Dietary supplements and female seniors: advice, facts, and adverse effects

Based on excerpts from the article “Use of dietary supplements by female seniors in a large Northern California health plan”, by Nancy P Gordon and Donna M Schafferat BioMedCentral.com

Edited (with Introduction) by Dr. Don Rose, Writer, Life Alert

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Multiple factors are likely to result in continued use (and increased use) of supplements by seniors in the coming years: increasing costs for prescription drugs (since many insurance plans provide only partial coverage), increasing availability and use of knowledge (via websites or other sources) about supplements that can serve as drug alternatives, and the advancing “AgeWave” (Boomers that are taking their independent self-improvement habits with them into seniorhood). The study discussed in Gordon and Schaffer’s article looked at one side of the equation: the prevalence of supplement use among elderly females in the population. The need for health care providers and patients alike to deal with the potential for adverse drug-supplement interactions is one of several issues dealt with in the study.  –D.R.
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Overview
Women aged 65 and older are known to use prescription and over-the-counter medications in relatively high amounts and/or frequency, and many of these women are also taking dietary supplements. As the large segment of the population known as “Baby Boomers” become seniors in increasing numbers, both trends are likely to increase. However, dietary supplement use by older women is a concern because of possible side effects and interactions between drugs and supplements. Many people are not aware of these effects, or when they are, they may not have all the facts to make the most optimal choices.

The primary aim of this study was to provide a comprehensive picture of dietary supplement use among older women in a large health plan in Northern California, to raise awareness among health care providers and pharmacists about the need for implementing structural and educational interventions to minimize adverse consequences of self-directed supplement use. A secondary aim was to raise awareness about another fact: the focus on use of herbals and megavitamins that has occurred in most surveys of complementary and alternative therapy use results in a significant underestimate of the proportion of older women who are using all types of dietary supplements for the same purposes.

Methods
The study used data about the use of different vitamin/mineral (VM) supplements and non-vitamin, non-mineral (NVNM) supplements, including herbals, from a 1999 general health survey (mailed to a random sample of adult members of a large Northern California health plan). The goal: to estimate prevalence of, and characteristics associated with, supplement use among women aged 65 to 84 (n = 3,109).

Results and Recommendations
Based on weighted data, 84% had in the past year used more than one dietary supplement, 82% a VM, 59% a supplement other than just multivitamin or calcium, 32% an NVNM, and 25% an herbal. Compared to white, non-Hispanic women, African-Americans and Latinas were significantly less likely to use VM and NVNM supplements and Asian/Pacific Islanders were less likely to use NVNM supplements. Higher education was strongly associated with use of an NVNM supplement. Prevalence did not differ by number of prescription medications taken. Among white, non-Hispanic women, models showed that college education, good health, belief that health practices have at least a moderate effect on health, and having arthritis or depression significantly increased likelihood of NVNM use, while having diabetes decreased likelihood.

An extremely high proportion of older women are using dietary supplements other than multivitamins and calcium, many in combination with multiple prescription medications. Increased resources should be devoted to helping clinicians, pharmacists, supplement vendors, and consumers become more aware of the safety, effectiveness, and potential side effects of dietary supplements. Several surveys have found that patients do not tend to report use of herbals and other dietary supplements to their health care providers in clinical encounters. Because of this lack of communication, there is a great potential for adverse interactions of drugs and dietary supplements in this age group.

It may also be the case that some dietary supplements, or particularly high dosages of supplements, might actually cause symptoms or changes in physiological indicators that may be incorrectly attributed to other underlying health problems, resulting in unnecessary or inappropriate treatment either by the woman or her clinician.

There is another element at play as well: the financial factor. As the cost of prescription medications continues to rise and health insurers continue to place caps on medication coverage, it is likely that increasing numbers of older women, especially those on limited incomes, will turn to dietary supplements as a lower-cost alternative for treating health conditions. In tandem with this trend, the incidence of supplement-related health problems is likely to increase.

This study’s finding that nearly 60% of older women in this population were using dietary supplements other than multivitamins and calcium underscores the importance of

• clinicians asking patients about use of all types of dietary supplements when assessing health problems and prescribing medications – and, as a backup,
• pharmacists inquiring about use of dietary supplements that may interact with prescription and over-the-counter medicines being purchased.

Initiation of the communication by clinicians and pharmacists is likely to result in increased patient awareness that these dietary supplements may affect their health and treatment outcomes, which should then lead to higher rates of patient-initiated communication about dietary supplements they are using or considering using. Greater clinician and pharmacist awareness of all the different prescribed and self-directed regimens patients are using may lead to more proactive interventions to decrease adverse effects of supplement use.

However, in order for clinicians and pharmacists to be able to respond to patient questions about dietary supplements, as well as to identify individuals at high risk for adverse effects, better information about the safety, effectiveness, and side effects of dietary supplements need to be available and easily accessible – such as through the Natural Standard and National Medicines Databases.

Conclusion
This study indicates that use of dietary supplements to treat or prevent health problems is very prevalent among older insured women, and that based on current use in younger age groups, the prevalence can be expected to increase over the next few decades. It will be important for federal agencies, professional associations, manufacturers, and consumer groups to promote research into the safety and effectiveness of commonly used dietary supplements, to develop standards for product quality, and to develop guidelines for recommended dosages based on age, weight, and health history that can be disseminated to both health care professionals and stores or clinics which sell these products.

At the same time, it is important to begin to educate patients and the broader public about the importance of more thoroughly researching the safety, effectiveness, and potential negative effects of particular dietary supplements before beginning to use them.

The information provided here is, to the best of our knowledge, reliable and accurate. However, while Life Alert always strives to provide true, precise and consistent information, we cannot guarantee 100 percent accuracy. Readers are encouraged to review the original article, and use any resource links provided to gather more information before drawing conclusions and making decisions.

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Dr. Don Rose writes books, papers and articles on computers, the Internet, AI, science and technology, and issues related to seniors.

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