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Vitamin B12 Deficiency in Elderly Common and Can Be Treated

vitamin B12 deficiency in elderly

It’s long been known that vitamin B12 deficiency affects a large percentage of the elderly and that it can play a significant role in several serious health conditions associated with this age group. Here’s some of the latest on vitamin B12 deficiency in elderly individuals, what to look for, and how to treat it.


A new study highlights the presence of vitamin B12 deficiency in elderly individuals in long-term care facilities. The authors, who are from the University of Waterloo in Ontario, Canada, pointed out that up to 70 percent of adults age 65 and older who live in long-term care facilities are at risk for undernutrition, a condition that is poorly studied in this population. Malnutrition is accompanied by nutrient deficiencies, including vitamin B12.

Vitamin B12 deficiency
Vitamin B12 is of special concern because elderly individuals have difficulty absorbing this nutrient, not only because of advancing age but also because they typically take multiple medications, which can disrupt absorption of the vitamin. Older adults are often deficient in vitamin B12, and such a deficiency can lead and/or contribute to blood and neurological disorders, including anemia and dementia.

Other signs and symptoms associated with a vitamin B12 deficiency include the following. The items in this list can easily be attributed to other health problems or diseases, which is why a deficiency of this nutrient is often overlooked among older adults.

  • Unusual sensations, tingling, or numbness in the hands, legs, or feet
  • Balance problems and/or difficulty walking
  • Vision loss
  • Shortness of breath and heart palpitations
  • Swollen, inflamed tongue
  • Weakness and/or fatigue
  • Difficulty with memory, reasoning, and/or thinking
  • Anemia
  • Jaundice (yellowed skin)
  • Hallucinations or paranoia

B12 deficiency and elderly in care facilities
Unfortunately, research into the presence of vitamin B12 deficiency in older adults living in long-term care facilities is scarce, while a few studies have revealed that the vitamin deficiency affects up to 43 percent of older individuals living in the community. Adults in care facilities may be at greater risk.

One concern is that older adults who are moved into a long-term facility are especially susceptible to anxiety, stress, and depression because of their relocation. At the same time, such a move can involve a change in the individual’s primary doctor and the possibility that medications and/or supplements that are part of the patient’s treatment fail to make it into their post-admission care plan.

In this new study, the authors set out to identify the prevalence of vitamin B12 deficiency among older adults who were entering a long-term care facility and the status of the nutrient one year later. These facilities have a policy of checking B12 levels at admission and then yearly.

The authors evaluated data from 412 residents (mean age, 83 years) in eight long-term care homes. These residents had a mean of 6 diagnoses and were taking a mean of 10 medications each.

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At admission to the facility, their vitamin B12 status was

  • Deficient (less than 156 pmol/L; 13.8% of admitted residents)
  • Subclinical deficiency (without signs or symptoms, 156-300 pmol/L; 38.3%)
  • Normal (greater than 300 pmol/L; 47.6%)

Therefore, more than half of the individuals entering the facilities had subnormal levels of vitamin B12. Analysis of a subsample (163 residents) at one year showed that the percentage of individuals with a vitamin B12 deficiency had dropped to 7 percent and the incidence of new cases of deficiency was 4.2 percent.

Overall, this study showed that the prevalence of vitamin B12 deficiency was nearly 14 percent, with a range across the 8 sites of 4.1 percent to 27 percent. This range is in line with the four studies conducted over the past 10 years among residents in long-term care facilities (8%-34%), yet none of those studies considered status of deficiency at admission or incidence after admission.

Bottom line
A significant percentage of older adults have a vitamin B12 deficiency, and it may be overlooked if individuals have symptoms that are attributed to other conditions. Therefore, it's entirely possible that memory problems/dementia, balance difficulties, or tingling in the feet could be a vitamin deficiency.

If you have parents or other family members who are 65 years or older, it’s a good idea to have their vitamin B12 status checked, regardless of whether they are in a facility or still living in the community. A vitamin B12 deficiency can be corrected or avoided with supplementation or, in more serious cases, intramuscular or subcutaneous injections.

It’s not just the elderly who are at risk for vitamin B12 deficiency. Others who should check out their levels of this nutrient with a blood test include people older than 50, anyone who is using proton pump inhibitors (e.g., Nexium, Prevacid), H2 blockers (e.g., Pepcid, Zantac), or metformin, strict vegetarians/vegans, individuals who have undergone weight loss surgery, and anyone who has a condition that interferes with food absorption.

Also Read: Value of vitamin B12 for multiple sclerosis
Vitamin B12 deficiency and supplements, surprising information
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Andrès E et al. Vitamin B12 (cobalamin) deficiency in elderly patients. Canadian Medical Association Journal 2004; 171(3): 251-59
Bronskill SE et al. Exploring variation in rates of polypharmacy across long term care homes. Journal of the American Medical Directors Association 2012; 13(3): 309-e315-321.
Isenring EA et al. Beyond malnutrition screening: appropriate methods to guide nutrition care for aged care residents. Journal of the Academy of Nutrition and Dietetics 2012; 112(3): 376-81
Mirkazemi C et al. Vitamin B12 deficiency in Australian residential aged care facilities. Journal of Nutrition, Healthy & Aging 2012; 16(3): 277-80
Pfeiffer CM et al. Biochemical indicators of B vitamin status in the US population after folic acid fortification: results from the National Health and Nutrition Examination Survey 1999-2000. American Journal of Clinical Nutrition 2005; 82(2): 442-50
Pfisterer KJ et al. Vitamin B12 status in older adults living in Ontario long-term care homes: prevalence and incidence of deficiency with supplementation as a protective factor. Applied Physiology, Nutrition, and Metabolism 2016 Jan 19 online