Everyone knows that vitamins and nutrition are important for health, and many older adults take a multivitamin.
But did you know that even among older persons who do this, many still end up developing a serious deficiency in one particular vitamin?
It’s Vitamin B12.
If there’s one vitamin that I’d like all older adults and family caregivers to know more about, it would be vitamin B12.
(Second on my list would be vitamin D, but it’s much harder to develop low vitamin D levels if you take a daily supplement, as I explain in this post. Whereas vitamin B12 deficiency does develop in many older adults who are getting their recommended daily allowance.)
A deficiency in any vitamin can be catastrophic for health. But vitamin B12 deficiency stands out because a) it’s very common — experts have estimated that up to 20% of older adults may be low in this vitamin — and b) it’s often missed by doctors.
Geriatricians also like to pay attention to vitamin B12 because a deficiency can cause — or usually worsen — cognitive impairment or walking problems.
But if you know the symptoms and risk factors, you can help ensure that you get a vitamin B12 deficiency detected. Treatment is safe and effective, as long as you catch the problem before permanent damage occurs. Here’s what to know.
How Vitamin B12 Deficiency Harms Health
In the body, vitamin B12 – also known as cobalamin — is especially vital to making red blood cells, and maintaining proper function of nerve cells. When vitamin B12 levels are low, a person can develop health problems related to red blood cells and nerve cells malfunctioning.
The most common problems related to low vitamin B12 levels include:
- Anemia. This means the red blood cell count is low. Red blood cells carry oxygen in the blood, so anemia can cause fatigue or shortness of breath. The breakdown of faulty red blood cells can also cause jaundice. (Learn more about anemia here: Anemia in the Older Adult: 10 Common Causes & What to Ask.)
- Neuropathy. This means that nerves in the body are not working well. This can cause a variety of symptoms, including tingling, numbness, burning, poor balance, and walking difficulties.
- Cognitive impairment. This means that nerve cells in the brain are not working well. This can cause memory problems, irritability, and even dementia.
You may have heard that vitamin B12 deficiency can cause pernicious anemia. But in fact, the term “pernicious anemia” means a specific vitamin B12 deficiency caused by the loss of the body’s ability to make “intrinsic factor.” Intrinsic factor is in the lining of the stomach, so a weakened stomach lining (which is called “atrophic gastritis” can cause pernicious anemia. The body needs intrinsic factor to absorb vitamin B12; without it, vitamin B12 levels eventually drop. This often causes anemia, but sometimes symptoms of nerve and brain problems occur first.
Why Low Vitamin B12 Levels Are Common in Older Adults
To understand how low vitamin B12 levels happen in aging adults, it’s good to start by learning how the body usually obtains and processes this vitamin.
In nature, vitamin B12 is available to humans only in meat and dairy products. However, in modern times, you can easily get it via a supplement or multivitamin. The recommended daily allowance for vitamin B12 for adults is 2.4 micrograms. Experts have estimated that a Western diet contains 5-7 micrograms of vitamin B12, and a multivitamin often contains 12-25 micrograms.
Once you ingest vitamin B12, it is processed by acids and enzymes in the stomach and small intestine. The processed vitamin is then absorbed by the small intestine and stored in the body, especially in the liver.
This stash can actually meet the body’s needs for a few years; although vitamin B12 is essential, only a tiny bit is needed every day. So if a healthy person stops taking in vitamin B12, it often takes a few years before the body runs out of it and develops symptoms.
So why does vitamin B12 deficiency particularly affect older adults?
As people get older, their ability to absorb vitamin B12 decreases. This is because aging adults often develop problems with the acids and stomach enzymes needed to process the vitamin.
Common risk factors for low vitamin B12 levels in older adults include:
- Low levels of stomach acid. This can be due to weakening of the stomach lining (also known as “atrophic gastritis”), or to medications that reduce stomach acid.
- Medications such as metformin (used for diabetes), which interferes with vitamin B12 absorption.
- Alcoholism, which irritates the stomach and sometimes is linked to a poor diet.
- Surgeries to remove parts (or all) of the stomach or small intestine.
- Any problem that causes poor absorption in the stomach or small intestine, such as Crohn’s disease.
Why Vitamin B12 Deficiency Is Often Missed in Aging Adults
Vitamin B12 deficiency is often missed because the symptoms – fatigue, anemia, neuropathy, memory problems, or walking difficulties – are quite common in older adults, and can easily be caused by something else.
