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Supporting The Immunity Of Our Older Population

Supporting The Immunity Of Our Older Population
By Ellie Isom 2 months ago 13280 Views

Do you get concerned around those times of the year when the prevalence of infections is high ? Are you an older individual, or perhaps have a friend or family member who is more at risk?

Fear not! In this blog we focus on the older population, highlighting factors that increase their risk, and what can be done to help support their overall health and immunity. Whether it is yourself, or a loved one, there are so many areas that can proactively be addressed to help increase immunity.

Who is at risk?

In most cases, viral or bacterial infections generally result in mild symptoms, ranging from cold like symptoms to a fever. However, there are some groups of individuals who may develop more severe symptoms, such as pneumonia. At risk individuals can be categorised as those who are aged 70 years and over,[i][ii] and those of any age with a pre-existing health conditions such as Cardiovascular Disease (CVD), kidney disease, and diabetes.

So why might older individuals be more at risk?

An age-related decline in immune function is one of the most recognised consequences of ageing.[iii] This age-related change is driven by reduced production of white blood cells, free radical damage, and increased inflammation.[iv] The immune system of older individuals is therefore prone to mounting a weaker response to ‘threats’ such as bacteria and viruses than that of younger individuals.

It is common for older individuals to have one or more health conditions which can compromise their immune system further. A health survey published in 2018 reported that 33% of women and 42% of men aged 75 and over were living with cardiovascular disease,[v] whereas the prevalence was around 5% for both genders aged 16-34 years.

Use of multiple medications is prevalent amongst the older population. 1 in 10 people aged 65 and over take at least 8 different prescribed medications a week, with this increasing to 1 in 4 of those aged 85 and over.[vi] But did you know that certain medications can actively deplete nutrients? For example, proton pump inhibitors (PPIs) and non-steroidal anti-inflammatory drugs (NSAIDs) can deplete iron and vitamin C, blood pressure medications (e.g. diuretics, beta blockers) can deplete zinc, and bronchodilators and statins can deplete vitamin D.[vii] Commonly prescribed medications can therefore reduce an individual’s level of the very nutrients required for a strong immune system! For those on multiple medications, we encourage them to contact us, the Clinical Nutrition team, so we can advise them about which nutrients they might need to increase their intake of.

Dehydration is common amongst older individuals. Some dislike the taste of water, while others opt for a cup of tea instead, not realising that tea and coffee are ultimately dehydrating due to the caffeine. There is even a suggestion that older individuals may be less likely to experience thirst and more likely to drink less as a consequence.[viii] Dehydration can impair blood flow and cellular activity which might then compromise immunity. It is also a risk factor for urinary tract infections (UTIs) and poor kidney health,[ix] which can put further strain on the immune system.

Poor digestion - as we get older, stomach acid production tends to decline by 30-40% which can compromise our ability to digest and absorb nutrients efficiently from food.[x] This can make us more prone to nutrient depletion, which can then compromise the health of the immune system and beyond. Many medications also directly impact our gut microbiome, such as antibiotics[xi] and PPIs,[xii] further compromising our digestive and immune system. Poor digestion coupled with other factors such as low dietary diversity and use of multiple medications, is likely putting older individuals at risk of nutrient deficiencies/insufficiencies which are weakening their immune system, including:

  • Zinc supports the function of white blood cells and low levels impair immunity.[xiii],[xiv],[xv]Zinc deficiency may increase the risk of pneumonia amongst older individuals.[xvi]
  • Vitamin A supports multiple aspects of the immune response.[xvii],[xviii] Deficiency is associated with an increased risk of infection.[xix]
  • Vitamin D supports bone health,[xx] immune function,[xxi] and mental health[xxii] to name just a few functions. Up to 50% of adults aged 65 and over in the UK are deficient in vitamin D though![xxiii] Vitamin D has specifically been shown to help prevent and manage the symptoms of viral infections in older individuals.[xxiv]
  • Iron is vital to healthy oxygen transport around the body.[xxv] Iron deficiency therefore limits oxygen delivery to cells, driving fatigue and decreased immunity.[xxvi],[xxvii]

