How Commonly Do Elderly Patients Take Dietary Supplements?
How Commonly Do Elderly Patients Take Dietary Supplements?
Nahin RL, Pecha M, Welmerink DB, et al; Ginkgo Evaluation of Memory Study Investigators
J Am Geriatr Soc. 2009;57:1197-1205
Healthcare providers recognize that dietary supplement use can cause adverse effects and drug interactions. However, clinicians may not be aware of the prevalence of supplement use in the elderly. One study found that about 13% of those 65 or older used an herbal product within the previous 12 months.
Nahin and colleagues studied the relationship between prescription medications and dietary supplements by analyzing medication use in patients 75 years of age or older enrolled in the Ginkgo Evaluation of Memory (GEM) study. Dietary supplements were defined according to the 1994 Dietary Supplement Health and Education Act and included vitamins, minerals, herbs or other botanicals, and amino acids. Exclusions to the GEM study included dementia, cancer within 5 years, or warfarin therapy.
At baseline, patients brought in all prescription medications and dietary supplements, and trained interviewers recorded medication information. Patients also completed a questionnaire reporting the use of any supplement, specifically of 11 highly used supplements, over the previous 2 weeks.
The investigators found that 82.5% of patients used at least 1 dietary supplement, and 54.5% used 3 or more. The average number of prescription medications used per patient was 3.5; the average number of supplements was 3.4. The majority (83%) of prescription medication users also used supplements. No difference was found in supplement or prescription use with respect to sex or age. A weak correlation between the number of prescription medications used and number of supplements used was identified. Classes of prescription drugs most frequently coadministered with supplements were nonsteroidal anti-inflammatory drugs, thyroid medications, and estrogens.
Previous studies evaluating supplement use in the elderly reported much lower rates of use. Higher reported use in this study may be associated with the methods. Because this population volunteered to be part of a study involving a supplement, patients more likely to use supplements in general may have enrolled. The definition of dietary supplement was broad in the study and included vitamins and minerals. Despite these factors, supplement use likely is increasing in the elderly. Therefore, clinicians need to consider many important implications and issues.
First of all, elderly patients may be receiving information that is not reliable and accurate. We have seen patients with expensive herbals or supplements not knowing why they are taking them. Several were persuaded to take the supplements by friends or family who sell the products or even by companies visiting assisted living facilities. Interestingly, patients with diabetes were the least likely to use supplements in this study. This may be due to more extensive multidisciplinary education in this population as compared with other disease states.
In previous studies, 51%-69% of patients who used supplements did not report that usage to any healthcare provider. Unaware that supplements may have adverse effects, elderly patients in my setting have taken vitamin supplements and have unknowingly affected the treatment decisions of providers unaware of their use. For example, a vitamin B12 level or vitamin D level needs to be interpreted in the context of what supplements patients are taking so that the clinician can make appropriate treatment decisions. It would have been interesting in this study to compare patient medication lists with the medication lists of the primary care providers.
Elderly patients may not be aware that supplements have drug interactions. The investigators found that thyroid medication was commonly taken with dietary supplements. Thyroid medication can be affected by certain vitamins and minerals if taken at the same time. In addition, nonsteroidal anti-inflammatory drugs were used frequently with supplements, and some interactions can increase the risk of bleeding.
Patients with dementia or recent cancer were excluded. These are 2 diseases for which effective treatment is often not available. Many will try anything to treat these diseases. Patients need assistance to make informed decisions balancing cost and evidence for benefit.
Patients taking warfarin also were excluded from this study. Because warfarin interacts with many supplements and patients on warfarin often receive extensive education on drug interactions, it would be interesting to see if supplement use in this patient group was different.
This study found that most elderly patients taking prescription drugs used at least 1 dietary supplement. Whether patients are taking zero or 20 prescription medications, clinicians need to ask all patients about these products and educate them about reporting their use to all healthcare providers. Patients need to be counseled about potential adverse effects and drug interactions associated with supplements. In addition, patients should be encouraged to use a single pharmacy so that a complete medication list can be maintained. No matter the setting, clinicians should understand the cautions associated with supplement use, particularly in specific patient populations such as the elderly.