Also, vitamin B12 deficiency tends to come on very slowly, so people often go through a long period of being mildly deficient. During this time, an older person might have barely noticeable symptoms, or the symptoms might be attributed to another chronic health condition.
Still, a mild deficiency will almost always get worse over time. And even when an older adult has many other causes for fatigue or problems with mobility, it’s good to fix whatever aggravating factors – such as a vitamin deficiency — can be fixed.
Unlike many problems that affect aging adults, vitamin B12 deficiency is quite treatable. Detection is the key; then make sure the treatment plan has raised the vitamin B12 levels and kept them steady.
Who Should Be Checked for Vitamin B12 Deficiency
An older person should probably be checked for Vitamin B12 deficiency if he or she is experiencing any of the health problems that can be caused by low levels of this vitamin.
I especially recommend checking vitamin B12 levels if you’re concerned about memory, brain function, neuropathy, walking, or anemia.
To make sure you aren’t missing a mild vitamin B12 deficiency, you can also proactively check for low vitamin B12 levels if you or your older relative is suffering from any of the common risk factors associated with this condition.
For instance, you can request a vitamin B12 check if you’re vegetarian, or if you’ve suffered from problems related to the stomach, pancreas, or intestine. It’s also reasonable to check the level if you’ve been on medication to reduce stomach acid for a long time.
How Vitamin B12 Deficiency is Diagnosed
The first step in checking for deficiency is a blood test to check the serum level of vitamin B12.
Because folate deficiency can cause a similar type of anemia (megaloblastic anemia, which means a low red blood cell count with overly-large cells), doctors often test the blood for both folate and vitamin B12. However, folate deficiency is much less common.
You should know that it’s quite possible to have clinically low vitamin B12 levels without having anemia. If a clinician pooh-poohs a request for a vitamin B12 check because an older person had a recent normal blood count, you can share this research article with the clinician.
Although MedlinePlus says that “Normal values are 160 to 950 picograms per milliliter (pg/mL)”, the clinical reference UptoDate says that a normal serum vitamin B12 level is above 300 pg/mL.
Normal vitamin B12 levels do not change with age, so there’s no need to look for a different cutoff as people get older.
If the vitamin B12 level is borderline, a confirmatory blood test can be ordered. It involves testing for methylmalonic acid, which is higher than normal when people have vitamin B12 deficiency.
In my own practice, especially if an older person has risk factors for vitamin B12 deficiency, I consider a vitamin B12 level of 200-400 pg/mL borderline, and I usually order a methylmalonic acid level as a follow-up.
How to Treat Vitamin B12 Deficiency in Older Adults
If the blood tests confirm a vitamin B12 deficiency, the doctors will prescribe supplements to get the body’s levels back up. The doctor may also recommend additional tests or investigation to find out just why an older person has developed low vitamin B12.
The usual dosage for initially treating vitamin B12 deficiency in older adults is 1000 micrograms, which can be given as a weekly intramuscular injection, or as a daily oral B12 supplement.
It’s common to start treatment for a significant vitamin B12 deficiency with weekly intramuscular shots (1000 micrograms of vitamin B12). This bypasses any absorption problems in the stomach or intestine, and is a good way to get an older person’s vitamin B12 level back to normal quickly.
High-dose oral vitamin B12 supplements (1000-2000 micrograms per day) have also been shown to raise levels, because high doses can usually compensate for the body’s poor absorption. However, oral treatments probably take longer to work than intramuscular shots. So they’re not ideal for initially correcting a deficiency, although they’re sometimes used to maintain vitamin B12 levels.
I’ve found that most older patients prefer oral supplements over regular vitamin B12 injections, which is understandable; shots aren’t fun. However, this requires the older person to consistently take their supplement every single day. If you (or your older relative) has difficulty taking medications regularly, scheduled vitamin B12 shots are often the better option.
And the good thing about vitamin B12 treatment is that it’s basically impossible to overdose. Unlike some other vitamins, vitamin B12 doesn’t cause toxicity when levels are high.
So if you’re being treated for vitamin B12 deficiency, you don’t need to worry that the doctors will overshoot. You just need to make sure a follow-up test has confirmed better vitamin B12 levels, and then you can work with the doctors to find the right maintenance dose to prevent future vitamin B12 deficiency.
