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The elderly is considered to be 65 years of age and older. 

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The elderly is considered to be 65 years of age and older. 

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-2 fried eggs (180 cal, 14g fat, 190mg sodium, 13g protein, 6% cal)
-1 cup of mixed fruit ( 60 cal, 1g fat, 0mg sodium, 1g protein, 2% cal)
-1 cup of coffee with soy milk (151 cal, 3g fat, 100mg sodium, 5g protein, 30% cal)
-total: 391 cal, 18g fat, 290mg sodium, 19g protein, 38% calcium)

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-2 whole-wheat pancakes (183 cal, 6g fat, 503 mg sodium, 7g protein, 22% calcium) with 1/2 tbs. honey (64 cal, 0g fat, 1mg sodium, 0g protein) and banana slices (105 cal, 0g fat, 1mg sodium, 1g protein)
-1 cup of fresh squeezed orange juice (112 cal, 0g fat, 2mg sodium, 2g protein, 207% vitamin C)
-total: 464 cal, 6g fat, 507mg sodium, 10g protein, 207% vitamin C)

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Introduction

Vitamin D plays a vital role in human health [ 35]. Low levels of vitamin D can drastically impact a person's physical and mental well-being [ 22, 36]. Traditionally, research focused on the role of vitamin D in the maintenance of skeletal health. In recent years, following the discovery of vitamin D receptors throughout the body, its role in the prevention and treatment of chronic diseases has become an important area of study. Vitamin D deficiency has been linked to various health problems, including cognitive decline, depression, osteoporosis, cardiovascular disease, hypertension, diabetes, and cancer [ 36, 39]. As persons age, the risk for vitamin D deficiency significantly increases. The percent of older adults suffering from vitamin D deficiency ranges from 20 to 100% in the United States (US)[ 37]. Risk factors contributing to vitamin D deficiency in older adults include reduced nutritional intake of vitamin D, increasing adiposity, decreased cutaneous synthesis of vitamin D, and less time spent outdoors () [ 22, 21]. The number of individuals aged 65 and older is expected to more than double from 2012 to 2060 [ 67]. Thus, understanding the relationship between vitamin D and chronic diseases in the older adult and whether treatment of vitamin D deficiency can prevent or ameliorate these disorders is important. This paper highlights the current evidence regarding the role that vitamin D may play in diseases associated with aging and also addresses the need for randomized clinical trials (RCTs) examining the impact of vitamin D on the prevention and treatment of these diseases in the older adult.

Table 1

Pathophysiology

Vitamin D can be obtained through diet, supplements, and sunlight. Vitamin D is naturally present in oily fish such as cod liver oil, swordfish, and salmon (vitamin D ₃) and ultraviolet (UV) exposed mushrooms (vitamin D ₂), fortified in products such as milk and orange juice, and available as vitamin D ₂ and D ₃ supplements [ 39]. Exposure to solar UV radiation causes the conversion of 7-dehydrocholesterol in the skin to form pre-vitamin D ₃ and later vitamin D ₃. Vitamin D ₂ and D ₃ from dietary ingestion and skin circulates first to the liver where it undergoes hydroxylation by vitamin D 25-hydroxylase (25-OHase) to 25 hydroxyvitamin D [25(OH)D ₃]. [25(OH)D ₃] then circulates to the kidneys where it undergoes a second hydroxylation by 25-hydroxyvitamin D-1-α-hydroxylase (1-OHase) to 1,25-dihydroxyvitamin D [1,25(OH) ₂D], the biologically active form of vitamin D (Calcitriol). As the concentration of [1,25(OH) ₂D] increases, vitamin D nuclear receptors (VDR) throughout the body become stimulated, causing activation of gene transcription. Interaction between [1,25(OH) ₂D] and VDR sites in various organs of the body produce numerous biological actions affecting the potential for the development of many diseases. These biological actions include, regulation of calcium and phosphorus in the intestines and bones (osteoporosis), insulin sensitivity and secretion (diabetes), regulation of cellular growth and angiogenesis (immune regulation and cancer), renin expression and inhibition of vascular smooth muscle proliferation (hypertension and cardiovascular disease), and inflammation and amyloid plaque formation in the brain (cognitive decline and Alzheimer's disease) [ 39].

