What vitamins or supplements are safe for older adults to take without causing harm?

Safe Vitamins and Supplements for Older Adults

For older adults, a daily multivitamin, calcium (1,000-1,200 mg/day), and vitamin D (800 IU or more) are generally safe and may provide benefit, particularly when dietary intake is inadequate, while avoiding beta-carotene supplements (especially in smokers) and excessive doses of fat-soluble vitamins A and D. 1

General Safety Principles

With the exception of vitamins for which there is compelling evidence of net harm (such as beta-carotene supplementation in smokers), there is little reason to discourage older adults from taking vitamin supplements. 1 However, several important caveats apply:

• Patients should adhere to dosages recommended in the Dietary Reference Intakes of the Institute of Medicine 1
• Vitamins A and D may be harmful in higher doses; therefore, doses greatly exceeding the Recommended Dietary Allowance should be taken with care 1
• Look for products with a U.S. Pharmacopeia seal for quality control over content 1

Specific Recommendations by Vitamin/Supplement

Multivitamins

• A daily multivitamin supplement may be appropriate for older adults, especially those with reduced energy intake 1
• Multivitamins substantially increase vitamin and mineral intakes and blood concentrations, improving overall micronutrient status 2
• While routine multivitamin use has not been shown to prevent major chronic diseases, they help prevent deficiencies in older adults 3, 2

Calcium and Vitamin D (Strongest Evidence for Benefit)

• All older adults should be advised to have a calcium intake of at least 1,200 mg daily 1
• For women older than 50 years and men older than 70 years, the recommended dietary intake is 1,200 mg of calcium per day 1
• Vitamin D doses of at least 800 IU daily appear most beneficial for fracture prevention in older adults 1
• There is strong and compelling support for the health benefits of vitamin D and calcium supplements when intake/status is not optimal 3

Important caveat: Supplementation with 400 IU or less of vitamin D and 1,000 mg or less of calcium increases the incidence of kidney stones (one additional case per 273 women over 7 years) 1

Vitamins to Avoid or Use Cautiously

Beta-Carotene:

• Recommend against beta-carotene supplements, either alone or in combination 1
• In trials restricted to heavy smokers, beta-carotene supplementation was associated with higher incidence of lung cancer and higher all-cause mortality 1

Vitamins A, C, and E:

• The evidence is insufficient to recommend for or against routine supplementation with vitamins A, C, or E for disease prevention 1
• The evidence does not support a recommendation for vitamins A, C, E, or antioxidant combinations in the prevention of cardiovascular disease or cancer 3

Vitamin B12

• Older adults are particularly vulnerable to vitamin B12 deficiency 2
• Supplementation may be appropriate for older adults with inadequate dietary intake or absorption issues 2

Special Populations and Considerations

Elderly in Long-Term Care Facilities

• The imposition of dietary restrictions on elderly residents with diabetes in long-term health facilities is not warranted 1
• Malnutrition and dehydration may develop because of lack of food choices and unnecessary restrictions 1
• It is recommended that residents are served the regular menu with consistency in the amount and timing of carbohydrate 1

Monitoring and Safety

• Involuntary gain or loss of more than 10 pounds or 10% body weight in less than 6 months indicates a need to evaluate if the reason is nutrition-related 1
• Patients should be reminded that taking vitamins does not replace the need to eat a healthy diet 1

Common Pitfalls to Avoid

• Do not exceed recommended doses of fat-soluble vitamins (A, D, E, K), as toxicity can occur 1
• Avoid beta-carotene supplements entirely in smokers or former heavy smokers 1
• Be aware that mineral oil interferes with absorption of fat-soluble vitamins 4
• Thiazide diuretics combined with vitamin D supplementation may cause hypercalcemia in certain patients 4
• Monitor for kidney stone formation when using calcium and vitamin D supplements, particularly at higher doses 1