For an older person on vitamin B12 injections, once the blood level of vitamin B12 has normalized, the injections can be given once a month.
Are There Other Benefits To Taking Vitamin B12 Supplements?
Since we know vitamin B12 is necessary for the proper function of red blood cells and brain cells, you might be wondering if it’s good to take higher doses of vitamin B12 as part of a healthy aging approach.
It certainly won’t hurt, since vitamin B12 doesn’t cause problems at higher blood levels the way some vitamins do.
But once an older person has a good level of vitamin B12 in the body, it’s not clear that additional vitamin B12 will reduce the risk of problems like cancer or dementia. To date, much of the research on the benefits of extra vitamin B12 has been inconclusive.
However, research has definitely confirmed that a deficiency in this essential vitamin is harmful to the body and the brain, with worse deficiencies generally causing greater harm.
So to help yourself or a loved one make the most of this vitamin, focus on detecting and treating vitamin B12 deficiency. Remember, this common problem is frequently overlooked.
You can help yourself by asking the doctor to check vitamin B12 if you’ve noticed any related symptoms, or by asking for a proactive check if you have any risk factors.
Older adults often have enough health problems to deal with. Let’s make sure to notice the ones that are easily detectable and treatable.
Have you had any challenges related to vitamin B12 deficiency? I’d love hear from you in the comments below.
Teresa Bloomberg says
Hello there. My mom is 81yo and has had progressive decline in her cognition in past couple of years. She is in good health, no longer takes BP medicine, just aspirin and levothyroxine. Her cholesterol runs around 200.
Her Vitamin B12 level was critically low in 2020. (30years ago she was on B12 shots but they were stopped for some reason)
She saw my neurologist on my recommendation back in November 2020 where he detected an elevated MCV in her historical labs. This concerned him as that MCV was drawn early 2020, and that her PCP overlooked this.
She’s been getting regular B12 injections since December 2020. Past 5 mo are subcutaneous injections that my dad is administering to her. Her May B12 level was 198. I find this distressing. She was re-evaluated by my neurologist in March 2021 where we noted she is stable, diagnosed with MCI.
I’m a career RN so I’m knowledgeable. I work FT and live an hour away from my parents. I’m very concerned that she is not getting the medical attention she needs from her PCP.
I can really use your feedback as it is causing me stress. My Mom always had a sharp memory. Seeing these issues with short term memory worries me.
Thank you so so much! I very much look forward to hearing from you.
Teresa from New Jersey, USA
Nicole Didyk, MD says
Hi Teresa and thanks for taking the time to share your comments. I hope you’re staying well as a nurse during COVID, it’s been a difficult time.
It’s always hard to care for a parent from a distance, and I can understand your frustration about the gaps in health care for older adults. It sounds like you’re concerned about whether a missed B12 deficiency could have contributed to your mom’s mild cognitive impairment (MCI).
For most older adults, oral B12 replacement is sufficient, unless there’s a lack of intrinsic factor and B12 can’t be absorbed by the gut. But 198 is a lower B12 level than I like to see in older adults (I usually consider over 300 to be the target for B12 levels).
The relationship between Vitamin B12 and cognition is complicated. When we look at large databases of older adults with Vitamin B12 levels, like in this review of 18 studies of B12 levels, it seems that low homocysteine levels (which is seen in individuals with low B vitamin levels) correlate with higher rates of dementia. But replenishing B12 in those with low levels doesn’t appear to help with cognitive performance, or to prevent progression to dementia.
It sounds like you’re such a good support and advocate for your parents and you’d probably enjoy Dr K’s new book: When Your Aging Parent Starts Needing Help. It has useful advice about how to maximize communication with your parents’ healthcare providers which can greatly reduce stress. The book can also help you decide how to “pick your battles” and decide where to focus your energy.
When it comes to MCI, my advice is to exercise, eat well, and stay socially connected (hard to do during COVID). I made a video about that which you can watch here.
Thanks again for taking the time to share your story and I hope you keep coming back to the site.
