What causes nutritional deficiencies in elderly adults?
In the UK, the elderly population (aged 65 and over) is at a higher risk of nutritional deficiencies for a variety of reasons.
- Forgetting to eat, or developing bad eating habits – especially common in the elderly who live alone.
- A reduced or fixed income, which limits how much can be spent on food.
- Medication side effects, that reduce how much we absorb of certain vitamins and minerals.
- Gastrointestinal issues, whether from a GI tract infection or surgical procedure.
- Smoking tobacco and over-consumption of alcohol.
- Loss of appetite or easily feeling too full, caused by hormonal and neurotransmitter changes.
The 4 most common nutritional deficiencies in the elderly in the UK
The top 4 worst deficiencies in the elderly in the UK – vitamin D, B12, folate and protein – can all mimic the early symptoms of senile dementia or Alzheimer’s disease. They can also make people who do have these conditions worse.
The other deficiency symptoms include a weakened immune system, typically causing recurring thrush infections (candida albicans) in the mouth or persistent chesty coughs and bronchitis. They will also, of course, all cause significant tiredness and lethargy.
VITAMIN D Deficiency – bone fracture and memory loss
Vitamin D deficiency is so widespread among the elderly in the UK that we almost regard the symptoms as just a part of old age. Research has found that older men are at even greater risk of developing a serious vitamin D deficiency than women.
Causes: The skin’s ability to synthesise vitamin D from sunlight decreases with age. Additionally, elderly individuals often spend less time outdoors, further reducing their exposure to sunlight. Cholesterol-lowering drugs such as cholestyramine and colestipol can interfere with the absorption of vitamin D.
Effects: A deficiency in vitamin D sneaks up slowly and can be quite hard to distinguish from rapid ageing. It is associated with many geriatric syndromes, including forgetfulness, difficulty with mental tasks that used to be easy, and worsening dementia and Alzheimer’s in people who already have those illnesses. It makes people constantly tired and lethargic, and lose enthusiasm for life. It can lead to weakened bones, increased risk of fractures, osteoporosis, and muscle weakness, which contributes to a higher risk of falls.
Recommendation: The NHS recommends that all people in the UK take a daily supplement of vitamin D during winter – the standard dose is 400 IU. People over 70 should take 800 IU daily, which is double the daily dose for younger adults.
VITAMIN B12 Deficiency – can mimic dementia
Vitamin B12 deficiency is common in older adults, with studies suggesting that at least 20% of people over the age of 60 in the UK may be deficient.
Vitamin B12 (cobalamin) deficiency in elderly patients, Emmanuel Andrès, Noureddine Henoun Loukili, Esther Noel, Georges Kaltenbach, Maher Ben Abdelgheni, Anne Elisabeth Perrin, Marie Noblet-Dick, Frédéric Maloisel, Jean-Louis Schlienger and Jean-Frédéric Blicklé
Causes: The body’s ability to absorb vitamin B12 from food decreases with age due to reduced stomach acid production, which is necessary for the absorption of B12. Conditions such as atrophic gastritis, medications (like proton pump inhibitors and metformin), and poor dietary intake also contribute to deficiency.
Effects: B12 deficiency causes neurological issues like tingling or numbness in the hands and feet. It can make the mouth constantly sore and cause a red, sensitive tongue. It may also make the skin look yellowy, and it’s common for people with a B12 deficiency to get a lot of headaches.
Deficiency in vitamin B12 can lead to anaemia, fatigue, and memory loss with confusion and mood changes which are easily misdiagnosed as dementia.
Recommendation: Absorption of vitamin B12 from natural sources like meat and dairy becomes less efficient with age. This means it becomes harder to get enough B12 even if you eat plenty of these foods. Supplements typically contain 1000 microgrammes of vitamin B12 and it’s best to take the two activated forms, methylcobalamin and adenosylcobalamin.
FOLATE (VITAMIN B9) Deficiency – a threat to the heart and brain
Folate deficiency is strongly connected with vitamin B12. The deficiency symptoms overlap, and a deficiency in one can be hard to separate from the other. This can occur in older adults due to poor diet or medical conditions that affect nutrient absorption.
Causes: The biggest cause of folate deficiency is not eating your greens! Alcohol use, and certain medications (such as anticonvulsants and methotrexate) can contribute to folate deficiency.
Effects: Folate deficiency can lead to anaemia, cognitive impairment, depression, and an increased risk of cardiovascular disease.
Recommendation: Eat vegetables rich in folate and consider discussing supplements with your GP.
PROTEIN Deficiency – devastating muscle wasting
Many elderly people don’t eat enough protein foods, which is crucial for maintaining muscle mass and overall health.
