to April 2020. Data was extracted, tabulated and summarised with clinical information relevant to pharmacists and clinicians involved in the care of older people taking medicines. Results A total of 23 clinical studies were identified reporting medicine-induced nutrient deficiencies in older adults. Vitamin B12, sodium, magnesium were identified as the 3 main nutrients susceptible to deficiency by medicines used to treat cardiovascular disease, neurological conditions, gastrointestinal conditions, and diabetes. The coenzyme CoQ10 was depleted by statins. Conclusion: Certain medicines commonly prescribed to older adults are associated with nutrient deficiencies that may be clinically significant. Given the high prevalence of comorbidities and polypharmacy it is possible that some of these individual drug-induced nutrient deficiencies are compounded, warranting both clinical and research attention.
... Vitamin B12 deficiency is common in the elderly, and its prevalence increases with age (78,79). Chronic atrophic gastritis, ingestion of drugs that affect gastric acid secretion or acid (i.e., proton pump inhibitors and antacids), H. pylori infection, overgrowth of intestinal bacteria, inadequate food intake, alcohol abuse, and smoking can all lead to B12 deficiency (79,80). ...
... The clinical manifestations of B12 deficiency are heterogeneous; generally, there are no visible clinical symptoms. Its classical manifestations include Hunter's glossitis, megaloblastic anemia, and subacute combined degeneration of the spinal cord, and are associated with atherosclerotic vascular disease and neuropsychiatric disorders (78). B12 deficiency is particularly difficult to diagnose in elderly individuals. ...
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Helicobacter pylori (H. pylori) has so far infected more than half the global population. It is the most important and controllable risk factor for gastric cancer. The elderly, who are at a higher incidence of the infection, are also commonly found to develop antibiotic resistance. The symptoms, diagnosis, clinical features (of gastric or extra-digestive diseases), and treatment of H. pylori infection in the elderly, are different from that in the non-elderly. Health conditions, including comorbidities and combined medication have limited the use of regular therapies in elderly patients. However, they can still benefit from eradication therapy, thus preventing gastric mucosal lesions and gastric cancer. In addition, new approaches, such as dual therapy and complementary therapy, have the potential to treat older patients with H. pylori infection.