Dietary and health supplement use among older Australians: results from a national survey

Objectives: To measure the extent of dietary and health supplement use among older Australians and to contrast older supplement users from older non‐supplement users. Method: Survey participants (n= 1,263) provided information related to demographic, health and lifestyle features. The target population were Australians aged 65 years and over, randomly chosen from the Australian Electoral Commission. Data was obtained using a 12‐page self‐administered, mail questionnaire. Results: Forty‐three percent (n=548) of the sample reported using at least one dietary and health supplement, 52% of females and 35% of males. Supplement use was significantly related to several demographic and lifestyle features including: gender, educational level, smoking status and number of visits to complementary health therapists. Conclusions: Clearly, supplements were chosen more for their perceived ability to attenuate or modify ailments, rather than their role in correcting nutritional deficiencies. Older Australians appear intent on taking health matters in their own hands. Approximately one third of them rarely inform their doctor about the supplements they use, which raises concerns about the safety and appropriateness of this action.     

Vitamin/calcium supplement use in Taiwan: findings from the 1994 National Health Interview Survey

This study aimed to provide the prevalence of vitamin/calcium supplement use and, to explore the gender differences in and the correlates of supplement use. Data came from the 1994 National Health Interview Survey of 3,814 households; and 7,019 respondents (3,561 females and 3,458 males) aged 25 years old and older were included in the analysis. Supplement users were defined as individuals who reported taking any supplements at least once a week. Associations between supplement use and its correlates were examined by using chi-square analysis and logistic regression. The results indicated that 22.2% of females and 12.7% of males used vitamin supplement, and 10.2% of females and 3.7% of males took calcium supplement. The adjusted sex odds ratio was 2.8 (95% CI = 2.4-3.2) for vitamin supplement use and 3.8 (95% CI = 3.0-4.7) for calcium supplement use when sociodemographic and health variables were controlled. Increased likelihood on the use of vitamin/calcium supplement was associated with sociodemographic characteristics (females, over 45 years old, more educated) and health behaviors (more regular exercise and check on blood pressure). Additionally, females who received regular Pap smear or with no chronic disease tended to take more vitamin supplement and females who perceived themselves with a poor health condition were more likely to use calcium supplement than others.     

Recognition and Management of Hypertension in Older Persons: Focus on African Americans

Hypertension is the most commonly diagnosed condition in persons aged 60 and older and is the single most important risk factor for cardiovascular disease (ischemic heart disease, heart failure, and stroke), kidney disease, and dementia. More than half of individuals with hypertension in the United States are aged 60 and older. Hypertension disproportionately affects African Americans, with all age groups, including elderly adults, having a higher burden of hypertension‐related complications than other U.S. populations. Multiple clinical trials have demonstrated the beneficial effects of blood pressure (BP) reduction on cardiovascular morbidity and mortality, with most of the evidence in individuals aged 60 and older. Several guidelines have recently been published on the specific management of hypertension in individuals aged 60 and older, including in high‐risk groups such as African Americans. Most recommend careful evaluation, thiazide diuretics and calcium‐channel blockers for initial drug therapy in most African Americans, and angiotensin‐converting enzyme inhibitors and angiotensin receptor blockers in those with chronic kidney disease or heart failure. Among the areas of controversy is the recommended target BP in African Americans aged 60 and older. A recent U.S. guideline recommended raising the systolic BP target from less than 140 mmHg to less than 150 mmHg in this population. This article will review the evidence and current guideline recommendations for hypertension treatment in older African Americans, including the rationale for continuing to recommend a SBP target of less than 140 mmHg in this population.     

