Introduction

Mild vitamin deficiencies are very common among elderly persons (particularly frail and institutionalized elderly) and are associated with cognitive impairment, poor wound healing, anemia, and an increased propensity for developing infections. Trace mineral deficiencies are associated with immune system dysfunction and many other disorders.

Elderly persons who are at risk of or who are suspected of having protein-energy undernutrition should be presumed to also be at risk for multiple vitamin deficiencies. Undernutrition of < 1 year usually causes deficiencies in the B vitamins and in vitamin C (ie, the water-soluble vitamins). Undernutrition of longer duration usually also causes deficiencies in vitamins A, D, E, and K (ie, the fat-soluble vitamins) and in vitamin B₁₂, which have larger body stores. Deficiencies can also be associated with certain diseases, high-risk behaviors (eg, smoking, alcohol abuse), and medication use (see Table 60-1).

Tests to diagnose early vitamin deficiencies can be difficult and expensive; thus, supplementation with a multivitamin containing at least the recommended dietary allowances (RDAs) is recommended for elderly patients at risk. Because extreme vitamin deficiency can cause irreversible organ damage, supplementation should begin before signs appear.

The benefit of routine vitamin supplementation for healthy elderly persons is controversial. A diet that includes at least five or six daily servings of fruits and vegetables usually contains sufficient vitamins (as well as other healthful phytochemicals available only in food). However, a less healthful diet probably requires daily supplementation. There is also evidence that a multivitamin supplement improves immune status in healthy elderly persons. The new Dietary Reference Intakes (an expansion of the RDAs) issued by the Food and Nutrition Board at the Institute of Medicine lists the recommended daily requirements of vitamins and minerals for healthy persons, including tolerable upper intake levels.