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s the population ages and lives longer, one of the hottest topics in the media is healthy aging—and it is no longer a matter of fighting the process with “anti-aging” remedies. There has been a mental shift toward the acceptance of growing older while curtailing physical, mental, and emotional decline as much a possible. According to national trends, the number of persons 65 years of age or older is projected to increase from 35 million in 2001 to 71 million in 2030, the number of persons 80 years of age or older from 9.3 million in 2000 to 19.5 million in 2030.¹ Therefore, the need for preserving health and vitality for a longer period of time is an important public health concern for the future.
       One of the most effective ways to promote healthier aging is optimal nutrition. The position on aging by the American Dietetic Association (ADA) is that nutrition is one of the major determinants of successful aging.² Although the big-picture focus is on the macronutrients (ie, protein, carbohydrates, and fat), pinpointing the finer details of micronutrients (ie, vitamins and minerals) reveals the vital interplay among small-scale nutrients. Vitamins and minerals play significant roles throughout all stages of the life cycle, especially during the later years of life. For healthcare professionals who are working with an aging population, there is no greater need than supplying proper nutrition to fight off infection, heal wounds, aid in proper nutrient absorption, and alleviate cognitive dysfunction and physical decline. Care for residents must meet 2 goals: maintenance of health through medical care and maintenance of quality of life.³

The Importance of Vitamins and Minerals

       Why are vitamins and minerals essential as persons age? From conception, human beings need vitamins and minerals for proper growth and development. For example, B vitamins (eg, folic acid) play an instrumental role at different growth stages. In utero, adequate folic acid is necessary for proper development of the fetal neural tube. As we age, however, this B vitamin is also needed to prevent megaloblastic anemia. Of course, too much of a good thing is not good, as excessive consumption can camouflage a vitamin B12 deficiency. Another example is vitamin A, which is required for normal vision throughout life; its function is multidimensional, however, as its antioxidant properties aid in healthy regulation of the immune system. Minerals like calcium aid in bone and teeth health throughout life; a vital part of aging well is maintaining bone density and strength. Excessive calcium intake can, however, result in kidney stones and abnormal kidney function. Thus, homeostasis of nutrients is imperative to overall health.
       That is why guidelines for vitamin and mineral intake have been established. Since 1940, The Food and Nutrition Board of the Institute of Medicine (IOM) has been the nationally recognized, scientific authority on nutrition guidelines. It has set “Dietary Reference Intakes” guidelines for nutrients for all age groups. Older adults are classified into 2 age groups: 50 to 70 years of age and more than 70 years of age. The guidelines may be used in assessing current nutrient intakes and planning future changes in the residents’ diet.³ They provide Recommended Dietary Allowances (RDAs), Adequate Intakes (AIs), and Tolerable Upper Intake Levels (ULs) for essential vitamins and minerals. (For dietary intake guidelines for older adults with regard to vitamins and minerals, respectively, visit the IOM at http://www.iom.edu/object.file/master/7/296/0.pdf and http://www.iom.edu/object.file/master/7/294/webtableminerals.pdf.) Additionally, these guidelines provide food-based sources of each nutrient. Assuming for a moment that absorption rates, appetite, and disease are not barriers, food should be the first line of nutritional defense, followed by supplements.
       The marketplace is overflowing with dietary supplements targeting, primarily, older adults. The Dietary Guidelines for Americans 2005of the US Department of Agriculture (USDA) places its emphasis on the need for dietary supplements when persons are not getting the recommended amount of nutrients from food. Its key recommendations for persons 50 years of age and older are to consume adequate vitamin B12 from fortified food and/or supplements and get additional amounts of vitamin D from fortified foods and/or supplements, especially if exposure to sunlight is minimal and/or the persons are dark-skinned. However, the guidelines stress that while dietary supplements are recommended in some cases, they cannot replace a healthful diet.²

Assessing Supplement Labels

       In the virtual sea of supplements at the corner drug store, how can one decipher which is best? While many dietary supplements promise to provide the best vitamin and mineral profile, the public needs to be savvy about reading labels. The good news is that dietary supplements are regulated by the US Food and Drug Administration (FDA) under The Dietary Supplement Health and Education Act (DSHEA) of 1994.⁴ However, it gets tricky when purchasing supplements because the provisions of DSHEA do not mandate that manufacturers of dietary supplements provide evidence of efficacy or safety prior to marketing products.⁵ Therefore, assessing product labels for adequate nutrient RDAs is one of the best ways to judge a product’s health-enhancing merits.
       Some of the prominent supplements marketed for persons 50 years of age or older are Theragran–M^® Premier 50 Plus (Walgreen Co.), Centrum^® Silver^® (Whitehall-Robins Healthcare), One-A-Day^® 50 Plus (Bayer Healthcare), and Nature Made^® Multi 50+ (Pharmavite LLC). All of these products claim to promote optimal health and market their uniqueness with statements like “age-essential nutrients.” Many of these supplements are enhanced with antioxidants like lycopene for cancer and lutein for eye health, while others contain coenzyme-Q 10 (Co-Q 10) for heart health and improved energy. The upside is that the Federal Trade Commission (FTC) is responsible for ensuring that print and broadcast claims are “truthful, not misleading, and substantiated.”⁶
       The makers of dietary supplements—the pharmaceutical companies—are keenly aware that there is a need for certain product enhancements to meet the needs of older adults. Since many people in this age group are taking a variety of prescribed medications, it is important to formulate supplements that do not hinder the absorption or counteract the beneficial action of daily medications. For example, there has been an association between statin medications used to control cholesterol and the reduced production of Co-Q 10. Therefore, supplements have been formulated with additional Co-Q 10. Another area of concern is a person’s iron level. Most supplements are formulated without iron, since food sources usually provide enough of this mineral. But excessive iron can build up in the bloodstream and be detrimental to the health of older adults.

The Bottom Line on Supplements

       Just as a resident’s care plan is based on individual need, the role of supplements must be monitored differently for each person. Depending on current prescription medications, overall health status, and overall physical functioning of the individual, dietary supplements should serve to enhance the total health picture.
       When choosing dietary supplements, be aware of the RDAs for nutrients, pay close attention to the upper limits of nutrients (since most supplements do not exceed these limits), and understand that a supplement is not intended to take the place of a healthy diet. To meet individual needs, healthcare professionals must consider each person holistically, including personal goals, overall prognoses, benefits and risks of treatment, and—perhaps most importantly—quality of life.³ By becoming educated on the ever-changing nutrient needs of the older population, caregivers should be able to more successfully stave off cognitive decline, maintain healthy cells, encourage eye health, improve energy, and supply bones with adequate mineral stores for a lifetime of physical activity. In other words, preserving long-term quality of life is the goal—and using vitamin and mineral supplements can fill in the dietary blanks.