Vitamin and mineral supplement use by older rural adults

BACKGROUND: Vitamin and mineral supplement products are widely consumed by older adults. This study describes supplement product use in a multiethnic rural population, relates supplement usage to dietary nutrient intake, and determines predictors of supplement usage. METHODS: Data are from a population-based sample of 130 community-dwelling adults aged 70 years and older in two rural North Carolina counties. The sample was 34% African American, 36% European American, and 30% Native American. Interviewer-administered semiquantitative food frequency questionnaires were used to obtain data on usual diet and supplement use. In-home interviews allowed verification of supplement composition. Intakes from diet and supplement products were examined for vitamins A, E, B6, C, folate, iron, zinc, and calcium. RESULTS: Of those who participated in the study, 47% reported using one or more supplement products. African Americans were significantly less likely to take supplements than Native Americans or European Americans. Based on dietary intakes, 65% of the participants were deficient (<2/3 recommended dietary allowance [RDA]) for at least one nutrient. The use of supplement products for the eight nutrients investigated was not related to dietary nutrient deficiency. For all nutrients investigated, except iron and calcium, a greater proportion of those without dietary deficiency took a supplement product than those with deficiency. Using logistic regression, ethnicity (European American and Native American), and gender (women) were significant predictors of supplement use. CONCLUSIONS: These findings suggest that although both dietary deficiencies of vitamins and minerals and supplement use are relatively high in this population, there is no association between supplement use and deficient dietary intakes for the eight nutrients examined. Health care providers should be aware that nutritional counseling and guidance on appropriate supplement usage is needed in this population.     

Intake of vitamin and mineral supplements in an elderly german population

AIM: To assess the prevalence of vitamin and mineral supplement use in a free-living elderly population and the contribution of these supplements to usual dietary intake. METHODS: Analyses are based on data obtained from 388 subjects (>or=60 years) participating in the longitudinal study on nutrition and health status in an ageing population in Giessen (GISELA), Germany, in 2002. Nutrient intake from food was assessed by means of a 3-day estimated dietary record. Supplement use was recorded over a period of 3 days using a self-administered questionnaire. RESULTS: Nearly half of the study population consumed at least 1 supplement within these 3 days. The use of supplements was more prevalent among women than among men (51.5 vs. 33.9%). On average women consumed 2.03+/-1.30 products and men 1.65+/-1.07 products. Magnesium, vitamin C and vitamin E were supplemented most often by men, while women supplemented magnesium, vitamin E and calcium most often. Most of the supplemented nutrients did not distinctly increase the average intake of the respective nutrients from the diet in this population. However, supplement use markedly decreased the proportions of elderly subjects with an intake below the current reference values for certain nutrients, particularly for vitamin E. CONCLUSION: Results indicate that the intake of supplements is a common behavior in the population under investigation and therefore has to be considered when nutrient intake is evaluated.     

Recent trends in use of herbal and other natural products

BACKGROUND: The benefits of herbal and other natural products (dietary supplements) are increasingly cited in the media. Dramatic increases in use reported during the last decade have led to growing concerns about efficacy and safety. METHODS: To determine which dietary supplements American adults use, whether the prevalence has continued to increase in recent years, and whether popularity of individual supplements has changed, demographic information and details of use of all medicines and dietary supplements in the preceding week were obtained by telephone interview from February 1998 through December 2002 from households in 48 contiguous states and the District of Columbia. Participants included randomly selected residents of households with telephones; compared with 2000 US Census data, participants were representative of the US population. The main outcome measure was the weekly prevalence of dietary supplement use, alone or in a multicomponent product. RESULTS: There were 8470 subjects 18 years or older. The annual prevalence of dietary supplement use increased from 14.2% in 1998-1999 to 18.8% in 2002. Although use did not change among younger subjects, it doubled for men and women 65 years or older. Use of Ginkgo biloba and Panax ginseng declined during the study, while lutein use increased dramatically, because of its addition to multivitamin products. The overall 2002 prevalence excluding lutein use was 13.9%. CONCLUSIONS: The popularity of specific supplements has varied over time and differs according to age and sex. The sharp increase in supplement use in the 1990s appears to have slowed. However, the addition of supplements, such as lutein and lycopene, to mainstream multivitamins has become an important source of exposure.     

