“Brown bag” vitamin review for elders

Abstract

The use of nutritional supplements by the elderly is common, with an estimated 3070% taking vitamins (1), usually on a -selfprescribed basis. Older adults are at special risk for toxicity from large doses of vitamins and other over-the-counter nutrition supplements because of their reduced tolerance for excess nutrients, due to age-related, physiologic changes in body composition and metabolism. In addition, the average senior takes two to five drugs daily (2), thus increasing the risk of drug/nutrient interactions, particuarly if supplements are taken without medical advice. Many older Americans have inadequate incomes, so the widespread use of supplements, which are often expensive, is worrisome from an economic view, as well. A nutrition education program focusing on the appropriate use of vitamins and other supplements was developed for local seniors participating in the Elderly Nutrition Program (ENP). The ENP prOVides nutritious meals to seniors nationwide at Nutrition Centers, typically as hot lunches served weekdays at senior centers. The ENP also provides older adults with social and educational opportunities at these Nutrition Centers, including nutrition and health education activities such as the vitamin review described below. The basic service offered at the brown Llg vitamin review was the chance for seniors to sit down, one-to-one, with a registered dietitian or qualified nutritionist to review the contents of a bag (hence the term bag) brought from home, containing samples of any vitamin, mineral or miscellaneous nutritional supplement currently being taken by the elder. Pharmacists were also present, and offered individual gnidance on the use of medications brought from home. Recently, brown bag medication reviews have become a fairly common health promotion activitiy, but the brown bag vitamin review is a new idea. Short talks by a dietitian and a pharmacist preceded individual vitamin and medication reviews, whil:h were done at Nutrition Centers directly following lunch. The nutrition presentation emphasized food as the safest and best source ofnutrients, and pointed out that not all seniors need supplements. The presentation featured simple. large-print posters to show elders how to read labels in order to identify inexpensive, low-dose multivitamin products. Handouts -included guidelines fiJr a healthy diet, a checklist for the safe use of supplements, and a true/false quiz about vitamins. In an attempt to individualize and break down information into smaller units, half-page, large-print handouts were made up for each nutrient, to be given to seniors who actually brought supplements from home. These handouts listed food sources of the nutrient and any signs of toxicity resulting from a megadose. These handouts were suitable for posting on a refrigerator as a reminder to choose foods containing nutrients that may be lacking in the diet. The brown bag sessions were planned jointly by the ENP dietitian, the director of the geriatrics department and the director of pharmacy from a local hospital, and the directors of the senior centers at which the programs were held. Publicity efforts were cooperative, and included flyers, announcements by Nutrition Center directors at meal sites, visits to centers bv the ENP nutritionist prior to the event to explain its logistics and purpose, and articles in local newspapers and newsletters targeted to area seniors. In the future, the local communitvaccess cable television company will tal;e brown bag sessions, to be aired on their weeklv informational program for seniors. To reduce waiting time for clients, dietetic interns were recruited to assist on the dav of the event by doing supplement review;. To prepare them for this task, the interns were given an in-service training session by the ENP nutritionist. In addition, nutritionists from other ENPs volunteered to assist at the earlier programs. This gave them the chance to observe the program before offering it at their own senior centers. Records of supplements were maintained, including name of product, type of product (Le.. multivitamin, single-ingredient mineral, megadose, etc.), cost, dosage, frequency, duration, whether the supplement was self-prescribed or recommended by a doctor, the client's reason for taking it, and the advice given by the dietitian or nutritionist. The actual interchange between the senior and the dietitian was structured as a brief, informal, client-centered interview, with the supplement record designed as a rapid checklist to be completed at the close of the review. This procedure kept the focus of the review on the client rather than on the information gathered.