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Senior's Health

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Osteoporosis
Vitamin D deficiency increases the risk of osteoporosis in senior men and women and supplements may be useful in reducing bone loss and the occurrence of fractures. In a study published in 1997, researchers at Tufts University in Boston assessed the effects of calcium (500 mg per day) and vitamin D (700 IU per day) in 176 men and 213 women aged 65 years or older. When bone density was measured after a three-year period, those taking the supplements had higher bone density at all body sites measured. The fracture rate was also reduced by 50 per cent in those taking the supplements.¹¹ However, other studies have not shown any reduction in fracture rates in those taking vitamin D supplements.¹² Vitamin D supplements may also be useful in preventing bone loss in patients taking corticosteroid drugs.¹³

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Antioxidants
Research suggests that the antioxidants beta carotene, vitamin C, vitamin E and selenium may help to prevent aging-related diseases such as cardiovascular disease, cancer, cataracts, rheumatoid arthritis and Alzheimer's disease.

Growing evidence suggests that free radical damage may be an underlying cause of the aging process, thus leaving open the possibility that antioxidants may be able to slow this process.

Beta Carotene
As well as exerting protective effects against various aging-related diseases, beta carotene may protect against memory impairment and other loss of mental function in seniors. In a recent Dutch study, researchers studied 5182 people aged 55 to 95 from 1990 to 1993. They found that those with intakes of less than 0.9 milligrams of beta carotene per day were almost twice as likely to have impaired memory, disorientation and problem solving difficulty as those with intakes of 2.1 milligrams of beta carotene.¹⁴

Researchers involved in a 1997 Swiss study found similar results. The study, which was reported in the Journal of the American Geriatrics Society, involved 442 men and women, aged from 65 to 94 in 1993. Antioxidant levels were originally tested in 1971 and then again in 1993, when the participants were also given memory-related tests. Higher vitamin C and beta carotene levels were associated with higher scores on free recall, recognition and vocabulary tests.¹⁵

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Vitamin C
Vitamin C deficiency in seniors can increase susceptibility to many disorders. Low vitamin C levels are associated with lowered immunity, which increases the risk of infection.

Low vitamin C intakes also increase the risk of cardiovascular disease in seniors. During a study which was begun in 1981, USDA researchers assessed the health and nutrition status of 747 seniors. Particular attention was paid to the foods the participants usually ate and the levels in their blood of the antioxidant vitamins C, E and beta carotene. The researchers following up the subjects from nine to 12 years later found that among people who ate lots of dark green and orange vegetables, there were fewer deaths from heart disease and other causes. The results showed that a daily intake of more than 400 mg and higher blood levels of vitamin C were linked to reduced risk of death from heart disease.¹⁷

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Vitamin E
High vitamin E intakes are linked to lower risks of several disorders including cardiovascular disease, cancer, Parkinson's disease and cataract. Supplements have also shown beneficial effects in several studies.

A study by researchers from the National Institute on Aging, published in 1996, examined the effects of vitamin E and vitamin C supplement on mortality risk in 11,178 persons aged from 67 to 105 who were taking part in the Established Populations for Epidemiologic Studies of the Elderly from 1984 through 1993. During the follow-up period, there were 3490 deaths. The results showed that those using the vitamin E supplements had a 34 per cent lower risk of death when compared to those not using vitamin E supplements, and around half the risk of death from coronary disease. Those taking both vitamin C and vitamin E had a 42 per cent reduced risk.¹⁸

Vitamin E supplements also improve the effectiveness of the immune system in seniors. In a 1997 study of 88 healthy people aged 65 or older, those who took 200 mg (300 IU) each day for about four months showed an improvement in immune response. Researchers assessed the effects of either 60 mg (90 IU), 200 mg (300 IU) or 800 mg (1,333 IU) on a measure of immune system strength known as delayed hypersensitivity skin response. The results showed that those who took 200 mg a day had a 65 per cent increase in immune function. Those taking 60 mg or 800 mg of vitamin E also showed some improvements in immune function but the ideal response was seen in those taking 200 mg.¹⁹ Vitamin E may also provide relief from some of the symptoms of menopause, particularly hot flashes.²⁰

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Calcium
High calcium intakes are associated with reduced risk of some types of cancer and high blood pressure. Optimal calcium intake is particularly important in preventing the bone-thinning associated with osteoporosis. Although the problem also occurs in men, women are at particularly high risk of osteoporosis, with as many as 35 per cent of women suffering from the disease after menopause. Most of the bone loss seen in osteoporosis in postmenopausal women occurs in the first five to six years after menopause due to low calcium intake, a decline in female hormones, and an age-related reduction in vitamin D production.

It is never too late to slow the bone loss seen in osteoporosis and early postmenopausal years are an important time to ensure optimal calcium intake. Some research shows that taking calcium supplements later in life may lower vertebral fracture rate and prevent bone density decrease in seniors.

