6 Common Nutrient Deficiencies in the Elderly

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For the elderly, getting enough nutrients is not always easy.

There are several natural consequences of aging that can lead to nutrient shortfalls in the elderly like poor appetite and difficulties chewing or swallowing.

The body also becomes less efficient at absorbing key nutrients with age, and many may not have regular access to nutritious foods or lack the financial resources to frequently consume them.

This article highlights six common nutrient deficiencies in the elderly and how to prevent them.

nutrient deficiencies in the elderly

1. Vitamin D

Vitamin D is important for bone health, immune and muscle function, and blood sugar control (1).

It’s unique from other vitamins because your skin can make it from sunlight.

Older adults, however, are prone to deficiencies in vitamin D because aging reduces the production of vitamin D in the skin from sunlight.

Older adults also tend to spend less time outdoors to stay cool or because of physical limitations.

Moreover, older adults are at an increased risk of vitamin D deficiency due to a decline in kidney function, which typically occurs with age (2).

The kidneys help convert vitamin D to its active form that the body can use.

Older adults can meet some of their vitamin D needs by eating foods that naturally contain vitamin D or foods fortified with the vitamin.

Natural sources of vitamin D include fatty fish like salmon and tuna, egg yolks, and beef liver. Foods commonly fortified with vitamin D include orange juice, milk, yogurt, and breakfast cereals.

Although there are health benefits to consuming both natural and fortified sources of vitamin D, it can be difficult for older adults to get enough vitamin D through the diet alone.

Instead, the most sustainable option for older adults to ensure they get enough vitamin D is by taking a supplement containing 1,000–2,000 IU (25–50 mg) of vitamin D per day (3, 4).

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2. Vitamin B12

Vitamin B12 plays an essential role in the production of red blood cells and DNA as well as nervous system function (5).

The vitamin is found primarily in animal products like meat, eggs, poultry, and dairy.

Older adults are at an increased risk for a vitamin B12 deficiency due to decreased stomach acid production (6).

Stomach acid helps separate vitamin B12 from the protein in foods so that your body can absorb it.

Many older adults, however, have reduced stomach acid production due to inflammatory conditions like atrophic gastritis or long-term use of medications like antacids that block the production of stomach acid (7).

Ultimately, this puts many older adults at risk for vitamin B12 deficiency, even if they regularly consume foods naturally high in the vitamin.

Conversely, foods fortified with vitamin B12 or supplements containing the vitamin are not bound to protein and are therefore better absorbed.

For this reason, it’s recommended that adults older than 50 years get most of their vitamin B12 from supplements or fortified foods, like breakfast cereals (8).

The recommended dietary allowance (RDA) for vitamin B12 is 2.4 mcg per day. Some older adults, however, may require more to prevent a deficiency (8).

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3. Protein

Protein is important for immune and muscle health, fluid balance, as well as transporting and storing other nutrients.

Consuming enough protein — along with regular weight training — becomes especially important with age to maintain muscle strength and mobility while decreasing the risk of illness and falls.

Unfortunately, aging causes what’s referred to as “anabolic resistance,” where older adults become resistant to the effects of protein for maintaining muscle size and strength (9).

This means that older adults require more protein than their younger counterparts to achieve the same muscle stimulating effects.

Older adults can meet their protein needs by consuming protein-rich meals equally spaced throughout the day.

The best sources of protein tend to be animal-based such as meat, poultry, fish, eggs, and dairy products, but plant sources like soy, beans, and legumes also provide protein (10).

Drinking nutritional supplements like Ensure between meals can help older adults meet their protein intake (11).

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The RDA for protein is 0.36 grams per pound (0.8 kilograms) of body weight per day.

However, this recommendation is only the amount needed to prevent a protein deficiency — not what is optimal for health.

That said, most older adults can benefit from consuming 0.45–0.54 grams of protein per pound of bodyweight (1–1.2 grams of protein per kilogram) per day (12).

This amount translates to 68–82 grams of protein for the 150-pound (68-kg) person.

4. Omega-3 fatty acids

Omega-3 fatty acids are a type of unsaturated fat that supports the health of your brain, heart, lungs, and immune system.

While several types of omega-3 fatty acids exist, the most common are alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA).

The best sources of these fatty acids include flaxseed oil, chia seeds, walnuts, and fatty fish like salmon, herring, and mackerel.

While a deficiency in omega-3 fatty acids is rare, many older adults could benefit from higher intakes.

Some observational studies have shown a link between higher intakes of omega-3 fatty acids and a reduced risk of heart disease, certain cancers, and mild cognitive decline (13, 14, 15).

Higher intakes of omega-3 fatty acids have also been linked with a reduced risk of age-related macular degeneration, a major cause of vision loss among older adults (16).

The Dietary Guidelines for Americans recommend that adults consume eight ounces (227 grams) of fish higher in EPA and DHA and lower in mercury per week like salmon, herring, and sardines for heart health (17).

In addition to the regular consumption of fish, supplements like fish or krill oil can offer a convenient and relatively inexpensive way to get more omega-3 fatty acids.

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5. Fiber

Fiber is something that most people don’t get enough of — including older adults (18).

It’s a nondigestible carbohydrate that comes from plant-based foods like fruits, vegetables, whole grains, beans, and legumes.

Fiber helps maintain healthy cholesterol levels, supports immune function, and can reduce the risk of colon cancer (19).

It can also help ease constipation and promote bowel regularity.

Many older adults experience constipation due to various age-related factors including decreased gastric motility, certain diseases, decreased physical activity, and side effects of medications.

Low dietary intakes of fiber also contribute to constipation in older adults.

Older adults should gradually increase their intake of fiber to reduce stomach discomfort.

The dietary reference intake for fiber is 14 grams per 1,000 calories consumed (20).

High-fiber cereals are a great choice to increase older adults’ fiber intake.

6. Water

Water is vital for life.

It regulates body temperature, transports nutrients, aids in digestion, and removes waste.

Without adequate water, your body becomes dehydrated, a condition that occurs when you use or lose more water than you take in.

Unfortunately, older adults are prone to becoming dehydrated due to immobility, an impaired thirst mechanism, decreased kidney function, and cognitive impairment (21).

Older adults are also more likely to take medications that further increase the risk of dehydration like diuretics and laxatives.

While water is the best choice for staying hydrated, it’s not the only choice.

Beverages like tea, coffee, fruit juices, and milk all increase hydration.

Eating foods like fruits and vegetables and lean meats can also help older adults stay hydrated.

There is no formal recommendation regarding how much water older adults should drink each day as everyone’s hydration needs depend on activity level, diet, and body size.

As a general guideline, however, the National Academy of Medicine established the following recommendation for daily water intake (22):

  • Women: 91 ounces (2.7 liters) of total water per day
  • Men: 125 ounces (3.7 liters) of total water per day

These recommendations include water from all beverages and foods.

The bottom line

There are several age-related risk factors that can cause nutrient deficiencies in the elderly.

Some of the most common nutrient deficiencies include vitamins D and B12, protein, omega-3 fatty acids, fiber, and water.

Understanding why older adults are at an increased risk for these deficiencies and how to prevent them are key for healthy aging.

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