Multivitamins for the Senior Population

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Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.

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Many individuals in the elderly population may find it difficult or challenging to meet their nutritional needs through dietary means alone. Elderly individuals are more likely to take multiple medications; various medications may cause nutrient depletion, as well as adverse effects that may lead to decreased appetite, thereby affecting the nutritional status of these patients.

Currently, a wide variety of multivitamin/multimineral nutritional supplements are formulated to meet the nutritional needs of individuals aged 50 and older. These multivitamin supplements may include higher levels of vitamin C, folic acid, vitamin D, vitamin E, vitamins B₁, B₂, B₆, B₁₂, and other nutrients, but not iron, because individuals aged 50 and older require less iron and generally meet their iron needs through diet alone.^1-3 Some studies have suggested that high iron stores may contribute to chronic diseases such as cancer and cardiovascular disease; however, research to date is inconclusive.⁴ Some formulations contain gingko biloba for improved memory and concentration, and some formulations are gender-specific to meet the individual nutritional needs of women and men.

Various studies have investigated the nutritional needs of individuals aged 50 and older. Examples of the studies include:

• Researchers found that elderly individuals in Iowa had low intake of most vitamins and minerals and concluded that this patient population would benefit from taking a multivitamin supplement. The study also reported that 80% of the seniors in this study had inadequate intake of 4 or more nutrients.⁵
• Results from a study by McKay et al involving patients aged 65 years and older reported that the use of a multivitamin/mineral supplement decreased illness due to infectious disease by 50% and also enhanced mental function. The study concluded that supplementation with a multivitamin formulated at roughly 100% of the recommended daily allowance could reduce the prevalence of suboptimal vitamin status in older adults and improve their micronutrient status to levels associated with reduced risk for several chronic diseases.⁶
• A study by Chandra reported that the daily use of a multivitamin supplement may improve immune function in the elderly patient population.⁷
• Durga et al investigated whether folic acid supplementation slows age-related hearing loss. The study concluded that folic acid supplementation slowed a decline in hearing of the speech frequencies associated with aging in a population from a country without folic acid fortification of food; however, this requires confirmation, especially in populations from countries with folic acid fortification programs.⁸

Pharmacists should remind elderly patients to discuss the use of a supplement with their primary health care provider before use to ensure its appropriateness. When assisting patients with the selection of a multivitamin supplement, pharmacists should assess the patient's medical history and medication profile to determine if a potential exists for a drug/micronutrient interaction or contraindication. In addition, pharmacists should remind patients to take these supplements as directed and that no substitute exists for consuming a balanced diet. Pharmacists also can refer patients to registered dietitians when warranted.

For more information relating to nutrition and the senior patient population, please visit the Office of Dietary Supplements at the National Institutes of Health Web site at ods.od.nih.gov/index.aspx.

Table

Examples of OTC Multivitamin Supplements for Individuals Aged 50 and Older One A Day Men's 50 Plus Advantage Tablets One A Day Women's 50 Plus Advantage Tablets Centrum Silver Tablets and Chewables Bausch & Lomb Ocuvite Adult 50 Plus Eye Vitamin & Mineral Supplement Nature Made Multi For Her 50+ Multi Vitamin/Mineral Supplement, Tablets Nature Made Multi For Him 50+ Multi Vitamin/Mineral Supplement, Tablets Nature Made Essential 50+ Multi Vitamin/Mineral Supplement, Tablets Nature's Bounty ABC Plus Senior Tablets Rainbow Light Active One Senior Multivitamin Tablets Theragran-M Premier 50 Plus High Potency Multivitamin/Multimineral Supplement with Lutein & Lycopene Caplets

References

1. One A Day Vitamins Web site. www.oneaday.com. Accessed December 11, 2008.
2. Centrum Silver Website. www.centrum.com. Accessed December 11, 2008.
3. Nature Made Vitamins Web site. www.naturemade.com. Accessed December 11, 2008.
4. HuckleberryY, Rollins C. Essential and Conditionally Essential Nutrients. In: Berardi RR, Kroon LA, McDermott JH, et al, eds. Handbook of Nonprescription Drugs. 15th ed. Washington, DC: American Pharmacists Association; 2006:461.
5. Marshall TA, Stumbo PJ, Warren JJ, Xie XJ. Inadequate nutrient intakes are common and are associated with low diet variety in rural, community-dwelling elderly. J Nutr. 2001;131(8):2192-2196.
6. McKay DL, Perrone G, Rasmussen H, et al. The effects of a multivitamin/mineral supplement on micronutrient status, antioxidant capacity and cytokine production in healthy older adults consuming a fortified diet. J Am Coll Nutr. 2000;19(5):613-621.
7. Chandra RK. Effect of vitamin and trace-element supplementation on immune responses and infection in elderly subjects. Lancet. 1992;340(8828):1124-1127.
8. Durga J, Verhoef P, Anteunis LJ, Schouten E, Kok FJ. Effects of folic acid supplementation on hearing in older adults. Ann Intern Med. 2007;146(1):1-9.