Swapnil Dusange says
Hi, this is Swapnil from India…i m 25 yrs old male..on 22nd april i felt like a breathlessness..so i scared a lot after then. My heart was beating very fast (98-115/mnt)…for 15 days, So i went to local MD doc..he gave me tablet of anxiety and depression (typtomer 10 and inderal 40)..when i took that medicine at afternoon..my head was like full of worse thoughts , felt like i was alone…then i stopped that medicine, wait for 4 days..in those 4 days every day after waking i have feeling of sleepiness like my eyes are closed. So on 8th may i went to MD neurologist. He did blood urine and vitamin b12 test…B12 level was 225. He gave me 5 rejunex forte injections and told me that take it on every 3rd day…till now i took 2 shots…heart beats are normal. That scared feeling is low but till there..will those remaining 3 doses gives me full recovery?? Please help .
Nicole Didyk, MD says
My practice is in Geriatrics so I don’t work with older adults, and I can’t give medical advice over the internet, especially to one so far away in India. It sounds like you’re really concerned about your health and I’m glad to hear that you have a local MD to work with. Good luck.
bhevin singh says
Hi Nicole,
In the recent test of my mom who is 71, we found her B12 level is 220….she also has cholesterol and low iron…when we met the doctor he only gave medicine to control cholestrol, but didn’t mention supplements for b12 and iron…..we mentioned about b12, but he says, its normal, no need to give….but i feel its low, and its better to treat early rather than wait. My question can we give b12 supplements to patients who is having cholesterol issues…and what should be the dose…..between 500 -1000 mcg ? waiting for your reply.
Nicole Didyk, MD says
Hi Bhevin. As far as I know, there’s no reason to avoid B12 supplementation if a person has high cholesterol or is being treated for high cholesterol.
When I recommend a B12 supplement, I usually suggest 1000 mcg, but I can’t give medical advice over the internet, so I would check with your pharmacist to know what does is right for your mom.
Sriram Krishnan says
Dear Dr.Leslie Kernisan
Your articles both on B12 and Vitamin D and the FAQ’s has been of a great directional help on these required micronutrients for a common person on the street. I am a 54 year old male from India and a vegetarian since birth. I have been taking supplement for the both B12 and D3 for the last 2 years when the level of b12 was 112 and d3 was15. After the initial loading doses when these levels were above the required normal, my great confusion was how to maintain these levels. Your articles have cleared my doubts and I now take the maintenance doses with lot of confidence. Many thanks for helping and supporting us through these expertly articles . Looking forward to your guidance in future and also wish u pots of good luck and God bless u. Thanks from India.
Nicole Didyk, MD says
Hi Sriram and thanks for taking the time to share your story! I’m so glad that you found a routine that works for your health needs. Your kind feedback about the articles is greatly appreciated. Keep reading!
sharlene delauter says
I am 73 yo female who has been a vegetarian for 50+ years. I recently (within the last year) started taking Vitamin B12 supplements of 1000 mcg/day because I learned of poor absorption after 65 and that vegetarians are at higher risk for stroke because of low homocysteine levels. My B12 level checked out at 598 pg/ml in August. I’m assuming I should continue doing what I am doing. But is there any danger of having levels get too high at this dose?
Nicole Didyk, MD says
It’s safe to take Vitamin B12, even at doses much higher than is recommended. Thanks for the question!
Nicole Didyk, MD says
Vitamin B12 is considered to be harmless, even at doses much higher than the RDA. Here’s a an answer to a prior comment that might help.
Kathryn says
Have issue walking and balance and pain and being tried all the time need help
Nicole Didyk, MD says
Sorry to hear about your difficulties. Symptoms like the ones you describe could be related to a low Vitamin B12 level, but they are also what we doctors call “non-specific” which means that they could be part of many different disorders.
When I see a patient with complaints of fatigue, pain, and balance problems, I start by asking questions to find out more about how long the symptoms have been there, what makes them worse, whether they are associated with any other features, and so on. I would also do a complete physical examination and probably run a few lab tests.
Another very important piece of the puzzle is to look at the medications that an older person is taking. Unfortunately, medication side effects can include fatigue and balance issues in some cases.
David C says
I have taken 2000mg of Metformin daily for at least 12 years. My RBC count is borderline low (4.1). I experience daily fatigue despite walking two miles daily. I am 74. I suspect my age and Metformin use could cause B12 deficiency. Would you advise being tested for B12 and folate levels?
Nicole Didyk, MD says
Metformin, commonly used to treat Diabetes, can reduce the absorption of Vitamin B12 in up to 30% of those who take it, and the longer a person takes Metformin, the higher the risk of lower B12 levels. For most individuals, adequate dietary intake of B vitamins, or the use of a multivitamin or Calcium supplement is enough to keep B12 deficiency at bay, but if a person has other risk factors for B12 deficiency, then it’s probably a good idea to get it checked.
