Nutraceuticals, Dietary, and Herbal Supplements

The use of over-the-counter supplements and nutraceuticals by aging adults over age 60 in the United States is common, with a 67% increase over 10 years (Mishra S, Dietary supplement use among adults: United States, 2017–2018. NCHS Data Brief, no 399. Hyattsville: National Center for Health Statistics, 2021). Over half of USA adults use at least one dietary supplement and use grows in advancing age, with an estimated 74.3% of those 60 and older taking dietary supplements (Mishra S, Dietary supplement use among adults: United States, 2017–2018. NCHS Data Brief, no 399. Hyattsville: National Center for Health Statistics, 2021). The number of supplements used also is greater with age, with a quarter of older adults taking four or more supplements. The most frequently used are multivitamin-mineral supplements, vitamin D, omega-3 fatty acids, calcium, and vitamin B12. Due to the paucity of evidence, clinicians may be unprepared to answer questions or make recommendations about these products. This chapter offers an overview of what is known regarding the efficacy and safety of various common supplements which have purported benefits for psychiatric symptoms and syndromes in aging adults. Improving and maintaining overall health are the most commonly reported reasons for taking supplements (Bailey RL, JAMA Intern Med 173:355–361, 2013). As people age, they tend to burn fewer calories, be less physically active, gradually lose lean muscle mass, need fewer calories, and experience decreased appetite. Therefore, aging adults may need more nutrients via supplementation to maintain proper health. Aging adults also report specific motivations for using supplements such as heart, bone/joint, or eye health (Bailey RL, JAMA Intern Med 173:355–361, 2013). This broadens the range of products typically used by the geriatric population to include not only dietary supplements but also medicinal herbs (sometimes referred to as phytoceuticals or phytochemicals) and other “natural products.” See Table 18.1.