Vitamin D Recommendations

Side Effects of Taking Vitamin D

Although vitamin D deficiency is commonly seen in practice, vitamin D toxicity is very rare [ 21]. Vitamin D toxicity is defined by most experts as having a serum 25-hydroxyvitamin D [25(OH)D] concentration of more than 150 ng/mL [ 55]. Vitamin D toxicity is caused by excessive ingestion of vitamin D supplements over an extended period of time and is not attributed to prolonged sunlight exposure [ 21]. Clinical signs and symptoms of vitamin D toxicity are often vague, such as poor appetite, weight loss, increased urination, and arrhythmias [ 55]. Additionally, high levels of vitamin D for long periods have been attributed to hypercalcemia and hyperphosphatemia and, subsequently, cardiovascular and kidney damage [ 55]. Therefore, patients who are being treated for vitamin D deficiency with high doses of vitamin D supplementation for a long period of time should have their lab values monitored closely [ 21].

Psychological Aging

Cognitive Decline

Cognitive decline is a devastating mental health problem that includes a spectrum of illnesses, ranging from mild cognitive impairment to advanced stages of dementia. As a person ages, their risk for cognitive decline increases dramatically; affecting nearly 25% of all persons 65 and older in the US [ 19]. Recent findings suggest that low vitamin D levels in older adults are associated with an increased incidence of cognitive decline [ 49].

A prospective study conducted by Llewellyn and colleagues [ 49], followed 858 Italian individuals, aged 65 and older for over six years and found that older adults with severely low levels of 25(OH)D (<25 nmol/L) were at an increased risk of developing significant cognitive decline. However, a prospective study conducted in the US followed 1,604 elderly men, aged 65 and older for almost five years, and found no significant relationship between vitamin D levels and cognitive function or decline [ 62]. Although 179 men had cognitive impairment at baseline and over 200 men developed cognitive impairment during the study, the association between low vitamins D levels and cognitive decline was not significant after adjusting for covariates, such as race and educational status.

Depression

Some studies have examined the relationship between depression and taking vitamin D supplements. A RCT conducted by Sanders and colleagues [ 58] investigated the effects of a yearly, large dose of 500,000 IU of vitamin D3 on depressive symptoms in 2,258 women, aged 70 and older, over the course of three to five years. The results, from a subgroup of 150 women whose blood was analyzed, concluded that although serum 25(OH)D levels were 41% higher in the women who received the vitamin D supplements versus the placebo after one year, no significant change in mood or mental well-being was found. Similar results were reported by Kjaergaard and colleagues [ 43] who examined the effects of a weekly, large dose of 40,000 IU of vitamin D3 on depressive symptoms in 243 adults, aged 30 to 75, over the course of six months. The findings revealed that low vitamin D levels were associated with symptoms of depression; however, vitamin D supplementation showed no improvement in depressive symptoms. Limitations of the study were the short time frame, self-report of depressive symptoms by participants, and the exclusion of individuals who were diagnosed with depression or who took anti-depressants.

A recent systematic review and meta-analysis of vitamin D deficiency and depression in adults included one case-control study, ten cross-sectional studies and three cohort studies for the analysis [ 3]. Findings revealed lower levels of vitamin D in persons with depression compared to controls, especially when comparing individuals with the lowest to the highest vitamin D categories. The authors recommended the need for RCTs to determine the effect of vitamin D in the prevention and treatment of depression.

