Seniors and supplements: Making dietary supplements easier for seniors to take

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Getting old ain’t what it used to be. In fact, by some estimates it’s better. That’s because today’s seniors are as likely to try their hand at a new language or enter a 5K—socially distanced, of course—as they are to sharpen their bingo skills and kick back.

But no matter how they spend their time, seniors have earned the right to hold their golden years to a high standard—as they do their dietary supplement choices. After all, seniors turn to supplements to improve their quality of life; so, if the act of supplementation itself is a drag—whether because of pill burden, fishy reflux, or otherwise—it defeats the whole purpose, right?

That’s why supplement brands that cater to savvy seniors had better consider the demographic’s unique needs when designing their products. As Dan Peizer, senior director, global consumer health marketing and strategy, Catalent Pharma Solutions (Somerset, NJ), says, “Making the dosing process as easy as possible for seniors can really help with adherence.”

Serious about Supplementation

The more we learn about aging, the more we learn about the role that everyday interventions can play in helping us do so successfully.

As Steve Holtby, president and CEO, Soft Gel Technologies Inc. (SGTI; Commerce, CA), points out, “The best actions we can take to prevent chronic disease, maximize immune-system response, decrease inflammation, and prevent premature aging include all those basic things that keep us physically and psychologically fit anyway: exercise, sleep, recovery, stress reduction, healthy relationships, and, importantly, diet and nutrition.”

In other words, “Getting older is inevitable, but people can age well by incorporating supplements into their daily regimens,” he says.

And in remarkably reliable numbers, older consumers do. “The market among seniors for supplementation is significant,” says Peizer, who points to Council for Responsible Nutrition (CRN; Washington, DC) data from the association’s 2019 Consumer Survey on Dietary Supplements showing that 79% of adults age 55 and older take dietary supplements.

The science supports their decision. As Peizer says, “Research that’s emerged on supplementation’s benefits, along with the expanded formulation choices available, has certainly played a part in this increase.”

The COVID Connection

Now that COVID-19 has everyone thinking about how to bolster their baseline health, seniors have even more reason to seek out supplements.

“As information emerges about the risk factors that increase COVID-19 severity—like diabetes, hypertension, and cardiovascular disease—seniors, and frankly all demographics, have taken more interest in supporting and maintaining a healthy immune and other systems through supplementation,” Peizer says. “While it’s too early for a deep quantitative analysis of purchase trends, anecdotally we’ve seen a lot of interest in taking formulations that may help provide this support, including those with vitamins C, D3, and K2.”

Enough Already

But seniors already have a lot to take—literally. More than one-third of the drugs prescribed in the United States go to senior patients, notes Peizer. One AARP study¹ even found that Americans aged 50 to 64 take three to four different prescription drugs daily, with older Americans regularly taking as many as five. No wonder the Department of Health and Human Services figures a 55% prescription-drug noncompliance rate among seniors.

“Clearly, adding supplements to the mix only increases this burden,” Peizer says. Yet seniors continue to lean on supplements for the nutrients they need.

Tough Pill to Swallow

As if that weren’t burden enough, Peizer continues, “Seniors are challenged more than other age groups when taking supplements because of the natural changes associated with the aging process.”

Holtby agrees, noting that a Harris Interactive poll found roughly 40% of American adults struggle to swallow pills. “Commonly cited issues include gagging, a lingering aftertaste from an incomplete swallow, and having a pill become lodged in the throat,” he notes.

What’s more, supplements may present some of the heaviest pill burdens that seniors face. FDA researchers, reviewing the agency’s Center for Food Safety and Applied Nutrition Adverse Reporting System database, examined² 10 years of supplement-associated swallowing reports related to pill size and found upwards of 75% occurring in seniors aged 65-plus trying to take supplements that were simply too big. USDA recommends that generic tablets not exceed 17 mm in any dimension, the report notes, yet researchers found the 10 most troublesome supplements to be larger.

Unintended Consequences

Another concern: drug interactions. “This is an important issue when considering supplementation for seniors, and one that the medical community focuses on,” Peizer says.

Consider that a 2016 JAMA Internal Medicine study³ followed more than 2,000 subjects aged 62 to 85 over two intervals spaced five years apart and found that concurrent use of five prescription medications rose from 30.6% to 35.8% during the study period, while supplement use rose from 51.8% to 63.7%. “Of note, the researchers cited an almost-400% increase in omega-3 use among the group, which was attributed to consumer awareness of the supplement’s heart-health benefits,” Peizer points out. “Of concern, however, was the number of seniors who might have also been on prescription medication because of the stroke risk.”

Holtby adds that nutrition drinks pose another potential threat. Given that an 8-oz beverage might deliver up to 40% of a senior’s daily vitamin K requirement, he says, “If a senior consumes multiple such drinks per day, the amount of vitamin K can directly affect the efficacy of blood thinners like warfarin, or Coumadin.”

In industry’s defense, Peizer notes, “It’s beyond supplement makers’ purview to advise on risks related to seniors’ established prescriptions regimens.” Nevertheless, he continues, “It’s still important that industry help educate medical professionals and pharmacists on supplementation’s benefits, so that they, in turn, can help seniors benefit from them safely.”

Easy Does It

Meanwhile, supplement makers can focus on what they do best: designing the most effective formulations to support seniors’ health, and delivering them in the most palatable formats available.

First, formulation: Although nutrients like as B vitamins and vitamin D are available in small formats, omega-3s and calcium, to take two examples, appear in larger forms needed to carry relevant doses—“often with unpleasant side effects like reflux and a chalky mouthfeel, respectively,” Peizer concedes.

So, combining nutritionally relevant doses of multiple in-demand nutrients in an easy-to-take supplement system is the order of the day. “Having to take many supplements individually really adds to the problems with pill burden,” Peizer says.

“Dose form is another critical factor in ensuring that the product is easy to take,” he continues, “accounting for chewing and swallowing issues, reflux, and other challenges.”

For example, according to Holtby, capsules tend to be tougher to swallow than tablets because they’re lighter than water. “That means that they float on the surface of any liquid you try to swallow with them.”

By contrast, more than eight in 10 consumers associate softgels with efficacy, ease of swallowing, and easy digestion,” contends Peizer, pointing to a 2009 survey on the matter⁴. Even better, he continues, “Their formulation flexibility allows for beneficial combinations.”

Fast-dissolving tablets offer another “great option” for seniors, Peizer goes on, “especially where swallowing is an issue.” The format requires no water and can accommodate flavoring, better to mask off-notes associated with some nutrients.

In fact, Catalent’s Zydis product dissolves in as little as three seconds, Peizer says, and more conventional “melt” tablets and granules take about half a minute to dissolve in the mouth, or in water. “Both technologies directly address seniors’ needs and provide a path for supplement companies to offer more differentiated products to this important segment faster.”

And as more seniors appreciate supplementation’s benefits, that promises to make everyone’s experiences better.

References

1. AARP survey. “Prescription drug use among midlife and older Americans.” Published in January 2005. Accessed at: https://assets.aarp.org/rgcenter/health/rx_midlife_plus.pdf
2. American College of Physicians media release. “Multivitamins and calcium supplements among most difficult pills for seniors to swallow. Published on August 20, 2019. Accessed at: https://www.scimex.org/newsfeed/dietary-supplements-are-toughest-pills-to-swallow-for-senior-citizens
3. Dima M et al. “Changes in prescription and over-the-counter medication and dietary supplement use among older adults in the United States, 2005 vs 2011.” JAMA Internal Medicine, vol. 176, no. 4 (April 2016): 473-482
4. Market Analysts LLC. “OTC/VMS Delivery Forms Study.” 2009.