Treatment which combines calcium and estrogen is likely to be better at building bone than treatment with estrogen alone. In a 1998 review, researchers analyzed the results of 31 studies and found that the postmenopausal women who took estrogen alone had an average increase in spinal bone mass of 1.3 per cent per year, while those who took estrogen and calcium supplements had an average increase of 3.3 per cent. Increases in bone mass in the forearm and upper thigh were also greater in women taking supplements. The added benefit from the calcium was seen when the women increased their intake from an average of 563 mg per day to 1200 mg per day.²¹

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Iron
Iron deficiency is common in seniors as they often have reduced stomach acid and therefore reduced absorption ability. Low blood plasma levels of iron can contribute to fatigue, heart disease and deterioration in mental functioning.

Iron requirements are lower in women who have reached menopause, as they no longer lose iron in menstrual blood. However, deficiency is still relatively common and all seniors should ensure they get sufficient iron in their diets. A 1997 National Institute of Aging study suggests that low iron levels are linked to an increased likelihood of death in seniors. Researchers looked at the iron status of nearly 4,000 men and women aged 71 and over. Results showed that low iron levels increased the risk of total and coronary heart disease deaths. Those with higher iron levels had decreased risk. Men with the highest iron levels had only 20 per cent of the risk of dying of heart disease of those with the lowest levels. Women with the highest levels were about half as likely to die of heart disease compared to those with the lowest levels.²²

The iron overload disorder, hemochromatosis, can result in increased risk of heart disease, liver problems and other disorders. This is one of the most common inherited diseases in certain groups of people, and middle-aged and older men may be particularly badly affected. Iron supplements should be avoided in these cases.

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Magnesium
Marginal magnesium deficiency is considered to be very common, especially in seniors. Inadequate intake may contribute to cardiovascular disease, high blood pressure, osteoporosis, diabetes and various other disorders. Supplements are likely to be beneficial in seniors.

Selenium

• Selenium Up, Mortality Down

Selenium is a vital part of the antioxidant enzyme glutathione peroxidase, and so may protect seniors against free radical damage and its consequences. It is also necessary for thyroid and immune system function, which may be disrupted in seniors. Optimal intake may also help combat psychological disorders like depression, anxiety, fatigue and appetite loss.

Sodium
Sodium restriction may be a useful way to lower blood pressure in seniors suffering from hypertension. In a two-month double blind, randomized, placebo- controlled crossover study published in 1997 in The Lancet, researchers found that modest reduction in salt in the diets of seniors led to lower blood pressure. The study involved 29 patients with high blood pressure and 18 with normal blood pressure. The average blood pressure fall was 8.2/3.9 mmHg in the normal subjects and 6.6/2.7 mmHg in those with high blood pressure.²³ In those with normal blood pressure, cutting salt may have little effect, according to an analysis of 83 studies published in the Journal of the American Medical Association in 1998.²⁴

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Zinc
Inadequate consumption of zinc-rich foods can result in reduced sense of taste and possibly lead to reduced appetite or increased consumption of sugary or salty foods that may aggravate malnutrition. Zinc is vital for wound healing and an effective immune response, and a deficiency can leave seniors susceptible to infection and prolong recovery from illness. Seniors often have zinc-poor diets and low blood levels.

CoenzymeQ10
Coenzyme Q10 also helps protect against oxidation and age-related diseases. It is essential for energy production in the mitochondria, especially in the heart. It can reduce damage to the heart muscle in ischemic heart disease. Typical preventive doses of CoQ10 would be 50 - 100 mg daily, but if someone has signs of age-related disease - particularly cancer, heart disease or immune disorders - the  Coenzyme Q10 dose may be increased to 100 - 400 mg daily.

Herbal medicines and Seniors' Health
Herbs and flavonoids can help prevent and treat age-related conditions. See the individual herb descriptions for detail information and references. For example, St. John's wort treats depression, a common problem in seniors; while hawthorn berry, garlic, and grape seed extract protect the heart and the eyes. Saw palmetto helps prostate disorders common in men older than 50. Ginkgo biloba preserves memory, reduces vertigo, and improves small blood vessel circulation that helps with the functional signs of atherosclerosis. Memory loss is one of the most distressing signs of aging. 60 mg of standardized gingko is recommended two or three times a day.

