Supplements for Institutionalized Elderly Patients
Abstract & commentary
Synopsis: Low-dose supplementation of zinc and selenium provides significant improvement in elderly patients by increasing the humoral response after vaccination and could have considerable public health importance by reducing morbidity from respiratory tract infections.
Source: Girodon F, et al. Arch Intern Med 1999;159:748-754.
Antioxidant supplementation is thought to improve immunity and thereby reduce infectious morbidity. However, few large trials in elderly people have been conducted that include end points for clinical variables. Girodon and colleagues sought to determine the effects of long-term daily supplementation with trace elements (zinc sulfate and selenium sulfide) or vitamins (beta-carotene, ascorbic acid, and vitamin E) on immunity and the incidence of infections in institutionalized elderly people. They conducted a randomized, double-blind, placebo-controlled intervention study including 725 patients older than 65 years (mean age 83.9), institutionalized in 25 geriatric centers in France. Patients received an oral daily supplement of nutritional doses of trace elements or vitamins or a placebo within a 2 × 2 factorial design for two years.
Correction of specific nutrient deficiencies was observed after six months of supplementation and was maintained for their first year, during which there was no effect of any treatment on delayed-type hypersensitivity skin response. Antibody titers after influenza vaccine were higher in groups that received trace elements alone or with vitamins. The vitamin group had significantly lower antibody titers (P < 0.05). The number of patients without respiratory tract infections during the study was higher in groups that received trace elements (P = 0.06). Supplementation with neither trace elements nor vitamins significantly reduced the incidence of urogenital infections. Survival analysis for the two years did not show any differences between the four groups.
Low-dose supplementation of zinc and selenium provides significant improvement in elderly patients by increasing the humoral response after vaccination and could have considerable public health importance by reducing morbidity from respiratory tract infections.
Comment by john la puma, md, facp
These French investigators assessed the prevalence of nutrient deficiency by assessing serum value and finding approximately 80% of patients to be deficient in selenium. Deficiencies were not significantly different across the groups. Supplemental zinc (20 mg) and selenium (100 mcg) were provided. Except for zinc, serum concentrations of vitamins reached a plateau after six months; zinc levels rose throughout the study, as zinc is absorbed slowly in older people. Adherence was very good—more than 85%.
Trace mineral supplementation was associated with fewer respiratory tract infections—markedly so.
Measuring mineral levels is not yet a standard assessment and, for this indication, seems unnecessary. The cost of the needed intervention is small, the side effect profile favorable, and the therapy efficacious. Compared with colds in nursing homes, zinc and selenium supplements look great.
All residents of long-term care institutions older than 65 years should take a trace mineral supplement of zinc and selenium, in addition to regular vitamins—about twice the U.S. RDI for vitamin C, beta-carotene, and vitamin E. (Dr. La Puma is Professor of Nutrition, Kendall College, Director, C.H.E.F. Clinic, C.H.E.F. Skills Research, Alexian Brothers Medical Center, Elk Grove Village, Ill.)
Elderly institutionalized patients had increased humoral response after vaccination with:
a. mineral supplementation.
b. vitamin supplementation.
c. a combination of vitamins or minerals.
d. None of the above
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