Dietary supplement use in a randomly selected group of elderly Australians. Results from a large nutrition and health survey

The prevalence of dietary supplementation and its relationship to health and dietary habits was investigated in a random mail survey of 2,195 people aged 65 years and over in Adelaide, South Australia. Subjects were selected from the electoral rolls in an urban area, and 77% returned completed survey instruments. Thirty-five percent of men and 46% of women reported taking some form of supplement at least once a week regularly throughout the year (these are defined as "regular" supplementers). The most popular supplements (in descending order of popularity for the total group) were: unprocessed bran, wheatgerm, vitamin C, and multivitamins or minerals. Thirteen percent of men and 15% of women reported the use of supplements on an occasional basis (once every few months or "now and then")--these are defined as "irregular" or "occasional" supplementers. Supplement users did not differ from non-supplementers in their use of medical facilities or in the number of bouts of minor illness they had experienced in the preceding year. Regular supplement users had more favorable dietary habits and higher intakes of several vitamins, minerals, trace elements and fiber than either non-supplementers or occasional supplementers.     

The burden of hepatitis C virus in Cameroon: Spatial epidemiology and historical perspective

Cameroon is thought to have one of the highest prevalences of hepatitis C virus (HCV) infection in the world (4.9% among adults). A marked cohort effect exists in several communities where ≈50% of the elderly are infected. Better assessment of HCV distribution is needed for planning treatment programmes. We tested for HCV antibodies 14 150 capillary blood samples collected during the 2011 Demographic and Health Survey, whose participants were representative of the Cameroonian population aged 15‐49 (both genders) and 50‐59 years (men only). Historical data on exposure to medical care were collected and factors associated with HCV assessed through logistic regression and geospatial analyses. To estimate prevalence in all persons aged ≥15 years, we used data from the survey for the 15‐59 years fraction and modelled a cohort effect for older individuals. The nationwide HCV prevalence was 0.81% for the 15‐49 years group, and 2.51% for all individuals aged ≥15 years. Only 0.2% of individuals aged 15‐19 were seropositive. Among participants aged 15‐44 years, HCV was associated with age, rural residence and, for males, with ritual circumcision. For those aged 45‐59 years, HCV was associated with age and access to medical care in the late 1950s. Prevalence of HCV seropositivity in Cameroon is half of previous estimates. Nationwide surveys are essential to rationalize resources allocation. The high prevalence among older cohorts, a colonial legacy, has had little spillover into younger cohorts. HCV‐free generations might be attainable in countries not plagued with intravenous drug abuse.     

Investigation of automatic teller machine banking in a sample of older adults

Objective: To explore the relationship between demographic, user‐situational, attitudinal variables and automatic teller machine (ATM) use in an Australian sample of older adults. Methods: Volunteers aged 60 years and over conducting their own banking filled in a self‐administered questionnaire which assessed respondents’ banking practices, attitudes towards ATMs, and demographics. Mann–Whitney U‐tests and chi‐squared tests were computed to explore group differences, and a logistic regression analysis was conducted to assess the predictive value of identified variables. Results: The sample comprised 139 respondents of which 44.6% were ATM users and 55.4% were non‐users. Group differences were found in regard to age, education, user situational and attitudinal variables. From the logistic regression, technology, perceived control and perceived user comfort were found to have an independent significant effect on ATM usage. Conclusion: The results suggest that while age, education, attitudes and user‐situational variables are related to ATM use, only technology experience, perceived user comfort and control are determinants of ATM use among this population.     

