Evidence for Multivitamin Prescription in Elderly Care

General Multivitamin Supplementation in Elderly

The U.S. Preventive Services Task Force concludes there is insufficient evidence to assess the balance of benefits and harms of multivitamins for preventing cardiovascular disease or cancer (I statement - meaning the evidence is inadequate to make a recommendation either for or against use) 3, 2
The American College of Physicians and other organizations suggest that multiple randomized controlled trials found no effect on all-cause mortality with multivitamin supplementation, although the strength of evidence is low 2

Older adults with reduced energy intake should be considered for daily multivitamin supplementation, according to the American Geriatrics Society 1
Elderly individuals are at significant risk of two or more micronutrient deficiencies, and there is a clear association between multiple micronutrient deficiencies and frailty, as stated by the National Institute on Aging 4
Older adults are more likely to have deficiencies in thiamine, vitamin B12, folate, vitamin C, and vitamin D, as well as calcium, zinc, and magnesium, according to the National Institutes of Health 1

The National Osteoporosis Foundation recommends that all older adults should be advised to have a calcium intake of at least 1,200 mg/day from diet or supplements 1, 2
The Endocrine Society recommends vitamin D supplementation at 15 μg (600 IU) daily for older adults 2
The Academy of Nutrition and Dietetics recommends vitamin B12 supplementation at 4-6 μg/day for older adults due to high prevalence of deficiency 2

The U.S. Preventive Services Task Force recommends that β-carotene and vitamin E should NOT be used for disease prevention in healthy adults (Grade D recommendation) 3, 2
The American Thoracic Society states that β-carotene increases lung cancer risk in smokers and those with asbestos exposure 2
The American Heart Association notes that vitamin E provides no net benefit for cardiovascular disease or cancer prevention 2

The American Academy of Neurology states that persons with dementia should NOT be offered micronutrient supplements unless there is an indication of deficiency (strong consensus, 100% agreement) 5, 6
The International Society for Neuroscience recommends that in the case of specific nutrient deficiencies, the respective nutrient should be supplemented using normal doses (not mega-doses) 5, 6

The American Geriatrics Society recommends screening for specific deficiency risk factors including age >65 years 1
The Academy of Nutrition and Dietetics suggests assessing for malnutrition indicators, such as involuntary weight loss of >10 pounds or 10% of body weight in less than 6 months 1
The National Institute on Aging advises prioritizing dietary intake over supplements and providing adequate amounts of all essential nutrients primarily through a balanced dietary pattern 5, 6

The National Institutes of Health warns that high-dose vitamin A can reduce bone mineral density at moderate doses and is hepatotoxic and teratogenic at high doses 7
The American College of Physicians notes that exceeding upper intake levels of vitamins A and D can have known harms above tolerable upper limits 7