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From the Cleveland Clinic Journal of Medicine
Cindy Moore, MS, RD, LD, FADA, Director, Nutrition Therapy, Cleveland Clinic
Should everyone over age 75 take a multivitamin?
Age should not be the sole criterion used to determine whether someone needs to take a multivitamin. Many healthy, active older adults can get the vitamins and minerals they need by consuming a varied and balanced diet. Others, however, may need to take a multivitamin-mineral supplement for various reasons. A 1999 study commissioned for the Older-American Act found that 67% to 88% of the elderly, particularly the frail, homebound elderly, were at moderate to high nutritional risk.
Nutritional needs of the elderly
Although the recommended dietary allowances (RDAs) for many vitamins and minerals remain similar for people over 75 years of age compared with younger adults, some nutrients may be needed in greater amounts as a result of interactions with medications or problems with their ability to make or use the nutrient. An older person?s need for calories may decrease by as much as 25%. Surgery and other injuries may also increase the need for certain vitamins and minerals.
In practical terms, this means that an older person needs to get the same amount of vitamins and minerals from a smaller amount of food. This can be challenging since many older people have problems eating sufficient amounts of food and absorbing the nutrients from the foods eaten.
Causes of inadequate nutrient intake:
- poverty
- anorexia
- social isolation
- depression
- functional disabilities, such as chewing and swallowing problems
- chronic medication use
- acute or chronic medical problems
- inappropriate food selection
The minerals most likely to be consumed below RDA levels are iron, calcium, zinc and magnesium; the vitamins most likely to be deficient are riboflavin and vitamins D, A, B6 and B12. Often, deficiencies occur in combination. For example, many older people do not get enough calcium, and diets low in calcium are often also low in vitamins D, A, B6 and B12, riboflavin, magnesium, potassium and folate. Riboflavin deficiency in the elderly is actually quite common, occurring in 20% to 27% of older Americans. Vegetarians who avoid all animal products, including dairy and egg products, may need supplemental calcium, iron, zinc, and vitamins B12 and D.
Impaired absorption
Nutrient absorption can be reduced in those with digestive and liver disorders. Some older adults have difficulty absorbing the naturally occurring form of vitamin B12; breakfast cereals and multivitamin-mineral supplements are good sources of this nutrient. Because of the difficulty in absorbing vitamin D, many older adults benefit from supplements of vitamin D.
Different medications also interfere with nutrient absorption. Those taking corticosteroids, anticonvulsants, thyroid hormone, antibiotics, laxatives or diuretics may benefit from a multivitamin-mineral supplement.
Nutrition as preventive medicine
Calcium and vitamin D are recommended to prevent osteoporosis in the elderly. Folic acid, vitamin B6 and vitamin B12 can lower homocysteine levels, which may reduce the risk of coronary artery disease. Adequate intake of vitamin B6, B12 and folate may help prevent decline in cognitive function, associated with aging. Immune function may be improved by supplementation of protein, vitamin E, zinc and other micronutrients. The need for vitamin A, however, decreases with age, which makes toxicity from supplements more common.
Persons who are unwilling or unable to partake of a healthful, varied diet that includes multiple daily servings of fruits, vegetables, whole grains, dairy products and meats or meat alternatives should take a multivitamin-mineral supplement and include foods fortified with nutrients whenever possible. |
