Multivitamins for the Senior Population

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

Many individuals in the elderly populationmay find it difficult or challengingto meet their nutritional needs throughdietary means alone. Elderly individualsare more likely to take multiple medications;various medications may causenutrient depletion, as well as adverseeffects that may lead to decreased appetite,thereby affecting the nutritionalstatus of these patients.

Currently, a wide variety of multivitamin/multimineral nutritional supplementsare formulated to meet the nutritionalneeds of individuals aged 50 andolder. These multivitamin supplementsmay include higher levels of vitamin C,folic acid, vitamin D, vitamin E, vitaminsB₁, B₂, B₆, B₁₂, and other nutrients, butnot iron, because individuals aged 50and older require less iron and generallymeet their iron needs through dietalone.^1-3 Some studies have suggestedthat high iron stores may contributeto chronic diseases such as cancerand cardiovascular disease; however,research to date is inconclusive.⁴ Someformulations contain gingko biloba forimproved memory and concentration,and some formulations are gender-specificto meet the individual nutritionalneeds of women and men.

Various studies have investigated thenutritional needs of individuals aged50 and older. Examples of the studiesinclude:

• Researchers found that elderly individualsin Iowa had low intake ofmost vitamins and minerals andconcluded that this patient populationwould benefit from taking amultivitamin supplement. The studyalso reported that 80% of the seniorsin this study had inadequate intakeof 4 or more nutrients.⁵
• Results from a study by McKay etal involving patients aged 65 yearsand older reported that the use ofa multivitamin/mineral supplementdecreased illness due to infectiousdisease by 50% and also enhancedmental function. The study concludedthat supplementation with amultivitamin formulated at roughly100% of the recommended dailyallowance could reduce the prevalenceof suboptimal vitamin statusin older adults and improve theirmicronutrient status to levels associatedwith reduced risk for severalchronic diseases.⁶
• A study by Chandra reported that thedaily use of a multivitamin supplementmay improve immune functionin the elderly patient population.⁷
• Durga et al investigated whetherfolic acid supplementation slowsage-related hearing loss. The studyconcluded that folic acid supplementationslowed a decline in hearingof the speech frequencies associatedwith aging in a populationfrom a country without folic acidfortification of food; however, thisrequires confirmation, especiallyin populations from countries withfolic acid fortification programs.⁸

Pharmacists should remind elderlypatients to discuss the use of a supplementwith their primary health careprovider before use to ensure its appropriateness.When assisting patients withthe selection of a multivitamin supplement,pharmacists should assess thepatient's medical history and medicationprofile to determine if a potentialexists for a drug/micronutrient interactionor contraindication. In addition,pharmacists should remind patients totake these supplements as directed andthat no substitute exists for consuminga balanced diet. Pharmacists also canrefer patients to registered dietitianswhen warranted.

For more information relating tonutrition and the senior patient population,please visit the Office of DietarySupplements at the National Institutesof 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

• One A Day Vitamins Web site. www.oneaday.com. Accessed December 11, 2008.
• Centrum Silver Website. www.centrum.com. Accessed December 11, 2008.
• Nature Made Vitamins Web site. www.naturemade.com. Accessed December 11, 2008.
• 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.
• 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.
• 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.
• Chandra RK. Effect of vitamin and trace-element supplementation on immune responses and infection in elderly subjects. Lancet. 1992;340(8828):1124-1127.
• 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.