Vitamin nutrition in older adults

Proper vitamin nutrition is essential for all people but especially for elderly persons, because they are at higher risk for deficiency than younger adults. A review of the clinical effects of vitamin deficiency shows how easily deficiency can masquerade as other morbidities, such as skin, neurologic, and gait abnormalities. Given the numerous readily available forms and sources of supplementation, their low cost, and their rather limited potential for harm, the goal of good vitamin nutrition for the elderly is easily attainable. To be successful in this goal, physicians must look for patients at risk and for those with features of frank vitamin deficiency. Laboratory testing is most helpful with respect to vitamin B12 and folate deficiency. Given the great value of clinical assessment, the low cost of vitamins, and the higher cost of laboratory testing, the authors do not recommend testing before instituting multivitamin use or extra supplementation with individual vitamins unless the diagnosis of deficiency is in question or the use of supplementation would put the patient at risk. The authors' general recommendations are * one multivitamin daily * extra vitamin E for patients with cardiovascular risk factors or Alzheimer's dementia * extra vitamin D for patients with known osteoporosis, osteoporosis risk factors, or strong risk factors for vitamin D deficiency * extra folate for patients with cardiovascular risk factors (especially smokers) and alcoholics * extra thiamine for alcoholics.     

Antioxidant vitamin supplement use and risk of dementia or Alzheimer's disease in older adults

OBJECTIVES: To examine whether use of vitamins C or E alone or in combination was associated with lower incidence of dementia or Alzheimer's disease (AD).
DESIGN: Prospective cohort study.
SETTING: Group Health Cooperative, Seattle, Washington.
PARTICIPANTS: Two thousand nine hundred sixty-nine participants aged 65 and older without cognitive impairment at baseline in the Adult Changes in Thought study.
MEASUREMENTS: Participants were followed biennially to identify incident dementia and AD diagnosed according to standard criteria. Participants were considered to be users of vitamins C or E if they self-reported use for at least 1 week during the month before baseline.
RESULTS: Over a mean follow-up±standard deviation of 5.5±2.7 years, 405 subjects developed dementia (289 developed AD). The use of vitamin E was not associated with dementia (adjusted hazard ratio (HR)=0.98, 95% confidence interval (CI)=0.77–1.25) or with AD (HR=1.04; 95% CI=0.78–1.39). No association was found between vitamin C alone (dementia: HR=0.90, 95% CI=0.71–1.13; AD: HR=0.95, 95% CI=0.72–1.25) or concurrent use of vitamin C and E (dementia: HR=0.93, 95% CI=0.72–1.20; AD: HR=1.00, 95% CI=0.73–1.35) and either outcome.
CONCLUSION: In this study, the use of supplemental vitamin E and C, alone or in combination, did not reduce risk of AD or overall dementia over 5.5 years of follow-up.     

Comparison of health services use by Chinese urban and rural older adults in Yunnan province

Background:   This article examines and compares the pattern of determinants of health services use between Chinese older adults residing in urban and rural areas of Yunnan province, China.
Methods:   Data from the Sample Survey on Aged Population in Urban/Rural China (SSAPUR) are used to compare the patterns of determinants for both physician visit and hospitalization between the urban and rural respondents. Andersen's health service utilization model was adopted as a conceptual framework.
Results:   Findings revealed that different patterns of determinants in physician visits and hospitalization existed among the two groups, implying that different barriers in health access are faced. The financial barrier was a prominent factor faced by urban elders in access to both physician visits and hospitalization, while rural elders encountered physical barriers in addition to financial difficulty when accessing health care.
Conclusion:   Study of the elderly population in Yunnan province helps to contrast the differences in health service use between urban and rural elders, which would shed light on possible focus in health policy-making and resource allocation to tackle the different health access barriers.     