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References

1. Lesourd BM Nutrition and immunity in the elderly: modification of immune responses with nutritional treatments. Am J Clin Nutr, 1997 Aug, 66:2, 478S-484S
2. Fisher GJ; Wang ZQ; Datta SC; Varani J; Kang S; Voorhees JJ. Pathophysiology of premature skin aging induced by ultraviolet light. N Engl J Med, 1997 Nov, 337:20, 1419-28
3. Wilkinson TJ; Hanger HC; Elmslie J; George PM; Sainsbury R. The response to treatment of subclinical thiamine deficiency in the elderly. Am J Clin Nutr, 1997 Oct, 66:4, 925-8
4. van der Wielen RP; Löwik MR; Haller J; van den Berg H; Ferry M; van Staveren WA Vitamin B-6 malnutrition among elderly Europeans: the SENECA study. J Gerontol A Biol Sci Med Sci, 1996 Nov, 51:6, B417-24
5. Quinn K; Basu TK. Folate and vitamin B12 status of the elderly. Eur J Clin Nutr, 1996 Jun, 50:6, 340-2
6. Ortega RM; Mañas LR; Andrés P; Gaspar MJ; Agudo FR; Jiménez A; Pascual T Functional and psychic deterioration in elderly people may be aggravated by folate deficiency. J Nutr, 1996 Aug, 126:8, 1992-9
7. Fata FT; Herzlich BC; Schiffman G; Ast AL. Impaired antibody responses to pneumococcal polysaccharide in elderly patients with low serum vitamin B12 levels. Ann Intern Med, 1996 Feb, 124:3, 299-304
8. Nilsson Ehle H Age-related changes in cobalamin (vitamin B12) handling. Implications for therapy. Drugs Aging, 1998 Apr, 12:4, 277-92
9. Thomas MK; Lloyd Jones DM; Thadhani RI; Shaw AC; Deraska DJ; Kitch BT; Vamvakas EC; Dick IM; Prince RL; Finkelstein JS. Hypovitaminosis D in medical inpatients. N Engl J Med, 1998 Mar, 338:12, 777-83
10. McAlindon TE; Felson DT; Zhang Y; Hannan MT; Aliabadi P; Weissman B; Rush D; Wilson PW. Relation of dietary intake and serum levels of vitamin D to progression of osteoarthritis of the knee among participants in the Framingham Study. Ann Intern Med, 1996 Sep, 125:5, 353-9
11. Dawson Hughes B; Harris SS; Krall EA; Dallal GE Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med, 1997 Sep, 337:10, 670-6
12. Lips P, Graafmans WC, Ooms ME, Bezemer PD, Bouter LM. Vitamin D supplementation and fracture incidence in elderly persons. A randomized, placebo-controlled clinical trial. Ann Intern Med 1996 Feb 15;124(4):400-406
13. Buckley et al.Calcium and vitamin D3 supplementation prevents bone loss in the spine secondary to low-dose corticosteroids in patients with rheumatoid arthritis. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 1996 Dec 15;125(12):961-968
14. Jama JW; Launer LJ; Witteman JC; den Breeijen JH; Breteler MM; Grobbee DE; Hofman A. Dietary antioxidants and cognitive function in a population-based sample of older persons. The Am J Epidemiol, 1996 Aug, 144:3, 275-80
15. Perrig WJ; Perrig P; Stähelin HB The relation between antioxidants and memory performance in the old and very old. J Am Geriatr Soc, 1997 Jun, 45:6, 718-24
16. Pfitzenmeyer P; Guilland JC; dAthis P. Vitamin B6 and vitamin C status in elderly patients with infections during hospitalization. Ann Nutr Metab, 1997, 41:6, 344-52
17. Sahyoun NR; Jacques PF; Russell RM Carotenoids, vitamins C and E, and mortality in an elderly population. Am J Epidemiol, 1996 Sep, 144:5, 501-11
18. Losonczy KG; Harris TB; Havlik RJ Vitamin E and vitamin C supplement use and risk of all-cause and coronary heart disease mortality in older persons: the Established Populations for Epidemiologic Studies of the Elderly. Am J Clin Nutr, 1996 Aug, 64:2, 190-6
19. Martin A; Foxall T; Blumberg JB; Meydani M. Vitamin E inhibits low-density lipoprotein-induced adhesion of monocytes to human aortic endothelial cells in vitro. Arterioscler Thromb Vasc Biol, 1997 Mar, 17:3, 429-36
20. Barton DL et al. Prospective evaluation of vitamin E for hot flashes in breast cancer survivors. J Clin Oncol, 1998 Feb, 16:2, 495-500
21. Nieves JW, Komar L, Cosman F, Lindsay R. Calcium potentiates the effect of estrogen and calcitonin on bone mass: review and analysis. Am J Clin Nutr 1998;67:5-6, 18-24
22. Corti MC; Guralnik JM; Salive ME; Ferrucci L; Pahor M; Wallace RB; Hennekens CH. Serum iron level, coronary artery disease, and all-cause mortality in older men and women. Am J Cardiol, 1997 Jan, 79:2, 120-7
23. Cappuccio FP; Markandu ND; Carney C; Sagnella GA; MacGregor GA. Double-blind randomised trial of modest salt restriction in older people. Lancet, 1997 Sep, 350:9081, 850-4
24. Graudal NA et al. Effects of Sodium Restriction on Blood Pressure, Renin, Aldosterone, Catecholamines, Cholesterols, and Triglyceride. JAMA. 1998;279:1383-1391
25. Janson M. A Supplement Plan for Seniors; Nutrition Science News; December, 1999; Vol 4, No. 12; 558-564

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