Physical Aging

Current evidence suggests that low vitamin D levels may contribute to the development of diseases of aging, such as osteoporosis, cardiovascular disease, hypertension, type 2 diabetes, and cancer [ 22]. Consequently, numerous research studies are currently exploring the efficacy of vitamin D supplementation in preventing and treating common co-morbidities in the older adult population.

Osteoporosis

A Cochrane systematic review examined 45 RCTs of vitamin D and vitamin D analogues for preventing fractures in over 84,000 older adults [ 8]. It was found that vitamin D supplementation was not effective in preventing hip or vertebral fractures; however, administration of calcium and vitamin D together, was helpful in decreasing hip and non-vertebral fractures in frail elderly who were institutionalized. Similar results were found in an analysis of over 68,000 adults from 7 RCTs from both the US and Europe [ 28]. Participants who received vitamin D and calcium supplementation had a significantly decreased risk of all fractures, whereas participants who only received vitamin D supplementation showed no significant change in fracture risk.

Thus, it is evident that vitamin D is an essential nutrient needed for skeletal health. Vitamin D supplementation appears to be a promising solution to reduce fall and fracture risk among the older adult population; however, future research is still needed particularly in the area of supplement dosing.

Cardiovascular Disease

Cardiovascular disease is the primary cause of mortality in the world, with approximately 17 million individuals dying worldwide annually [ 75]. The role of vitamin D and its impact on the cardiovascular system gained interest a number of years ago due to epidemiologic evidence suggesting its beneficial effect on heart disease [ 70]. More contemporary work has called to question the efficacy of vitamin D on cardiovascular events.

Although numerous studies propose a potential inverse relationship between vitamin D and cardiovascular disease [ 41, 65], evidence from large RCTs is limited. A recent Cochrane review on vitamin D supplementation for prevention of mortality in adults [ 12] generated data from 56 RCTs that used vitamin D supplementation (cholecalciferol, ergocalciferol, alfacalcidol, calcitriol) for an average of over four years. Findings indicated that vitamin D ₃ seems to decrease overall mortality in the elderly who were not dependent on help or living in institutional care. However, no significant effect on cardiovascular mortality was reported for all participants. Similarly, a meta-analysis of observational cohort and randomized intervention studies reported comparable findings in that vitamin D ₃ supplementation reduced overall mortality among older adults; however, the researchers recommend the need for the future study of optimal dosing and duration [ 23].

Currently, there are two ongoing large RCTs examining the effects of vitamin D supplementation on cardiovascular disease, the ViDA study, or Vitamin D Assessment, in New Zealand, and the VITAL study, or Vitamin D and Omega-3 Trial, in the US [ 18]. Unfortunately, the results from these studies are not currently available. Consequently, because the current evidence is inconsistent, conclusions regarding vitamin D supplementation and cardiovascular disease cannot be drawn at this time.

Hypertension

Hypertension is a major risk factor contributing to cardiovascular disease [ 74]. The risk for hypertension increases significantly as a person ages. Therefore, early detection and treatment of high blood pressure is of utmost importance in older adults [ 74]. Several cross-sectional and prospective studies have proposed an association between vitamin D and high blood pressure [ 14]. One meta-analysis which examined 18 studies, 4 prospective and 14 cross-sectional, reported an inverse relationship between vitamin D levels and hypertension and found that for every 40 nmol/l increase in vitamin D level, the risk for hypertension was reduced by 16% [ 17]. Observational data from a number of systematic reviews has also demonstrated an association between low vitamin D levels and an increased incidence of high blood pressure as well as risk for hypertension [ 66, 68, 56]. RCTs from these same reviews; however, conflict with the observational data and fail to confirm a relationship between vitamin D supplementation and reduction in blood pressure [ 66, 68, 56]. Variability in sample size, type of population, length of study, and vitamin D dosages have been reported as possible reasons for the inconsistency in the data findings.

