Deficiency Series: What Deficiencies are Common in Seniors?
Technically any person over the age of ‘middle aged’ is considered a senior . This is over the ages of 65 years. In the UK alone, our ‘Senior’ population has doubled in the last 200 years. This is due to advancements in modern medicine and greater knowledge on how to prolong our lives.
The current UK average life expectancy is approximately 81 which has seen a great increase of 4-5 years from the 1990s.
How do deficiencies Occur in Seniors?
Like most groups in society, Seniors are prone to deficiencies. This could be due to physical social or socio-economic reasons that prevent them from getting the nutrition that they need. This includes the following reasons:
- Difficulty swallowing
- Poor Income, living off a pension may mean they are unable to afford nutritious food
- Bereavement, may cause a decrease in appetite
- Reduced Dental Health
- Loss of Taste
- Poor dexterity which makes the preparation of food more difficult
- Inability to cook
- Ready meals and easy-to-cook options are high in salt and fat and not nutritionally tailored towards seniors
- Unable to access the shops
- Memory loss which can lead to forgetting to eat or drink, etc.
This can lead to both under and over nutrition. Under nutrition is caused by a below average requirement intake of energy, fat, protein, and essential vitamins and minerals. This is often detectable by muscle wastage, fractures and increased susceptibility to infections. On the other hand, there is over nutrition, which is caused by increased intake of food and a decrease in movement/exercise. As we age our energy requirements decrease so food must be adjusted accordingly. This is easily reconsigned by rapid weight gain and decreased movement. One statistic found that of those people admitted to hospital at least 1/3 of them were undernourished.
What are Seniors likely to be Deficient in?
Many studies have been conducted on typical diets of seniors, it was found that despite improvements in nutrition knowledge, and care there are still a number of common nutrition deficiencies associated with ageing.
Vitamin D and Calcium
As we all know, ageing causes the onset of numerous bone and joint disorders. It’s common knowledge that to maintain bone health, Calcium is essential but so is Vitamin D. Calcium is one of the structural components of the bones, that help to keep them strong and prevent them from becoming brittle. However, Calcium cannot be absorbed for bone health unless Vitamin D is present. Beyond Post Peak Bone Mass (+30 years) our bone health begins to suffer. Especially in women as hormonal changes during menopause strip the body of its Calcium reserves and weakens bones. Osteoporosis is a major threat, more prominent in women but also found in men. Although it is a multifactorial disease inadequacies in Vitamin D and Calcium intake are thought to be linked to its development.
Vitamin D requirements increase as we age, because of ageing bones but also because as we age we tend to spend less time in the sun. The sun being the most potent form of Vitamin D. Anyone over the age of 65 should be consuming greater than 10ug of Vitamin D per day. Please note that smokers require more Vitamin D that non-smokers. Moreover, do not take more than 25ug as this could be harmful to your health. Dietary sources of Vitamin D include oily fish, plant oils, fortified margarine and the sun. Calcium in food is abundant, especially in green leafy vegetables and dairy products [3,4].
The B-Vitamins have many important roles in the body, and especially in the maintenance of health in senior years. B Vitamins are responsible for the production of energy, and red blood cells but also it contributes to the health of the skin, eyes and nervous system. The common reason why seniors have such poor B-Vitamin status is because as we age our ability to absorb nutrients through our gastrointestinal tract decreases. Particularly with Vitamin B12 (Cobalamin), as the production of IF-Intrinsic factor (required for B12 absorption) is produced less efficiently. The other reason for deficiency is that many of the rich sources of B-vitamins are not abundantly consumed by the senior population. B-Vitamins, such as B1,B2,B6,B12 and B9 (Folate) are the most under-consumed. In terms of health B6,B9 and B12 are most important as they are associated with the metabolism of cysteine and the production of new cells. New cells help regenerate old and ill-health cells that could cause disease. Cysteine is an amino acid that has been linked to heart disease and the onset of heart attacks. Moreover healthy intakes of Folic acid have been linked with a reduction in dementia, and depression . Whereas Vitamin B12 has been linked with symptoms of anaemia . Rich Sources of B-Vitamin include wholegrains, white meats and eggs, but also dairy products which are frequently consumed.
Deficiency in Vitamin C is thought to be due to a lack of fruit and vegetable intake. These are fresh groceries that have to be bought and consumed quickly to get the optimal nutritional properties. Therein lies a problem because seniors have reduced access to the shops, meaning that they will buy and consume fruit and vegetables infrequently. Moreover, they often have reduced dexterity and dental health which can make consumption difficult. Reduced Vitamin C intake can lead to kidney problems including kidney stones, and anemia due to reduced iron intake. It was found that 40% of seniors in residential care had Vitamin C statuses below average .
Vitamin C can be bought in supplement form which takes the difficulty out of consuming it from food. However, to make fruit and vegetable consumption easier, it is best to buy ready prepared fruits and vegetables, or eat them in soup/pureed form. Foods high in Vitamin C are green leafy vegetables, mangoes, strawberries, bananas, bell Peppers and broccoli [1,7].
The causes of low body Iron will either be due to low intakes of Vitamin C or due to ectopic bleeding. Vitamin C increases the bioavailability of the Iron meaning that more will be absorbed into the body. Additionally, when we age our membranes begin to thin, e.g skin and blood vessels so undetected bleeding is more common. Besides this bowel health is poor which can lead to hard stool and constipation which may cause some blood loss in the stool. Small losses of blood such as this are hard to track and can often lead to anemia. To avoid this, foods such as red meats, cocoa, and dark green leafy vegetables should be consumed. Alternatively, an Iron supplement taken alongside a Vitamin C tablet will aid deficient status.
The focus should be on nutrition first. Eating meals abundant in vitamins and minerals essential for a long and healthy life.
- BNF. (2016). Older Adults. Available: https://www.nutrition.org.uk/nutritionscience/life/older-adults.html .
- ONS. (2014). Life Expectancies. Available: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/lifeexpectancies
- Staveren.W, Groot.L,Horwath.C. (2012). 35: Nutrition and Ageing. In: Mann,J. Truswell,S. Essentials of Human Nutrition. 4th ed. Oxford: Oxford University Press. Pg. 572-587.
- Roberts, C. (2016). Vitamins for Older People . Available: http://www.ageuk.org.uk/health-wellbeing/healthy-eating-landing/vitamins-for-older-people/.
- Reynolds.E. (2002). Folic acid, ageing, depression, and dementia. British Medical Journal. 342 (7452), Pg. 1512-1515.
- Baik.H, Russel.R. (1999). Vitamin B12 deficiency in the elderly.. Annual Review of Nutrition . 19 (3), Pg. 357-377.
- Zagaria.M. (2010). Vitamin Deficiencies in Seniors. US Pharmacist. 35 (8), Pg. 20-27.
- Schultz.B, Freedman.M. (1987). Iron Deficiency in the Elderly. Baillieres Clinical Hematology . 1 (2), Pg. 291-313.
- Malnutrition Task Force. (2016). Malnutrition Factsheet. Available: http://www.malnutritiontaskforce.org.uk/resources/malnutrition-factsheet/.
- Walker. C. (2004). Eating Well of Older People-2nd Edition. Available: http://www.cwt.org.uk/wp-content/uploads/2014/07/OlderPeople.pdf.