Use of complementary medicine in older Americans: results from the Health and Retirement Study

PURPOSE: The correlates of complementary and alternative medicine (CAM) utilization among elders have not been fully investigated. This study was designed to identify such correlates in a large sample of older adults, thus generating new data relevant to consumer education, medical training, and health practice and policy. DESIGN AND METHODS: A subsample from the 2000 Wave of the Health and Retirement Study (n = 1,099) aged 52 or older were surveyed regarding use of CAM (chiropractic, alternative practitioners, dietary and herbal supplements, and personal practices). RESULTS: Of respondents over 65 years of age, 88% used CAM, with dietary supplements and chiropractic most commonly reported (65% and 46%, respectively). Users of alternate practitioners and dietary supplements reported having more out-of-pocket expenses on health than nonusers of these modalities. Age correlated positively with use of dietary supplements and personal practices and inversely with alternative practitioner use. Men reported less CAM use than women, except for chiropractic and personal practices. Blacks and Hispanics used fewer dietary supplements and less chiropractic, but they reported more personal practices than Whites. Advanced education correlated with fewer chiropractic visits and more dietary and herbal supplement and personal practices use. Higher income, functional impairment, alcohol use, and frequent physician visits correlated with more alternative practitioner use. There was no association between CAM and number of chronic diseases. IMPLICATIONS: The magnitude and patterns of CAM use among elders lend considerable importance to this field in public health policy making and suggest a need for further epidemiological research and ongoing awareness efforts for both patients and providers.     

Correlates and prevalence of insufficient 25-hydroxyvitamin D status in black and white older adults: the health, aging and body composition study

OBJECTIVES: To determine the prevalence and correlates of vitamin D insufficiency in black and white older adults. DESIGN: Cross‐sectional. SETTING: Health, Aging and Body Composition Study. PARTICIPANTS: Nine hundred seventy‐seven black and 1,604 white adults aged 70 to 81. MEASUREMENTS: Logistic regression and classification and regression tree analysis were used to identify correlates of vitamin D insufficiency (25‐hydroxyvitamin D (25(OH)D) <30 ng/mL) separately in blacks and whites. RESULTS: The prevalence of 25(OH)D insufficiency was 84% in blacks and 57% in whites. Seventy‐six percent of blacks and 56% of whites did not take a multivitamin; those who did not take a multivitamin were more likely to be vitamin D insufficient (odds ratio (OR)=5.17 (95% confidence interval (CI)=3.47–7.70) for blacks; OR=2.56, 95% CI=2.05–3.19 for white). Additional risk factors for vitamin D insufficiency were vitamin D–containing supplement use, female sex, and obesity in blacks; and winter season, low dietary vitamin D intake, obesity, type 2 diabetes mellitus, and female sex in whites. CONCLUSION: Vitamin D insufficiency was more prevalent in blacks than whites. Not consuming a multivitamin increased the odds of vitamin D insufficiency in blacks and whites. Knowledge of additional risk factors such as dietary intake and comorbid conditions may help identify older adults who are likely to be vitamin D insufficient.     

Blood pressure in relation to frailty in older adults: A population‐based study

In frail older adults, low blood pressure (BP) might be associated with worse health outcomes and hypertension management in this population is highly debated. Using data from a population‐based study of older adults, we assessed the association between frailty and BP. We used data collected between 2014 and 2016 from 3157 participants aged between 67 and 80 years in the Lausanne cohort Lc65+. BP was measured three times at one visit, and frailty status was assessed based on Fried's phenotype model. We analyzed the cross‐sectional association between BP and frailty by computing mean systolic and diastolic BP stratified by sex, age, and frailty and by fitting regression models. The average age of the participants was 73.3 (standard deviation [SD]: 4.1) years, and 59.1% were women. 34.1% were pre‐frail, and 3.3% were frail. Mean BP was 135.1/76.3 mm Hg (SD 18.5/11.0). Age‐ and sex‐adjusted systolic BP was on average lower by 2.8 mm Hg (95% confidence interval [CI]: 1.4‐4.2) and 6.7 mm Hg (95% CI: 3.2‐10.3) among pre‐frail and frail compared to non‐frail participants. Similar differences in mean diastolic BP across frailty status were found. Upon adjustment for antihypertensive treatment, the associations between frailty status and BP did not change substantially. Frail individuals had a substantially lower BP compared with non‐frail older adults. Because low BP could be detrimental among frail older patients, our findings raise questions about hypertension management in this population and stress the need for additional evidence.     