Type 2 Diabetes

The incidence of diabetes in older adults is alarming with almost 11 million or 30% of the population over the age of 65 affected by diabetes in 2010 [ 20]. Major complications of diabetes include cardiovascular disease, hypertension, and stroke [ 20]. Therefore, measures to combat the incidence of diabetes and reduce the occurrence of diabetes-related co-morbidities are of utmost importance.

Several RCTs have examined the benefit of vitamin D supplementation on diabetes outcomes. Two RCTs have reported conflicting results on the efficacy of vitamin D supplementation on improving insulin secretion. In one RCT, 92 obese adults consumed 2,000 IU of vitamin D once a day or 400mg of calcium twice a day for 16 weeks [ 51]. They found a significant improvement in beta cell functioning and insulin secretion in participants who took the vitamin D supplement, but not in those who only consumed the calcium supplement. Another RCT reported contrary findings [ 25]. In adults with pre-diabetes (hemoglobin A1C values between 5.8 and 6.9 %) and baseline vitamin D levels less than 30 ng/mL, following a mean weekly dose of 88,865 IUs of vitamin D (n=56), there was no change in insulin secretion, insulin sensitivity, or diabetes incidence compared to placebo (n=53) after one year. However, vitamin D supplementation increased vitamin D levels from an average of 22 to 70 ng/mL and slightly reduced hemoglobin A1C levels by 0.2%. Several systematic reviews support these findings. One review analyzed 15 RCTs and found that vitamin D supplementation did not improve fasting blood sugar, hemoglobin A1C, or insulin resistance in persons without diabetes. However, in those individuals who were diabetic or pre-diabetic, a slight improvement in fasting blood sugar and insulin resistance was found [ 31]. Another review examined 12 cross-sectional and 10 RCTs and found data to be inconsistent regarding insulin sensitivity and secretion [ 32]. This may be due to the short duration of supplementation (less than six months) and/or varying doses of supplements (400 IUs to 120,000 IUs). At this time, there is insufficient evidence to determine whether low levels of vitamin D contribute to the development of type 2 diabetes. Therefore, large RCTS with beneficial dosing of vitamin D are needed before supplementation can be recommended as an effective preventative therapy for diabetes management. One RCT currently in progress is the D2D study ( http://www.d2dstudy.org/) which will determine whether 4000 IUs daily or a placebo taken over a period of four years will modify diabetes risk in persons at risk for diabetes.

Immune Function

Cancer

Epidemiologic evidence has suggested that higher levels of vitamin D may reduce the risk of developing several cancers; most commonly, breast, prostate, and colon. Researchers have suggested that the transformation of 25(OH)D to 1,25(OH) ₂D in healthy cells of the breast, prostate, and colon may help to prevent cancer by stimulating cellular maturation and apoptosis, inhibiting angiogenesis and oxidative stress, and expressing genes to control cellular proliferation [ 39].

Conclusion

Vitamin D deficiency is a common, serious medical condition that significantly affects the health and well-being of older adults. Evidence has confirmed the association between vitamin D and osteoporosis; however, at this time, RCTs are needed to determine whether providing vitamin D can help to prevent, treat, or ameliorate the chronic conditions of aging such as cognitive decline, depression, cardiovascular disease, hypertension, type 2 diabetes, and cancer (). A comprehensive systematic review recently published reported similar findings. Although new studies have shown promising data regarding vitamin D's role in various health outcomes, such as bone and cardiovascular health, cancer, and the immune system, the findings are inconsistent and no firm conclusions can be drawn at this time [ 54]. As our nation's older adult population continues to grow, establishing universal guidelines for testing and treating vitamin D deficiency is needed. Although some have suggested the need to specify standard vitamin D values for certain disorders [ 5], much work in this area is warranted. Finally, research to examine the dosing of vitamin D supplements necessary to prevent the chronic diseases of aging would have significant benefit for future generations.

Table 2

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The Role of Vitamin D in the Aging Adult

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The number of individuals aged 65 and older is expected to more than double from 2012 to 2060. The role of vitamin D in the prevention and treatment of diseases associated with aging has not been well studied. Traditionally, the role of vitamin D focused ...