Causes: Having bad teeth is the commonest reason why many elderly people stop eating meat, and they also tend to lose their appetite. Some also have difficulty chewing or swallowing, and other dietary restrictions can lead to lower protein intake in older adults.
Effects: Insufficient protein intake can cause muscle wasting (sarcopenia), weakness, delayed wound healing, and impaired immune function.
Recommendation: To avoid muscle wasting, you should eat at least 1 gramme of protein per kilogramme of body weight every day, as a bare minimum.
If you have difficulty chewing meat, or just don’t like it, add powdered collagen or another protein supplement to drinks.
The worst deficiencies in elderly women
IRON Deficiency – opening the door to severe infections
Iron deficiency is relatively common in the elderly, particularly in women and those with certain health conditions. Whilst we’re well aware that younger women lose iron through having periods, many people don’t realise that older women are also vulnerable.
Causes: Many elderly women go off eating red meat altogether – and having weak teeth will make this more likely.
One of the first signs of iron deficiency is to find red meat quite nauseating, which of course immediately creates a vicious cycle.
Reduced dietary intake, chronic diseases (such as gastrointestinal bleeding, ulcers, or cancers), and reduced absorption due to age-related changes in the digestive system can lead to iron deficiency. Medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can also cause gastrointestinal bleeding, contributing to iron deficiency.
Effects: Iron is not well known for its crucial role as part of our immune defences. An iron deficiency doesn’t just lead to anaemia, with symptoms like fatigue, weakness, shortness of breath. It also causes an increased susceptibility to infections, which can be particularly devastating in the elderly.
Recommendation: A diet rich in iron-containing foods (like lean meats, beans, and fortified cereals) or iron supplements may be necessary for those at risk. If you are a vegetarian or vegan, consider asking your GP to check your iron levels.
CALCIUM Deficiency – the post menopausal hip and bone breaker
Calcium deficiency is a concern for older adults, particularly women, due to its role in maintaining bone health.
Causes: Reduced intake of dairy products, decreased absorption due to ageing, and certain medical conditions or medications that affect calcium metabolism can contribute to deficiency.
Effects: Calcium deficiency can lead to weakened bones, increasing the risk of osteoporosis and fractures.
Recommendation: Adults over 65 should aim for a daily intake of 1,200 mg of calcium, obtained through diet (dairy products, green leafy vegetables, fortified foods) or supplements if necessary.
The worst deficiencies in elderly men
MAGNESIUM Deficiency – a risk factor for heart disease
Magnesium deficiency is particularly dangerous for elderly men due to its impact on cardiovascular health.
Magnesium is crucial for maintaining a normal heart rhythm. Deficiency can lead to arrhythmias, which can increase the risk of stroke or sudden cardiac arrest. It also helps regulate blood pressure by relaxing blood vessels. A magnesium deficiency can contribute to hypertension, increasing the risk of heart attacks and strokes, which are more prevalent among elderly men.
Causes: Decreased dietary intake, use of certain medications (like diuretics and proton pump inhibitors), and reduced absorption due to gastrointestinal disorders can lead to magnesium deficiency.
Effects: Deficiency in magnesium can result in muscle cramps, weakness, fatigue, and an increased risk of cardiovascular issues and osteoporosis.
Recommendation: Bump up your intake of foods rich in magnesium (like nuts, seeds, whole grains, and leafy green vegetables) or consider taking supplements.
ZINC Deficiency – the prostate cancer threat
Zinc deficiency is common in the elderly due to factors like decreased dietary intake and absorption. Men need more zinc than women as they age, and the consequences of zinc deficiency in men can be particularly harmful as it’s associated strongly with benign prostate tumours turning into prostate cancer.
Causes: Reduced intake of zinc-rich foods (like meat, shellfish, legumes, and nuts), gastrointestinal disorders, and medications that affect zinc absorption can lead to deficiency. Proton pump inhibitors (PPIs) for gastritis and Penicillamine for rheumatoid arthritis are common causes of zinc deficiency.
Effects: Zinc is vital for the immune system, so a deficiency can impair immune function – ironically, many antibiotics will make a zinc deficiency worse. Low levels of zinc will also delay wound healing, reduce appetite, and put people off their food as they lose their sense of taste. The strong association of zinc with prostate cancer is alarming and well-proven.
Recommendation: For most elderly men, and especially any with benign prostate enlargement, zinc supplements are a wise precaution.
Conclusion
It’s essential for older adults to work with health visitors of their GP to identify and manage any deficiencies effectively.
Elderly men and women are more prone to nutritional deficiencies due to factors such as reduced food intake, diminished absorption, and certain health conditions. Addressing these deficiencies through a balanced diet, fortified foods, and targeted supplementation can help maintain health and quality of life.