Abstract
Concomitant Use of Prescription Drugs and Dietary Supplements in Ambulatory Elderly People
Nahin RL, Pecha M, Welmerink DB, et al; Ginkgo Evaluation of Memory Study Investigators
J Am Geriatr Soc. 2009;57:1197-1205
Study Summary
Healthcare providers recognize that dietary supplement use can cause adverse effects and drug interactions. However, clinicians may not be aware of the prevalence of supplement use in the elderly. One study found that about 13% of those 65 or older used an herbal product within the previous 12 months.
Nahin and colleagues studied the relationship between prescription medications and dietary supplements by analyzing medication use in patients 75 years of age or older enrolled in the Ginkgo Evaluation of Memory (GEM) study. Dietary supplements were defined according to the 1994 Dietary Supplement Health and Education Act and included vitamins, minerals, herbs or other botanicals, and amino acids. Exclusions to the GEM study included dementia, cancer within 5 years, or warfarin therapy.
At baseline, patients brought in all prescription medications and dietary supplements, and trained interviewers recorded medication information. Patients also completed a questionnaire reporting the use of any supplement, specifically of 11 highly used supplements, over the previous 2 weeks.
The investigators found that 82.5% of patients used at least 1 dietary supplement, and 54.5% used 3 or more. The average number of prescription medications used per patient was 3.5; the average number of supplements was 3.4. The majority (83%) of prescription medication users also used supplements. No difference was found in supplement or prescription use with respect to sex or age. A weak correlation between the number of prescription medications used and number of supplements used was identified. Classes of prescription drugs most frequently coadministered with supplements were nonsteroidal anti-inflammatory drugs, thyroid medications, and estrogens.
Viewpoint
Previous studies evaluating supplement use in the elderly reported much lower rates of use. Higher reported use in this study may be associated with the methods. Because this population volunteered to be part of a study involving a supplement, patients more likely to use supplements in general may have enrolled. The definition of dietary supplement was broad in the study and included vitamins and minerals. Despite these factors, supplement use likely is increasing in the elderly. Therefore, clinicians need to consider many important implications and issues.
First of all, elderly patients may be receiving information that is not reliable and accurate. We have seen patients with expensive herbals or supplements not knowing why they are taking them. Several were persuaded to take the supplements by friends or family who sell the products or even by companies visiting assisted living facilities. Interestingly, patients with diabetes were the least likely to use supplements in this study. This may be due to more extensive multidisciplinary education in this population as compared with other disease states.
In previous studies, 51%-69% of patients who used supplements did not report that usage to any healthcare provider. Unaware that supplements may have adverse effects, elderly patients in my setting have taken vitamin supplements and have unknowingly affected the treatment decisions of providers unaware of their use. For example, a vitamin B12 level or vitamin D level needs to be interpreted in the context of what supplements patients are taking so that the clinician can make appropriate treatment decisions. It would have been interesting in this study to compare patient medication lists with the medication lists of the primary care providers.
Elderly patients may not be aware that supplements have drug interactions. The investigators found that thyroid medication was commonly taken with dietary supplements. Thyroid medication can be affected by certain vitamins and minerals if taken at the same time. In addition, nonsteroidal anti-inflammatory drugs were used frequently with supplements, and some interactions can increase the risk of bleeding.
Patients with dementia or recent cancer were excluded. These are 2 diseases for which effective treatment is often not available. Many will try anything to treat these diseases. Patients need assistance to make informed decisions balancing cost and evidence for benefit.
Patients taking warfarin also were excluded from this study. Because warfarin interacts with many supplements and patients on warfarin often receive extensive education on drug interactions, it would be interesting to see if supplement use in this patient group was different.
This study found that most elderly patients taking prescription drugs used at least 1 dietary supplement. Whether patients are taking zero or 20 prescription medications, clinicians need to ask all patients about these products and educate them about reporting their use to all healthcare providers. Patients need to be counseled about potential adverse effects and drug interactions associated with supplements. In addition, patients should be encouraged to use a single pharmacy so that a complete medication list can be maintained. No matter the setting, clinicians should understand the cautions associated with supplement use, particularly in specific patient populations such as the elderly.
Abstract
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