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-One tuna cucumber wrap (whole wheat wrap)- ( 300 cal, 14g fat, 515mg sodium, 15g protein, 18% calcium)
-1 cup of chicken and vegetable soup (166 cal, 5g fat, 84 mg sodium, 12g protein, 3% calcium)
-16 ounces of water
-total: 466 cal, 19g fat, 599mg sodium, 27g protein, 21% calcium.

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- 1 1/2 cups of garden salad with oil and vinegar dressing(112 cal, 7g fat, 132mg sodium, 2g protein)
- Wheat flatbread with grilled chicken, avocados, and feta cheese(150 cal, 8g fat, 270mg sodium, 5g protein)
- 1 cup of unsweetened iced tea
-total: 208 cal, 12g fat, 402mg sodium,7g protein)

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-cocktail peanuts (170 cal, 15g fat, 55mg sodium, 7g protein) with raisins (108 cal, 0g fat, 4mg sodium, 1g protein) and orange slices (62 cal, 0g fat, 0mg sodium, 1g protein)
-16 oz water
-total: 340 cal, 15g fat, 59mg sodium, 9g protein

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- Salmon with asparagus(196 cal,11g fat, 51mg sodium,22g protein, 2% calcium)
- Whole grain pasta with olive oil drizzle(190 cal, 2g fat,8g protein)
- Cantaloupe(27 cal, 13mg sodium, 1g protein, 1% calcium)
- 8 oz of soy milk(73 cal, 2g fat, 117mg sodium, 6g protein, 30% calcium)
-total: 506 cal, 15g fat, 194mg sodium, 39g protein, 35% calcium

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-baby carrot sticks (70 cal, 0g fat, 156mg sodium, 1g protein) with hummus (50 cal, 3g fat, 160mg sodium, 2g protein)
-16 oz of water
-total: 120 cal, 3g fat, 316mg sodium, 3g protein)

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- Grilled Chicken(100 cal, 2g fat, 410mg sodium, 20g protein)
- Black Beans(114 cal, 1mg sodium, 8g protein, 2% calcium)
- Loose corn(59 cal,3mg sodium, 2g protein)
- Prunes(133 cal, 1mg sodium, 1g protein, 2% calcium)
- 8 oz of soy milk(73 cal, 2g fat, 117mg sodium, 6g protein, 30% calcium)
-total: 479 cal, 4g fat, 532mg sodium, 37g protein, 34% calcium)

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Fruit Salad:
-1/2 cup of seedless grapes (52 cal, 0g fat, 2mg sodium, 1g protein)
-1/2 cup of canned pineapple (39 cal, 0g fat, 1mg sodium, 1g protein)
-1/2 cup of diced strawberries (27 cal, 0g fat, 1 mg sodium, 1g protein)
-1/2 cup of blackberries (31 cal, 0g fat, 1mg sodium, 1g protein)
-total: 149 cal, 0g fat, 5mg sodium, 4g protein

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The effects of poor nutrition and how good nutrition leads to a healthy lifestyle.

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If the elderly eat a bad diet for their whole lives it can lead to depression, obesity, tooth decay, high blood pressure, and more.

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If the elderly follow a good balanced diet, it can help prevent diabetes, cancer, osteoporosis, cardiovascular disease.

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Sample Menus: Healthy Eating for Older Adults

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Planning meals and making a shopping list can help you eat healthier. Check out these sample menus for older adults for healthy meal and snack ideas.

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safefood | A healthy lifestyle has both short and long term health benefits

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The key to reducing the risk of these diseases is making small changes to your daily lives - eating healthier food, getting your 5-a-day, having treats occasionally, and taking more exercise.

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The elderly need more vitamin D and calcium to ensure that their bones are strong; older women need more calcium than older men because they typically have less bone mass.