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       Recommended dietary allowance (RDA): The average intake sufficient to meet the requirements of 97 to 98% of a group

       Adequate intake (AI): The recommended average intake level based on approximations or estimates of intake by a group or groups of healthy people and that are assumed to be adequate; used when an RDA has not been determined

       Tolerable upper intake level (UL): The highest average daily nutrient intake likely to pose no risk of adverse effects to almost all individuals in the general population

Detailed information on recommended intakes in the US and Canada for different age and gender groups is summarized by NASEM.³ The recommended nutrient intakes for the US and Canada were developed for healthy individuals. This underscores the unfortunate lack of research and thus the absence of formal guidelines for adjusting nutrient intake in the case of acute or ongoing illness. Given the diversity of medical conditions and variability in levels of severity, the determination of exact requirements for every illness is impractical. However, as noted in subsequent sections, a number of high‐risk conditions that are impacted by micronutrient status in older adults are known and can be addressed.

Table 16.1 Medical factors related to insufficient nutrient or energy intake and/or status.

      Source: Based on Joshi and Morley¹.

Increased metabolism

Movement disorders: parkinsonism and Tardive dyskinesia

COPD

Severe cardiac disease

Anorexia

Drugs including digoxin, psychotropic drugs, theophylline, cimetidine, ranitidine, L‐thyroxine

Gallstones, chronic and recurrent infections

Malignancy

Physiological anorexia of ageing

Oral and swallowing problems

Esophageal candidiasis

Teeth and denture problems

Severe tremors and strokes

Malabsorption

Late‐onset gluten enteropathy

Lactose deficiency

Feeding problems

Severe tremor

Strokes

Dementia

Medication influences on vitamin and mineral status

One of the most common concerns about nutrient needs for those with age‐related chronic illness involves the influence of medications on various components of nutrient metabolism. Use of prescription and over‐the‐counter drugs over the long term can increase the risk of subclinical and clinically relevant vitamin and mineral deficiencies, which may gradually develop over months or years.⁴ Examples of some of the most important diet/drug interaction are listed by drug category in Table 16.2. The number of research studies examining these interactions is small compared to the vast number of medications available.⁴ Information reviewed here is a brief summary from the comprehensive review of medication‐nutrient interactions associated with chronic use of frequently prescribed medications for commonly diagnosed conditions among US adults.⁴

Table 16.2 Medication and nutrient interactions.

      Source: Adapted from Mohn et al. (2018)⁴.

Drug category	Name of drug(s)	Nutrients affected	Change in nutrient status or function
Acid‐suppressing	Protein pump inhibitors	Vitamin B12, vitamin C, iron, calcium, magnesium zinc, beta‐carotene	Decreased
Non‐steroidal, anti‐inflammatory	Aspirin	Vitamin C, iron	Decreased
Anti‐hypertensives	Diuretics (loop, thiazide), diuretics (potassium‐sparing), angiotensin‐converting enzyme inhibitors, calcium‐channel blockers	Calcium, magnesium, thiamin, zinc, potassium, iron, folate	Generally decreased, but depends on the drug and the nutrient; ACE inhibitors associated with retention of potassium in the kidney, while loop and thiazide diuretics increase urinary potassium excretion
Hypercholesterolemics	Statins	Coenzyme Q10, vitamin D, vitamin E, beta‐carotene	Increased or decreased depending on the drug and nutrient
Hypoglycemics	Biguanides (metformin), thiazolidinediones	Vitamin D, calcium, vitamin B12	Decreased
Corticosteroids	Glucocorticoids (oral)	Calcium, vitamin D, sodium, potassium, chromium	Increased or decreased depending on the drug and nutrient
Bronchodilators	Corticosteroids (inhaled)	Calcium, vitamin D	Decreased
Antidepressants	Selective serotonin reuptake inhibitors (SSRIs)	Folate, calcium, vitamin D	Folate may increase effectiveness of SSRI; SSRI associations with poor bone health suggest effects of SSRI on calcium and vitamin D metabolism should be investigated

Age‐associated risk factors for the adverse influence of medications on vitamin or mineral status include marginal nutrient intakes as well as poor renal function. Polypharmacy is common in older adults, raising concerns that the use of multiple medications may exacerbate age‐related physiological changes that affect nutrient needs and drug metabolism. Although guidelines are lacking on how to manage and/or prevent drug‐induced nutrient inadequacies, it may be prudent to recommend a daily multivitamin/mineral (MVM) supplement that provides approximately 100% of the recommended amounts of vitamins and minerals (RDA or AI). Typical MVMs formulated for older adults will not provide sufficient amounts of calcium (bone health), coenzyme Q10 (which may be decreased with statin use), or fish oil (known to be beneficial for cardiovascular disease).⁴ These MVMs generally have low vitamin K (to decrease interactions with some anticoagulants) and very low amounts of potassium (US Food and Drug Administration [FDA] limits potassium in supplements to <100 mg; see Table 16.3).

Vitamins and minerals – functions and characteristics

      There

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