Proactive Nutrition & Lifestyle Support

  • Minimise the risk of nutrient deficiencies/insufficiencies by consuming a varied, colourful diet rich in fresh fruit, vegetables, and good quality protein sources, including eggs, pulses and legumes, good quality meat and fish, nuts and seeds. For those with digestive issues, focus on easily digestible foods such as soups, smoothies, stews, and bone broths.
  • For therapeutic support, consider supplementation with immune-supportive nutrients, such as zinc, vitamin A, C, and D. Feel free to contact our Clinical Nutrition team for advice about whether you can take such supplements, bearing in mind any medications which you are currently taking and if so, at what dosage.
  • Support digestion with probiotics from foods (e.g. live yoghurt, kefir) and a well-researched supplement, particularly if you’ve taken antibiotics recently. For those with particularly compromised digestion, supplementing with digestive enzymes might help by supporting the efficient breakdown of proteins, fats, and carbohydrates.
  • Increase your water intake by filling a jug or water bottle at the start of the day and using that as a visual reminder to drink that volume over the course of the day. Aim for around 1.5-2 litres per day unless instructed otherwise by your medical professional. Sip throughout the day to facilitate proper cellular hydration to ensure maximum benefit.
  • Exercise, do what you can, and if possible do it outside. This can be anything from a stroll or a hike, to doing yoga and simple stretches in the garden. Engage yourself in whatever you are physically capable of doing and crucially, enjoy. It is so important to keep moving for your immunity,[xxviii] emotional wellbeing, and overall health.[xxix]
  • If you live alone or are feeling a little isolated, do something fun and positive. Call or have a virtual cup of tea with a friend or family member, play your favourite music and get up and have a boogie, or pick a new hobby such as drawing or painting.

If you would like personalised advice, or would just like a friendly chat, feel free to get in touch with our Clinical Nutrition team who are on hand to help you.


Got a question?

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References

[i] Thompson WW, Shay DK, Weintraub E, et al. Mortality Associated With Influenza and Respiratory Syncytial Virus in the United States. JAMA. 2003;289(2):179–186. doi:10.1001/jama.289.2.179

[ii] Zhou F et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020; doi: 10.1016/s0140-6736(20)30566-3

[iii] Montecino-Rodriguez, E., Berent-Maoz, B., & Dorshkind, K. (2013). Causes, consequences, and reversal of immune system aging. The Journal of clinical investigation, 123(3), 958–965. https://doi.org/10.1172/JCI64096

[iv] Cabrera Á. J. (2015). Zinc, aging, and immunosenescence: an overview. Pathobiology of aging & age related diseases, 5, 25592. https://doi.org/10.3402/pba.v5.25592

[v] Shaun Scholes et al. (2018) Health Survey for England 2017 Cardiovascular diseases. NHS Digital, National Statistics ISBN: 978-1-78734-255-2

[vi] Moody, A. et al (2017) Health Survey for England 2016 Prescribed medicines. Health and Social Care Information Centre. Online http://healthsurvey.hscic.gov.uk/media/63790/HSE20...

[vii] Mohn, Emily S et al. “Evidence of Drug-Nutrient Interactions with Chronic Use of Commonly Prescribed Medications: An Update.” Pharmaceutics vol. 10,1 36. 20 Mar. 2018, doi:10.3390/pharmaceutics10010036

[viii] Popkin, B. M., D'Anci, K. E., & Rosenberg, I. H. (2010). Water, hydration, and health. Nutrition reviews, 68(8), 439–458. https://doi.org/10.1111/j.1753-4887.2010.00304.x

[ix] Ahmed M. El-Sharkawy, Opinder Sahota, Dileep N. Lobo, Acute and chronic effects of hydration status on health, Nutrition Reviews, Volume 73, Issue suppl_2, September 2015, Pages 97–109,

[x] Feldman M, et al. Effects of aging and gastritis on gastric acid and pepsin secretion in humans: a prospective study. Gastroenterology. 1996 Apr;110(4):1043-52.

