Cobalamin deficiency in elderly patients: a personal view

Area of Science:

• Geriatrics
• Nutritional Science
• Gastroenterology

Background:

• Cobalamin (vitamin B12) deficiency is prevalent in individuals over 65.
• Clinical manifestations are often subtle, leading to underdiagnosis.
• Neuropsychiatric and hematological complications can be severe.

Purpose of the Study:

• To highlight the commonality and diagnostic challenges of cobalamin deficiency in the elderly.
• To discuss the primary causes: pernicious anemia and food-cobalamin malabsorption.
• To review current and emerging management strategies, including novel administration routes.

Main Methods:

• Literature review of cobalamin deficiency in the elderly.
• Analysis of causes including atrophic gastritis, H. pylori, antacids, and biguanides.
• Examination of management options: injections, oral, and nasal cobalamin therapy.

Main Results:

• Food-cobalamin malabsorption, often linked to atrophic gastritis, is a key cause in the elderly.
• While injections are standard, oral and nasal routes are under investigation.
• Oral cobalamin therapy shows promise for food-cobalamin malabsorption.

Conclusions:

• Cobalamin deficiency requires increased awareness in the elderly population.
• Understanding the specific causes, like food-cobalamin malabsorption, guides effective treatment.
• Investigating new administration routes like oral cobalamin therapy is essential for improving patient outcomes.