Complementary and alternative medicine use as health self-management: rural older adults with diabetes

OBJECTIVE: . This study describes complementary and alternative medicine (CAM) use among rural older adults with diabetes, delineates the relationship of health self-management predictors to CAM therapy use, and furthers conceptual development of CAM use within a health self-management framework. Methods. Survey interview data were collected from a random sample of 701 community dwelling African American, Native American, and White elders residing in two rural North Carolina counties. We summarize CAM use for general use and for diabetes care and use multiple logistic modeling to estimate the effects of health self-management predictors on use of CAM therapies. RESULT: . The majority of respondents used some form of CAM for general purpose, whereas far fewer used CAM for diabetes care. The most widely used CAM categories were food home remedies, other home remedies, and vitamins. The following health self-management predictors were related to the use of different categories of CAM therapies: personal characteristics (ethnicity), health status (number of health conditions), personal resources (education), and financial resources (economic status). Discussion. CAM is a widely used component of health self-management among rural among older adults with diabetes. Research on CAM use will benefit from theory that considers the specific behavior and cognitive characteristics of CAM therapies.     

The use of health services by older adults

Using baseline data on the 5,151 respondents surveyed as part of the panel design of the Longitudinal Study on Aging (LSOA), this article estimates, cross-sectionally, the relationships hypothesized in the behavioral model of health services utilization. In addition to the traditional indicators of the predisposing, enabling, and need characteristics, the richness of the LSOA permits the inclusion of measures of multigenerational living arrangements, kin and nonkin social supports, health worries and the sense of health control, health insurance coverage, residential stability, and several multiple-item scales of functional limitations. Despite these innovations, the ability of the behavioral model to accurately predict the use of health services by older adults remains relatively unchanged. Important conceptual clarifications involving the hypothesized relationships, however, are identified and discussed.     

Faith and health self-management of rural older adults

This analysis uses in-depth interview data collected from 145 AfricanAmerican, European American and Native American men and women aged 70and older who reside in two rural North Carolina counties to understand therole of religious faith and prayer in the health self-management of theseolder adults. The analysis addresses three specific questions: how do theseolder adults use religion to help them manage their health; are there ethnicand gender differences in the use of religion; and are differences in healthstatus related to differences in the use of religion? The integral role ofreligion in the lives of these older rural adults is an overarching themepresent in the interview texts. Six major themes link religion and healthself-management: (1) prayer and faith in health self-management, (2)reading the Bible, (3) church services, (4) mental and spiritual health, (5)stories of physical healing, and (6) ambivalence. Faith and religiousactivities provide an anchor in the lives of these older adults. There is littlevariation in the use of religion for health self-management by gender,ethnicity or health status. These results suggest that the strength ofreligion in rural culture may limit the effectiveness of general religiosityscales to discern the relationship of religion to health and health behaviorin rural populations.     

Long-term compliance with a novel vitamin and mineral supplement in older people with PKU

Summary Background:  The long-term efficacy of vitamin and mineral preparations in dietary-treated adult patients with phenylketonuria (PKU) is unreported. Aim: In an open, intervention trial, the acceptability, safety and impact on biochemical and haematological micronutrient status of a new vitamin and mineral tablet (Phlexy Vits, SHS International) was investigated. Methods:  Fifteen subjects with PKU (median age 21 years, range 8–33 years) on low-phenylalanine diet from two PKU centres were recruited. No vitamins or minerals were added to their protein substitute and for 12 months they took their full daily requirements of vitamin and minerals from Phlexy Vits (5 tablets/daily). All but two subjects had taken alternative vitamin and mineral supplements before the trial. Fasting bloods were taken at baseline (week −2 and at week 0), 4 and 12 months for a range of biochemical and nutritional measurements. Results:  By 4 months, serum vitamin B₁₂ (p = 0.003), serum manganese (p=0.03) and plasma (p=0.03) and red blood cell (p=0.004) glutathionine peroxidase (GSHPx) all significantly increased but remained within normal reference ranges. By 12 months, serum vitamin B₁₂ (p<0.05) and plasma GSHPx (p<0.05) remained increased. The Phlexy Vits tablets scored better than conventional vitamin and mineral supplements for overall acceptability (p<0.05), and ease of swallowing (p=0.1) at 4 months, although swallowing score deteriorated by 12 months (p<0.05). There was a small but significant deterioration in compliance with taking the vitamin and mineral supplements between 4 and 12 months (p<0.05). Conclusion:  In the long term, these comprehensive vitamin and mineral tablets appeared acceptable and improved biochemical nutritional status, although there were long-term compliance and swallowing issues. Competing interests: This study was funded by SHS International.     

