1. Harzfeld-Kaplan Hospital, Rehovot, Israel. 2. Institute of Thrombosis and Hemostasis, Department of Hematology, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Israel. 3. The S. Daniel Abraham International Center for Health and Nutrition, Ben-Gurion University of the Negev, Israel. Correspondence: Dr. A Shahar: Harzfeld Geriatric Hospital, Gedera, 70700. Tel: 08-8693039, 08-8595237. E-mail: dvsst@netvision.net.il

Abstract: Background: The elderly are known to have higher rates of low and subnormal vitamin B12 levels than younger persons. Vitamin B12 deficiency has been extensively studied in the elderly, but primarily in outpatient settings. There is a paucity of data regarding the prevalence of low and low-normal B12 in frail, hospitalized, elderly patients, and its implications. Additionally, there is little information regarding vitamin B12 status in Israeli elders. Objectives: The objectives of the study were to estimate the prevalence of low and borderline vitamin B12 levels among frail, hospitalized, elderly patients, and their clinical implications. Methods: We conducted a chart review, using a retrospective cohort design. The participants were 895 patients admitted to Harzfeld Medical Center in Gedera, Israel. Records were abstracted for vitamin B12 and Folic Acid levels, gastric disease, and outcomes including death, cognitive impairment and neurologic disease. Results: Six hundred and forty patients were eligible for the study. In 15% of the patients, vitamin B12 level was in the low range (<150pmol/L) and in 25% in the low-normal range (150-250pmol/L). Gastric disease and antacid use were not associated with the vitamin B12 status. Mortality was higher in the high vitamin B12 group (p=0.02), perhaps reflecting a selection toward higher acuity in this group. Cerebrovascular disease was more common in patients with lower vitamin B12 levels (p=0.046). Conclusions: Forty percent of hospitalized elderly patients have low or borderline serum levels of vitamin B12, which may contribute to cerebrovascular disease and cognitive decline.

Key words: Elderly, frail elderly, hospitalized elderly, nutrition, vitamin B12, cobalamin, cerebrovascular disease, CVA, aging.