As we age, our bodies change in ways that can impact our nutritional needs and how we process medications. For older adults, keeping a close eye on vitamins, supplements, and over-the-counter (OTC) medications is crucial for maintaining good health. However, with so many products on the market, it is easy to feel overwhelmed. This guide will help older adults, caregivers, and family members understand the importance of managing vitamins, supplements, and OTC medications safely and effectively.
Why Older Adults Need Extra Attention for Vitamins and Supplements
Aging affects our ability to absorb and metabolize nutrients. Reduced appetite, digestive issues, or chronic illnesses can lead to nutrient deficiencies that may go unnoticed. Many older adults may not get enough of certain key vitamins and minerals from their diet, making supplementation necessary in some cases. Certain vitamin deficiencies can also lead to oral health conditions and complications in older adults, affecting dental care and treatment.
Like what you’re learning? Download a brochure for our Geriatric Dentistry Master Program certificate or master’s degree program.
Common Vitamin Deficiencies in Older Adults
Older adults are particularly prone to deficiencies in:
● Vitamin D: Important for bone health, Vitamin D helps the body absorb calcium. Lack of sun exposure, impaired skin synthesis of pre-vitamin D and the decreased hydroxylation in the kidney with aging contribute to the marginal vitamin D status in many older adults. In addition, dietary vitamin D intake is often low in older subjects. It’s been estimated that approximately ½ of older women consume less than 137 international units/day of vitamin D from foods, and nearly one-quarter consumes less than 65 units per day. Inadequate intake has also been linked to muscle weakness, functional impairment, depression and increased risks of falls and fractures. Older adults at higher risk for vitamin D deficiency include those who are institutionalized, housebound, have limited sun exposure, obesity, dark skin, osteoporosis and malabsorption.
A combination of exercise and vitamin D supplementation is associated with increase in muscle mass and improvements in function among older adults living in community. Therefore, increased consumption of dietary sources of vitamin D should be encouraged in all older adults. The Recommended Dietary Allowance (RDA) of vitamin D for adults through age 70 years is 600 IU, with the RDA increasing to 800 IU after age 71.
● Vitamin B12: B12 is vital for nerve function and the production of red blood cells. The prevalence of B12 deficiency in older adults ranges between 10-20%. Some persons with low serum B12 level may be deficient with neurological, psychological or hematologic disease. For a long time, vitamin B12 deficiency was primarily attributed to a lack of intrinsic factor—a protein needed for B12 absorption. However, recent findings reveal that around 15% of adults over 60 have difficulty absorbing B12 bound to proteins in food. This issue is often linked to decreased stomach acid (known as gastric achlorhydria) and atrophic gastritis, both of which can impair the breakdown of the B12-protein complex in the stomach.
This reduced stomach acid production can be a lasting consequence of current or past infections with Helicobacter pylori, a bacterium that damages the stomach lining and may lead to chronic gastritis. For these older adults, recognizing and addressing B12 deficiency is essential, as B12 plays a critical role in maintaining nerve function, red blood cell production, and overall energy levels.
Older adults with B12 deficiency can generally be treated with oral B12 and may benefit from increasing the intake of B12 in foods. Because B12 malabsorption is common in older adults, with potentially significant effects of vitamin B12 deficiency on the nervous system, individuals who are 51 years and older should take supplements containing vitamin B12, or eat fortified food products. It is prudent to advocate for daily intake of 10-15 mcg.
Some of these deficiencies could manifest in various oral health issues as vitamin B plays a critical role in maintaining the health of the oral mucosa. Vitamin B12 deficiency, which is associated as well with pernicious anemia, can develop symptoms such as burning sensation of the oral mucosa and tongue, angular cheilitis, and recurrent aphthous ulcers.
● Calcium: Calcium nutrition is strongly influenced by age. The efficiency of calcium absorption from gastrointestinal tract decreases significantly after age 60. Older adults between the age of 70 and 90 absorb approximately 1/3 less calcium than do younger adults. Osteoporosis affects more than 10 million people in the United States and can cause more than 1.5 million fractures within that population every single year.
Given the impact of calcium deficiency on cortical bone loss, the adequate intake reference value for those over 51 years old was increased from 800 to 1200 mg/day.
Calcium deficiency can also affect oral health, including the oral mucosa, as calcium is vital for maintaining structure integrity of teeth, bone and soft tissues. Some symptoms may include burning mouth syndrome, dryness in the mucosa, and recurrent aphthousulcers.
● Magnesium: Involved in many body functions, magnesium can help maintain healthy blood pressure, cognitive abilities, muscles and nerves. Aging, however, is often associated with a total magnesium deficit. This is often associated with a low magnesium intake while the requirements for the body processes do not change with age. Intestinal absorption of magnesium tends to fall with age and is worsened by impairment of vitamin D homeostasis.