In North America, it’s unusual to have a folate deficiency because of the addition of folate to many processed foods, but we often check it as well if a person is showing signs of B12 deficiency (like problems with the peripheral nerves or anemia).
Fatigue can be complex to sort out, and can have almost innumerable causes, so when I’m seeing a person with fatigue I usually need to go over their entire health history, physical examination, mediation list and more, before ordering tests. But checking B12 is often part of the complete workup.
Mary Kay says
Thank you for your article on Vitamin B12 deficiency. My Dad (turned 90 last week) has been suffering from chronic fatigue, walking problems/falls, and cognitive impairment for about 5 years. Early on he received a B12 shot and his blood levels of B12 have been well above 900 pcg/ml for several years now, but his symptoms continue. Despite the above normal level, one neurologist prescribed 1000 mg B12 supplement daily which he has never taken. Is it possible for an older person to have normal levels of B12 in the blood but a problem with the cells being able to use it? Would taking a B12 supplement help?
Nicole Didyk, MD says
Good question.
The lab test for Vitamin B12 is fairly good, with a “sensitivity” of over 90% (will detect the deficiency accurately 90% of the time). If a person has an intrinsic factor deficiency though (a condition also known as “pernicious anemia”), the test might give a normal result when a person is actually B12 deficient. This can happen with some other conditions as well, like some types of cancer, liver disease or kidney disease. So the test may be normal when a person is actually deficient.
When we see a patient with a suspected B12 deficiency, and they aren’t responding to B12 replacement therapy, there are some other lab tests that we can do to look more closely at cell metabolism. We can measure two other substances called Methyl-malonic acid (MMA) and homocysteine. Depending on what these tests who, this can help to determine if there’s a true B12 deficiency, or something else is going on.
You also ask if he could have normal B12 levels but not be using the B12 appropriately, and there are some conditions that can cause this. They are usually related to other factors that are needed for cell metabolism, such as a deficiency of another factor (like folate), so if that’s the case, the problem isn’t really a lack of B12, it’s something else and taking B12 wouldn’t correct it.
To avoid unnecessary lab tests, and because B12 is cheap and safe, we normally go ahead and give a B12 supplement when levels are low, or when we suspect that a B12 deficiency is present. In an older adult with multiple difficulties, a Geriatrician would probably look at more than just a B12 level to try to tease out what’s causing the symptoms and what to do to help.
CT Berg says
Your timing on this was perfect and thanks so much! I have horrible drenching night sweats daily at age 70 and female, an accelerating problem for the last year. I was just about to press for a B12 test when c19 precautions derailed everyday care and kept home. But I would love to get this aggravation solved.
My grandmother allegedly had pernicious anemia 50 years ago. So when I did a PubMed scan and found Canadian reports of a Swedish study where b12 injections solved the elderly night sweat problem quite well, I thought this might be my issue too, especially since I have no other bothersome symptoms.
Have you heard of B12 helping severe chronic night sweats? The few physicians I have been able to ask can’t even guess and my PCP might like hearing this is a plausible theory.
Nicole Didyk, MD says
I have never used B12 injections to treat unexplained night sweats and I confess to not being able to find the Canadian study that you quote (despite being Canadian myself), but I did see one in the Scottish Medical Journal that was a case study of 3 patients who had improvement in night sweats when the B12 was replenished. The theory was that the B12 deficiency caused a problem with the autonomic nervous system, which was caused by a B12 deficiency.
The occurrence of night sweats can signify a more serious issue in some cases, so I would only suggest trying a B12 supplement after other potential causes of the sweating have been ruled out.
CT Berg says
Thanks so much for your time. I think we were looking at the same root data — and yes it was conducted abroad, but also reported in a Canadian journal that I found via Google scholar. I am fairy confident the other possible causes will be ruled out in my case, but yes, will review with my PCP. Thanks again!
CT Berg says
FYI, here is the cite that I found:
Vitamin B12 deficiency causing night sweats
HU Rehman
First Published October 3, 2014 Case Report Find in PubMed
https://doi.org/10.1177/0036933014554875
Abstract
Vitamin B12 deficiency is common. It is known to cause a wide spectrum of neurological syndromes, including autonomic dysfunction. Three cases are discussed here in which drenching night sweats were thought to be caused by vitamin B12 deficiency. All three responded dramatically to vitamin B12 therapy.
