Several factors affect nutrient utilization in older adults, including diet, medications, and health conditions. Calcium absorption is of particular concern because in addition to the latter factors that could inhibit uptake, calcium depends on magnesium and vitamin D, making achieving adequate balance more difficult. Furthermore, calcium is especially important for older adults’ bone health; they’re at risk of fractures due to a higher prevalence of falls and the bone-thinning disease osteoporosis. However, in other conditions, such as chronic kidney disease, calcium must be limited.
If you have older patients or long term care residents who could benefit from more calcium in their diet, but they don’t like or tolerate dairy products or they have a low appetite, it could be very challenging for them to meet the Recommended Dietary Allowance (RDA) of 1,200 mg/day for women older than 50 and men older than 70.
The following are strategies RDs can take to enhance older adults’ calcium intake and absorption, as well as conditions in which RDs need to ensure calcium intake is limited.
Take a look at their medications. Certain antiseizure drugs, such as phenobarbital and phenytoin, decrease calcium absorption by lowering vitamin D levels. With long-term use, proton pump inhibitors and antacids taken for gastroesophageal reflux disease or other gastrointestinal disturbances also may affect calcium absorption by acid suppression. For this reason, calcium citrate is the best supplement to recommend since it’s more easily absorbed in a lower-acid environment.
Find a food source of calcium that works for them. As people age, they tend to eat less and have a reduced appetite as a result of decreased physical activity, taste changes, or loss of interest. Try enhancing their appetite by offering shakes or smoothies made with milk or ice cream and adding berries or other calcium-containing fruits. Apricots, kiwi, blackberries, strawberries, and raspberries each include more than 20 mg calcium per serving.
For those with lactose intolerance or a dislike of dairy products, try adding poppy or sesame seeds to recipes. Sesame seeds have 7%, and poppy seeds more than 10%, of the RDA for calcium for older adults in one tablespoon. Some nuts, such as almonds, contain calcium as well; 1 oz of almonds (about 23 nuts) delivers 6% of an older adult’s RDA.
Canned sardines with bones are an excellent source of calcium, and canned salmon with bones is a good source of calcium. Beans and lentils have some calcium and magnesium (which helps increase calcium absorption) as well.
Limiting calcium: consider health conditions. Conversely, some conditions may call for limiting calcium. For adults with chronic kidney disease, calcium may need to be limited due to imbalances in bone metabolism. The National Kidney Foundation recommends a maximum intake of 2,000 mg/day for those with renal disease (of note, the Tolerable Upper Intake Level for adults older than 50 is 2,000 mg as well). Adults with inflammatory bowel disease and obesity are at risk for kidney stones (calcium oxalate) and should limit calcium intake to 1,000 to 1,200 mg/day.
When it comes to ensuring that older adults have adequate calcium balance, there are several things to consider. By looking at the whole person—their medications, conditions, and diet—RDs can help older adults achieve calcium balance for the best health outcomes.
— Donna Rose, RDN, LDN, is a consultant dietitian and new freelance writer and blogger in the Washington, D.C., area. Follow her blog for easy-to-read, evidence-based nutrition articles.