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At age 62, you have suffered for years with frequent heartburn, and you’ve been taking an acid-reducing medication to alleviate your symptoms. Recently, you began feeling weak, fatigued, and short of breath. Your annual medical checkup revealed that you have macrocytic anemia due to vitamin B-12 deficiency. Due to reduced stomach-acid secretion, your absorption of vitamin B-12 has been impaired. What would you choose to boost your vitamin B-12 status?

Why are older adults at particular risk for vitamin B-12 deficiency?

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At age 62, you have suffered for years with frequent heartburn, and you’ve been taking an acid-reducing medication to alleviate your symptoms. Recently, you began feeling weak, fatigued, and short of breath. Your annual medical checkup revealed that you have macrocytic anemia due to vitamin B-12 deficiency. Due to reduced stomach-acid secretion, your absorption of vitamin B-12 has been impaired. What would you choose to boost your vitamin B-12 status?

Why are older adults at particular risk for vitamin B-12 deficiency?

BlackTom AI · Accepted Answer

Here is the question and the answer choices to consider:
Question: At age 62, you have suffered for years with frequent heartburn, and you’ve been taking an acid–reducing medication to alleviate your symptoms. Recently, you began feeling weak, fatigued, and short of breath. Your annual medical checkup revealed that you have macrocytic anemia due to vitamin B-12 deficiency. Due to reduced stomach-acid secretion, your absorption of vitamin B-12 has been impaired. What would you choose to boost your vitamin B-12 status?
Answer choices:
- Production of intrinsic factor declines with age.
- Production of stomach acid declines with age.
- Some medications interfere with digestion and absorption.
- All of these choices are correct.

Option 1: Production of intrinsic factor declines with age.
- Why this could be true: Intrinsic factor, a glycoprotein produced by parietal cells in the stomach, is essential for intestinal absorption of vitamin B-12. With aging, the function or production of intrinsic factor can diminish in some individuals, contributing to poorer B-12 uptake. This directly links to the observed B-12 deficiency and macrocytic anemia.
- Why it may be considered correct: If intrinsic factor decreases, even normal B-12 intake cannot be efficiently absorbed, so addressing intrinsic factor status matters for boosting B-12.

Option 2: Production of stomach acid declines with age.
- Why this could be true: Gastric acid (hydrochloric acid) helps release B-12 from dietary proteins, facilitating its binding to intrinsic factor for absorption. Age-related hypochlorhydria reduces this release, impairing absorption of B-12 from foods and supplements that rely on gastric acid for liberation.
- Why it may be considered correct: Reduced stomach acid is a well-known factor in diminished B-12 absorption, especially from natural food sources and some oral supplements.

Option 3: Some medications interfere with digestion and absorption.
- Why this could be true: Many commonly used medications in older adults—such as proton pump inhibitors, H2 blockers, metformin, and certain diabetes or cholesterol drugs—can impair B-12 absorption or its release from food. The stem notes acid-reducing medication, which exemplifies how pharmacology can contribute to deficiency.
- Why it may be considered correct: Medication-related interference is a recognized contributor to B-12 deficiency in the elderly and supports a strategy to boost B-12 status.

Option 4: All of these choices are correct.
- Why this could be true: If intrinsic factor production might decline, gastric acid production might decline, and various medications can interfere with B-12 absorption, then all three factors together provide a comprehensive explanation for deficiency and point to multiple approaches to boosting B-12 status (e.g., B-12 supplementation that bypasses gastric absorption, such as injections or high-dose sublingual forms, and addressing medications).
- Why it may be considered correct: The combination of age-related changes and medications commonly contributes to B-12 deficiency, so recognizing all factors as correct covers the full clinical picture.

Summary:
- Each of options 1–3 identifies a plausible contributor to impaired B-12 absorption in an older adult on acid-suppressing therapy. 
- Option 4 correctly asserts that all of these factors can be at play together, making it the most comprehensive and accurate choice given the scenario.
- The reasoning shows why focusing on intrinsic factor decline, reduced gastric acid, and medication interference are each relevant and how they collectively explain the deficiency.

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