Nicole Didyk, MD says
Yes, it’s the same article! Just remember that case studies are informative but don’t have the same level of scientific rigor as other types of research (like randomized clinical trials). Nonetheless, for some medical questions it’s the best evidence we have. Let us know how your trial works out!
Suzanne Dixon says
Hi, I was just wondering if B12 inj5ections helped with your night sweats, my Mum has all other classic low b12 and used to have injections pre covid but all of a sudden has started having night sweats. I too saw the case studies but her GP will not entertain it.
Nicole Didyk, MD says
It can be frustrating to feel like you’re not being heard by a medical professional. Oral B12 supplementation is a reasonable thing to try if injections aren’t feasible. I usually advise about 1 mg of B12 daily.
And again, don’t overlook other causes of night sweats, like infection or a medication side effect.
Anonymous says
Dear Dr. Kernisan, Date Composed: 7/11/2020
Thanks for your fascinating article on B12 deficiency. I’m also worried by it, as I’m 83 and I have had long-standing, slow developing symptoms in all your categories of Anemia, Neuropathy, and Cognitive Impairment.
I’m reluctant to ask my regular Kaiser physician for a blood level test, as going into the hospital for lab work means potential exposure to the corvid-19 virus, which I’ve worked hard to avoid. My wife, a retired nurse, suggested a note to you would the best way to start seeing if B12 might help.
Anemia. For 2 or more years now I suddenly became much more tired when taking a walk. Up one flight of stairs or half a block, and I want to stop and catch my breath. The tired, breathless feeling is like what used to happen after several flights and many blocks. I used a pulse oximeter, it showed 97-98% oxygen in my blood in spite of my feeling tired, but the tiredness is real.
Neuropathy. Tingling on tips of toes starting a couple of years ago, now over most of my feet. Charley horses in legs used to be rare, once or twice a year, now once a week or so. Neurologist diagnosed me with length dependent axonal symmetrical polyneuropathy, nothing to do about it. Not feeling as stable on my feet when walking, occasional mild, transient dizziness.
Starting in my early 20s, “tension” headaches. (I put quotes around “tension” as no doctor has ever done what seems obvious, put a hand on my temple to see if I feel tense…) Lots of diagnostic work, no cause found. I have records, slow creeping up of headache intensity/duration over decades, now chronic, lasting most of a day. Years ago aspirin or Tylenol, then they became no longer effective, started small doses of codeine w Tylenol. For the last several years regularly six 60 mg tablets per day on average, little variation. Not a cure, but keeps headache pain levels down some to where I can still write scientific journal papers in my fields, but much lessened productivity. No side effect that I know of from the codeine except temporary constipation for a few hours after taking, generally not a problem. At least 7-8 alternative Rx drug treatments tried, no reduction in headaches, unacceptable side effects of unsteadiness in walking and obvious forgetfulness.
Cognitive Impairment. I am still perceived as smart and normal from the outside, but from the inside my immediate sensory memory is shortened and less comprehensive, and I don’t feel as intelligent. I can retrieve what I need from long-term memory, but it takes longer.
I’m still active in my specialty research fields and would like to have more energy and fewer headaches: I have a number of interesting observations and useful (I hope) ideas to share that my younger colleagues might find of value.
So B12?
I’ll end with a story that may amuse you. My wife and I heard you lecture and were very impressed. Obviously we should have a gerontologist like you look over our medical treatments. I asked my primary care doctor to refer me to one of the Kaiser gerontologists. She looked at me for a few seconds, then told me “I’m sorry, there’s no way I can certify you as decrepit.” How nice! 😉
Thanks for your writings and this chance to ask a question.
Anonymous (for professional reasons)
Nicole Didyk, MD says
Thanks for sharing your story and that anecdote!
It’s true that a deficiency in vitamin B12 can cause symptoms that are similar to what you describe, as can a great many other disorders, or combination of disorders. When I see a patient with a slowly developing constellation of issues, I take the usual Geriatrics approach and take a look at everything from sleep and activity levels to medication lists, and all that’s in between.
It can be tempting to want to try a vitamin B12 supplement, and not likely to do any harm, but I would advise anyone to review things with a pharmacist or doctor before spending money on a potentially unnecessary tablet.