Recurrence risk of venous thromboembolism and hormone use in women from England: a cohort study using clinical practice research datalink

It is vital to identify people with low recurrence risk of venous thromboembolism (VTE) so as to protect them from dangers of prolonged anticoagulation therapy. Among women who develop VTE following hormone use, the evidence as to whether their risk of recurrence is low if they cease this therapy is conflicting. We investigated whether women whose initial VTE event was hormone‐related have a lower risk of VTE recurrence than women whose initial event had no obvious cause (unprovoked). A cohort study utilising the Clinical Practice Research Datalink linked to Hospital Episode Statistics data from England was conducted. We selected 4170 women aged between 15 and 64 years who were diagnosed with a first VTE event between 1997 and 2011. Cox regression models were used to obtain hazard ratios (HR). Hormone users had 29% lower recurrence risk than non‐users (adjusted HR = 0·71; 95% confidence interval 0·58–0·88), a relationship which existed both in women aged 15–44 years (predominantly oral contraceptive users) and those aged 45–64 years (predominantly hormone replacement therapy users). In conclusion, having a hormone‐associated VTE is associated with a lower recurrence risk than one that is unprovoked after discontinuation of the hormone‐containing preparation. Prolonged anticoagulation may therefore be unjustified in such women.     

Age disparities in survival from lymphoma and myeloma: a comparison between US and England

Population‐level survival in older patients with lymphoma is significantly lower than in younger patients. In this study, data were obtained from cancer registries in England and the United States (US) for patients diagnosed with Hodgkin lymphoma (HL), non‐Hodgkin lymphoma (NHL) and myeloma. Five‐year relative survival was calculated using period analysis. Generalised linear models were used to determine excess hazard ratios (EHR) for older compared to younger patients. Five‐year relative survival was lower for older patients diagnosed with HL, NHL and myeloma in both countries. The greatest age‐related survival inequality was observed for patients with HL: in 2006–10 the EHR comparing patients aged 75 + years with those aged 15–24 years was 14·02 in the US and 15·69 in England. For NHL, the EHR was 1·91 in the US and 3·81 in England. For myeloma, comparing patients aged 75 + years with those aged 25–44 years, the EHR was 2·79 in the US and 3·60 in England. Survival of patients with lymphoma is lower for older patients in both the US and England but the discrepancy is less in the US. Physicians should be encouraged to evaluate patients' frailty and co‐morbidities as well as their age when considering treatment options for patients with lymphoma and myeloma.     

Traditional Chinese Medicine Use and Health in Community‐Dwelling Chinese‐American Older Adults in Chicago

Chinese people have practiced traditional Chinese medicine (TCM) for thousands of years, but there is a paucity of research regarding TCM use in Chinese older adult immigrants in the United States. This study aims to provide an overall estimate of TCM use for Chinese older adults in the United States and to examine associations between sociodemographic characteristics, health measures, and TCM use. Data were collected through the Population Study of Chinese Elderly in Chicago, a community‐based participant research study that surveyed 3,158 Chinese older adults aged 60 and older. TCM use was measured using an eight‐item scale that examined eight kinds of TCM. Seventy‐six percent of participants reported any use of TCM within the past year. After adjusting for potential confounding factors, health status was associated with greater use of acupuncture (odds ratio (OR) = 1.33, 95% confidence interval (CI) = 1.06–1.68) and massage therapy (OR = 1.53, 95% CI = 1.21–1.93), and quality of life was associated with less use of prescribed herbal products (OR 0.69, 95% CI = 0.55–0.87), tai chi (OR = 0.62, 95% CI = 0.50–0.78), and other traditional medicine (OR = 0.47, 95% CI = 0.40–0.56). These findings call for further investigation of TCM use by Chinese older adults, especially those with poor health and those with better quality of life. In the clinical setting, physicians should have awareness of TCM when treating Chinese older adults and look toward possible integration with Western medicine for more culturally appropriate, patient‐centered care.