[xi] Zhang, Sheng, and De-Chang Chen. “Facing a new challenge: the adverse effects of antibiotics on gut microbiota and host immunity.” Chinese medical journal vol. 132,10 (2019): 1135-1138. doi:10.1097/CM9.0000000000000245

[xii] Maes, Marina L et al. “Adverse effects of proton-pump inhibitor use in older adults: a review of the evidence.” Therapeutic advances in drug safety vol. 8,9 (2017): 273-297. doi:10.1177/2042098617715381

[xiii] Wintergerst ES, Maggini S, Hornig DH. Contribution of selected vitamins and trace elements to immune function. Ann Nutr Metab 2007;51:301-23.

[xiv] Beck FW, Prasad AS, Kaplan J, Fitzgerald JT, Brewer GJ. Changes in cytokine production and T cell subpopulations in experimentally induced zinc-deficient humans. Am J Physiol 1997;272:E1002-7.

[xv] Solomons NW. Mild human zinc deficiency produces an imbalance between cell-mediated and humoral immunity. Nutr Rev 1998;56:27-8

[xvi] Barnett JB et al. Zinc: a new risk factor for pneumonia in the elderly? Nutr Rev. 2010; 68(1): 30–37.

[xvii] Huang Z et al. Role of vitamin A in the immune system. J Clin Med. 2018; 7 (9): 258.

[xviii] Iyer N, et al. Vitamin A at the interface of host-commensal-pathogen interactions. PLoS Pathog. 2019; 15 (6): e1007750.

[xix] Watson, J., Lee, M. & Garcia-Casal, M.N. Consequences of Inadequate Intakes of Vitamin A, Vitamin B12, Vitamin D, Calcium, Iron, and Folate in Older Persons. Curr Geri Rep 7, 103–113 (2018). https://doi.org/10.1007/s13670-018-0241-5

[xx] National Institutes of Health (2011) Vitamin D. [Online] Available at: http://ods.od.nih.gov/factsheets/VitaminD-HealthPr... [Accessed 2nd April 2014].

[xxi] Griffin, M.D., Xing, N. and Kumar R. (2003) Vitamin D and its analogs as regulators of immune activation and antigen presentation. Annual Review of Nutrition, 23, 117-145.

[xxii] Khoraminya et al. Therapeutic effects of vitamin D as adjunctive therapy to fluoxetine in patients with major depressive disorder. Aust N Z J Psychiatry. 2013; 47 (3): 271-5.

[xxiii] Bates B., Lennox A., Prentic A., Bates C., Page P., Nicholson S., Swan G. The National Diet and Nutrition Survey: Results from Years 1, 2, 3 and 4 (Combined) of the Rolling Programme (2008/2009–2011/2012) The Stationary Office; London, UK: 2014.

[xxiv] Grant, W.B.; Lahore, H.; McDonnell, S.L.; Baggerly, C.A.; French, C.B.; Aliano, J.L.; Bhattoa, H.P. Vitamin D Supplementation Could Prevent and Treat Influenza, Coronavirus, and Pneumonia Infections. Preprints 2020, 2020030235 (doi: 10.20944/preprints202003.0235.v1).

[xxv] Dallman PR. Biochemical basis for the manifestations of iron deficiency. Annu Rev Nutr 1986;6:13-40.

[xxvi] Haas JD, Brownlie T 4th. Iron deficiency and reduced work capacity: a critical review of the research to determine a causal relationship. J Nutr 2001;131:691S-6S.

[xxvii] Bhaskaram P. Immunobiology of mild micronutrient deficiencies. Br J Nutr 2001;85:S75-80.

[xxviii] Malaguarnera, L., Cristaldi, E., Vinci, M. et al. The role of exercise on the innate immunity of the elderly. Eur Rev Aging Phys Act 5, 43–49 (2008). https://doi.org/10.1007/s11556-007-0028-8

[xxix] Lautenschlager, Nicola T et al. “Can physical activity improve the mental health of older adults?.” Annals of general hospital psychiatry vol. 3,1 12. 29 Jun. 2004, doi:10.1186/1475-2832-3-12