Common Vitamin Deficiencies in the Elderly

As we age, our intake of micronutrients as well as our ability to absorb certain nutrients decrease.  This results in deficiencies.  The most common are vitamin B 12, vitamin D and calcium.  

It is recommended that people over the age of 51 take a Vitamin B 12 supplement or increase the foods plentiful in this vitamin.  Foods that are high in Vitamin B 12 are animal products including fish, meat, poultry, eggs and dairy products.  Cereals are also fortified with vitamin B 12 so this a source for vegetarians.  It is also available as a vitamin supplement.  Vitamin B12 is usually present as cyanocobalamin, a form that the body readily converts to active forms. Dietary supplements can also contain methylcobalamin and other forms of vitamin B12.  There is no evidence that one form is better over another.  Besides a pill form there is a sublingual preparation but there is no evidence that this is superior.  

People who are deficient in vitamin B 12 have anemia or a low blood count.  The red cells are larger than normal without vitamin B 12 so it is called a megaloblastic anemia.  Other symptoms are fatigue, weakness, constipation, loss of appetite, and weight loss. Numbness and tingling in the hands and feet, can also occur as well as difficulty maintaining balance, depression, confusion, dementia, poor memory, and soreness of the mouth or tongue Early diagnosis and intervention is important to avoid irreversible damage.  

Because elderly may not go outside often, vitamin D is generally low.  It is difficult to get vitamin D through the diet and sunshine is the most common source.  Sources of vitamin D are fatty fish such as salmon and tuna, fish oil and certain mushrooms.  Milk, some yogurts and orange juices are supplemented with Vitamin D.  Dietary supplements are available for vitamin D and the recommended amount is 600 IU for people less than 70 and 800 IU for people over the age of 71.  All elderly people should be encouraged to supplement with vitamin D.  

People who are deficient in vitamin D have been linked with muscle weakness, functional impairment, depression, and increased risk of falls and fractures.  Low vitamin D is associated with increased mortality.  

Calcium is also important in the elderly.  As we age we are not able to absorb the calcium from our guts and therefore we become deficient.  This leads to lower calcium in the bones and subsequent fractures.  It is recommended that everyone over the age of 51 increase their calcium intake to 1200mg /day.  

Foods that are rich in calcium include dairy products including milk, yogurt, ice cream and cheese.  Other foods such as dark leafy vegetables, beans, tofu, soy milk and almonds are also high in calcium.  Calcium supplements are also available.  They come in either carbonate or citrate formulas.  Due to its dependence on stomach acid for absorption, calcium carbonate is absorbed most efficiently when taken with food, whereas calcium citrate is absorbed equally well when taken with or without food.

It is important for the elderly to have a diet rich in the above micronutrients.  If this is not possible, they should have supplements added to their diets.