5. Conclusion
Vitamin B12 deficiency is common in the institutionalized elderly
with a prevalence of 34.9% by serum assay derived from the present
study. The majority was of a mild to moderate degree of deficiency,
which is likely to be related to food-cobalamin (vitamin B12) malabsorption.
The haematological manifestations of vitamin B12 in terms of anaemia
and macrocytosis seem to be trivial, and haemoglobin level and
MCV are not useful indicators of vitamin B12 deficiency. Traditional recommendation
for vitamin B12 measurement when there are overt signs
and symptoms, such as macrocytosis and anaemia, may miss the
detection of a significant proportion of patients with vitamin B12 defi-
ciency or delay the diagnosis. Thus, more liberal testing for vitamin
B12 status or universal prescription of vitamin B12 supplement to the
institutionalized elderly residents may be warranted. However, the
cost-effectiveness of detecting and treating subclinical or asymptomatic
vitamin B12 deficiency among institutionalized elderly residents versus
universal supplementation of vitamin B12, and the daily dosage
recommended, remain to be determined.