Most older adults do not eat a healthy diet everyday. There are various reasons why elderly individuals may not be getting the proper nutrition. But, it’s important that they find supplements as there are very dangerous health consequences of not meeting daily vitamin requirements. Anemia, cognitive impairment, increased risk for developing infections, and poor wound healing are manifestations of mild vitamin deficiencies in the elderly. Single vitamin deficiencies do occur, but usually multiple vitamin deficiencies are been with general malnutrition. Severe vitamin deficiency can lead to irreversible organ damage.
Causes of vitamin and mineral deficiencies
Older adults may not consume certain foods or may consume them in inadequate amounts. Smoking tobacco, malabsorption disorders, GI surgery, Helicobacter pylori infection of the GI tract, alcohol overconsumption, drug adverse effects and drug-nutrient interactions may also contribute. Age-related changes may cause seniors to eat less as well. They may have increased satiety with less food, due to the presence of more hormones that decrease appetite and fewer neurotransmitters that stimulate appetite.
Most vitamin absorption takes places in the small intestine. Anything that negatively affects that process will also negatively affect absorption. If anyone has had any GI surgeries that have shortened the amount of small bowel available, then they lose the amount of space available for absorption. Also, simply not eating enough food can also cause deficiency. As individuals get older, eating may not be as enjoyable, therefore they may just not do it as often.
Substance abuse and alcoholism can also damage organs, like the liver, that are responsible for secreting certain hormones and other cells that help to increase absorption. Although moderate intake of alcohol can be considered okay, excessive amounts can cause increasing number of problems throughout the lifespan.
Another group that is at high risk for malabsorption and vitamin/mineral deficiencies is hospitalization and institutionalization. These are individuals who are in long-term care and who may be immobilized or in care facilities without many resources. Although these individuals are surrounded by healthcare professionals, they may have mental disorders that impact their ability/desire to eat, or the food may not be as good and nutritious as one may think. Protein-energy malnutrition, a condition commonly affecting individuals who are hospitalized, occurs when muscle break down in those who are very sick and frail.
Undernutrition
Undernutrition can be attributed to a sole cause, typically comorbidities act together, contributing to undernutrition. The appearance of people who are undernourished may not change if there is only a specific nutrient that is lacking, an individual’s weight may be normal or higher. Many undernourished seniors, however, are clearly underweight and have little or no body fat. Mild vitamin deficiency is commonly seen in the frail and institutionalized elderly population with protein-energy malnutrition. Undernutrition in the elderly is an integral part of a general decline. Furthermore, there are disorders that increase energy requirements while at the same time decreasing appetit.
Recommended Intake
Dietary requirements for vitamins and other nutrients may be expressed in several ways.
- recommended daily allowance (RDA) which is used to meet the needs of 97%-98% of healthy people
- adequate intake which is based on observed or experimentally determined estimates of nutrient intake by healthy people and used when data to calculate an RDA are insufficient
- tolerable upper intake level which is the highest dosage of a nutrient most adults can ingest daily without risk of adverse health effects
Supplementation with a multivitamin containing at least the RDAs is recommended for seniors at risk for vitamin deficiency. The most valuable means of screening patients for vitamin deficiency or toxicity is through nutrition-focused history and physical exam. Also, supplementation for healthy seniors is controversial, there is evidence that a multivitamin supplement improves immune status in healthy elderly individuals.
Common manifestations of mild vitamin deficiencies in the elderly
Anemia is a generally well-recognized clinical problem in elderly individuals. According to the World Health Organization criteria, anemia is consistent with a hemoglobin concentration of <13 g/dL in men and <12 g/dL in women. Data indicate a high prevalence of anemia among hospitalized seniors, patients associated with geriatric clinics and institutionalized seniors. The most prevalent anemias in elderly populations are those associated with blood loss, inflammation and chronic disease and protein-energy malnutrition.
In elderly patients with an ineffective formation of erythrocytes, it is important for pharmacists to note that microcytosis (low mean corpuscular volume) should suggest sideroblastic anemia, while macrocytosis (high MCV) suggests B12 or B9 deficiency. Pernicious anemia is also common caused by the lack of intrinsic factor in the small intestine which is necessary for the absorption of B12.
Cognitive impairment can happen as a result of B12 deficiency caused by hypochlorhydria (decreased gastric acid production noted to occur in up to 15% of seniors older than age 65) and Helicobacter pylori infection of the stomach. Vitamin B12 deficiency can result in both hematologic signs and symptoms and neurologic signs and symptoms such as nonspecific paresthesias of the extremities and gait ataxia. Neuropsychiatric symptoms may occur secondary to Vitamin B12 deficiency, such as delirium manifesting as slow thinking, confusion, memory loss and depression which may be difficult to distinguish from dementia and Alzheimer’s. Low serum folate levels may be associated with destruction of brain matter known as cerebral cortex.
Vitamin D Deficiency and Seniors
In the US, severe Vitamin D deficiency is rare. Most Americans, though, do not achieve adequate vitamin D levels from sources that include sunlight, diet and supplements. Approximately 90% of adults between the ages of 51 and 70 do not get enough vitamin D from their diet. Those with low vitamin D levels have lower bone density and are at risk for osteoporosis and bone fractures as they age. Seniors, in particular, may have lower blood levels to vitamin D compared to younger counterparts, especially those who have minimal exposure to sunlight. Vitamin D deficiency causes osteomalacia in adults and rickets in children.
Drug-induced osteomalacia in associated with anticonvulsant therapy, rifampin and some hypnotic agents. Institutionalized patients or individuals with multiple concomitant anticonvulsant therapy are usually the only patients in which anticonvulsant-associated osteomalacia is present. Kidney failure and primary biliary cirrhosis are examples of conditions that alter vitamin D metabolism.
Conclusion
Vitamin deficiencies are common in older adults, and it’s important to screen and recognize them early as they can have severe manifestations. If you are an elderly person or have a patient or parent that could use some assistance in helping to maintain proper health, please reach out to Diverse Health Services to see what we can do for you.
Sources:
https://www.uspharmacist.com/article/vitamin-deficiencies-in-seniors
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