Many older adults use multivitamin supplements, but routine recommendation of these supplements remains uncertain. Multivitamin supplementation may be beneficial for older adults with a higher risk of nutritional deficiencies, such as those residing in long-term care facilities, to help meet recommended nutrient intakes.
Potential Risks and Overuse of Supplements
While supplements can offer health benefits, they can also pose potential risks. Many older adults are often prescribed multiple medications by different health care providers, putting them at an increased risk of drug-drug interactions and adverse drug events.
Overuse of Certain Vitamins
Potentially toxic levels of individual vitamins are possible in people who take very high-potency vitamins, which can be obtained in specialty stores, over the internet, and even in some pharmacies. High doses can also be achieved by taking large number of pills even if the dose per pill is not high enough. The Institute of Medicine (IOM) and the United States Office of Dietary Supplements has suggested tolerable upper intake levels for specific vitamins, which is the highest daily dose that is unlikely to cause adverse health effects in the general population (https://ods.od.nih.gov/factsheets/list-VitaminsMinerals/).
Water soluble vitamins (folate, vitamin C, vitamin Bs) can generally be tolerated at high doses,with toxicity occurring only at doses thousands of times the recommended dietary allowance (RDA). A possible exception is the risk of kidney stones, which may be increased after doses of vitamin C that are 10-25 times the RDA.
Fat-soluble vitamins (Vitamins A, D, E, K) are generally more toxic than water-soluble vitamins. Vitamin D may cause hypercalcemia at doses as low as 4000 units daily (recommended upper limit) in some older adults. Beta-carotene (which is converted to vitamin A) appears to increase the risk of lung cancer in adults who are at high risk because of smoking or asbestos exposure. Individuals taking anticoagulants should be advised against high doses of vitamin E because of the synergistic action of vitamin E with these medications
Understanding and following the recommended daily allowance (RDA) for vitamins and minerals is essential in avoiding potential health risks. The Nutrition Recommendation Database from the National Institute of Health Office of Dietary Supplement provides nutritional guidelines and fact sheets for all essential vitamins and minerals.
https://ods.od.nih.gov/HealthInformation/nutrientrecommendations.aspx
https://ods.od.nih.gov/factsheets/list-VitaminsMinerals
Approximately 70% of older adults in the United States report use of dietary supplements, often based on information found on the internet. However, these nonprescription supplements can interact with prescribed medications, potentially leading to harmful side effects. This highlights the importance of healthcare providers regularly discussing supplement use with patients and staying informed on best practices for screening and assessment. By opening up this dialogue and maintaining a proactive approach, we can better support our patients in making safe and informed choices about their health.
Postgraduate Geriatric Dentistry
Are you looking for improved ways to diagnose, treat, and manage the oral healthcare of older patients? Explore our online master’s and certificate program in Geriatric Dentistry.
Reference
1. MacLaughlin J, Holick MF. Aging decreases the capacity of human skin to produce vitamin D3. J Clin Invest 1985; 76:1536.
2. Schöttker B, Jorde R, Peasey A, et al. Vitamin D and mortality: meta-analysis of individual participant data from a large consortium of cohort studies from Europe and the United States. BMJ 2014; 348:g3656.
4. Institute of Medicine. Report at a Glance, Report Brief: Dietary reference intakes for calcium and vitamin D, released 11/30/2010. http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D/Report-Brief.aspx (Accessed on October 30, 2024).Andrès E, Affenberger S, Vinzio S, et al. Food-cobalamin malabsorption in elderly patients: clinical manifestations and treatment. Am J Med 2005; 118:1154.
5. Institute of Medicine. Report at a Glance, Report Brief: Dietary reference intakes for calcium and vitamin D, released 11/30/2010. http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D/Report-Brief.aspx (Accessed on Oct 30, 2024).
6. America’s bone health: The state of osteoporosis and low bone mass in our nation, National Osteoporosis Foundation, Washington, DC 2002.
7. Barbagallo M, Veronese N, Dominguez LJ. Magnesium in Aging, Health and Diseases. Nutrients. 2021 Jan 30;13(2):463. doi: 10.3390/nu13020463. PMID: 33573164; PMCID: PMC7912123.
8. Ford KL, Jorgenson DJ, Landry EJL, Whiting SJ. Vitamin and mineral supplement use in medically complex, community-living, older adults. Appl Physiol Nutr Metab. 2019 Apr;44(4):450-453. doi: 10.1139/apnm-2018-0515. Epub 2019 Jan 10. PMID: 30628461.
9. Gahche JJ, Bailey RL, Potischman N, Dwyer JT. Dietary Supplement Use Was Very High among Older Adults in the United States in 2011-2014. J Nutr. 2017 Oct;147(10):1968-1976. doi: 10.3945/jn.117.255984. Epub 2017 Aug 30. PMID: 28855421; PMCID: PMC5610553.