The social epidemiology of alcohol use by urban older adults

A sample survey of 928 Bostonians, aged sixty years or older, indicates that there are low levels of alcohol consumption: more than half report that they are abstainers; 6 percent indicate that they have two or more drinks daily. Levels of abstinence are particularly high among women, blacks, Jews, widows and widowers, the foreign-born, those with low levels of formal education, and those aged seventy-five years or older. Among social psychological variables, locus of control is most consistently associated with drinking: those who report little influence upon their futures--in terms of work, marriage, income, and leisure activities--are more likely to abstain. There is also an association with optimisim; those who are least optimistic about their prospects for work and leisure activities are most likely to abstain. Analysis of variance shows that gender, education, ethnicity, religion, age, and locus of control regarding work are independent correlates of alcohol use. The data suggest that older people drink mainly in social contexts and to facilitate social interaction.     

Participation of metropolitan, urban and rural community-dwelling older adults

Environmental factors are important in maintaining a high level of participation. This cross-sectional study aimed at comparing the level of participation of older adults living in rural, urban and metropolitan environments and exploring sociodemographic factors associated with participation according to each type of environment. A total of 350 community-dwelling participants showing a normal aging process were randomly recruited. Participation in daily activities and social roles was measured with the Assessment of Life Habits. Sociodemographic and environmental data were gathered using a questionnaire. Participants from the rural region reported less schooling, a lower income, no access to public transportation and less access to stores than others. Participants from the metropolitan region differed in terms of less use of a car, less satisfaction with their social support and feeling less secure in their neighborhood. However, no significant difference was found between the metropolitan, urban and rural groups for participation in daily activities and social roles. Furthermore, the variables most associated with participation were similar for all three regions. This suggests that although the environment of older adults living in metropolitan, urban and rural region differs, their level of engagement in daily activities and social roles is similar.     

The nature of self-directed learning in older rural adults

As a result of this research we know that older rural adults from this sample were deeply involved in a variety of self-directed learning. The nature of the self-directed learning was of particular interest. This personal learning was seen as highly engaging, variably structured, collaborative, and goal-directed. This is based on a sample of ten older rural adults who were nominated to be in this study. This was a basic qualitative study incorporating constant comparative analysis. Findings indicate the importance of self-directed learning in the lives of older rural adults. He holds a Ph. D. degree in Adult Education and Certification in Gerontology. He also holds a Master’s degree in Recreation and Leisure Studies. In addition, he has worked with the organization of Campus Crusade for Christ, Intl. in a variety of locations. Other research interests include learning that takes place in the context of recreation and leisure, especially travel. Dr. Roberson is a native of the state of Georgia.     

Participation of older adults in cyberspace: How Australian older adults use the Internet

Aim: The present study explores how Australian older adults use the Internet. Method: Older adults were recruited online to complete an online survey. Results: Participants primarily used the Internet for interpersonal communication, followed by information seeking, commerce and entertainment. Conclusion: The Internet is an important technology in helping older adults lead independent and social lives.     

Principles of antimicrobial use in older adults

The fundamental principles of treating infectious diseases apply to elderly patients, but certain aspects of therapy such as the selection of empiric regimens and risk stratification for severe or atypical disease are influenced by comorbidities, lifestyle, and immunosenescence. Knowledge of age-related changes in pharmacokinetic parameters and potential drug-drug interactions assists the clinician in determining appropriate dosing and monitoring parameters. Based on current evidence, the recommended approach includes careful selection and aggressive dosing of initial broad-spectrum antimicrobials followed by de-escalation to appropriate agents to maximize clinical outcomes and minimize toxicity and adverse effects. Greater enrollment of the elderly in therapeutic studies is needed to detect differences in the efficacy and safety of antimicrobials.