Supplement utilisation patterns of older Australians: results from a randomly selected national sample.

Abstract

Objective: The aim of the present study was to measure the prevalence and patterns of dietary and health supplement utilisation of older Australians.

Design: A self-administered mail questionnaire.

Subjects and setting: Almost 2500 Australians aged 65 years and over were randomly selected from the 2000 Australian Electoral Commission roll. All states and territories were proportionally represented in the sample. Responses were obtained from 1263 predominantly independently living Australians aged 65 years and over.

Results: At the time of the survey, 43% (n = 548) reported the use of some form of supplement: females 52% (n = 324) and males 35% (n = 224). The supplements used most often were vitamin C (26%), multivitamin/mineral preparations (17%), fish oils (17%), vitamin E (16%), calcium (+/- vitamin D) (13%), garlic capsules or oil (11%), vitamin B (single or mixed) (9%), other single vitamins or minerals (7%), zinc (6%) and gingko (5%). The majority of supplements were consumed regularly (daily or every few days) and for an extended period (more than three years). Supplement users appeared to rely on their doctor, newspapers, family or friends and pharmacy staff for information about supplements. The most commonly cited reasons for supplement use were to enhance energy levels, improve stamina and promote feelings of wellness.

Conclusion: A high proportion of older supplement users reported regular and prolonged patterns of supplement use. Health professionals should explore the motives that maintain this behaviour, evaluate the appropriateness of the type and patterns of supplement use and provide supplement users with information that explains the potential risks associated with commonly used supplements.

Key words: Australia, dietary supplementation, elderly, questionnaires, utilisation

(Nutr Diet 2005;62:89-94)

Introduction

Drawing accurate conclusions about the prevalence and patterns of supplement use by older Australians is confounded by the lack of definition for the term 'dietary supplement', significant methodological differences between studies, insufficient data about supplement practices (e.g. dosage, frequency and duration of use) and inadequate information about the methods used to categorise supplements.

The earliest attempt to quantify the use of supplements by older Australians was a study conducted by the Commonwealth Scientific and Industrial Research Organisation (CSIRO) Division of Human Nutrition in 1988. (1) Using a self-administered mail survey, data about vitamin supplement use and dietary habits were collected from 2360 randomly selected individuals aged 18 years and over. Regular vitamin supplement use (defined as vitamin supplement use at least once a week) was reported by 20% of the sample aged 60 years and over. Since then, five studies have examined the prevalence of supplement use among older Australians. One study used a self-administered mail questionnaire to measure the use of 10 specified dietary supplements one month prior to survey in a randomly selected sample of 2195 Adelaide residents aged 65 years and over. (2) Another study conducted personal interviews and used a dietary history to study the diets and use of supplements in a group of 105 war veterans aged 60 years and over (interval of study not specified). (3) The Australian National Health Survey conducted personal interviews to assess the use of vitamins/minerals and herbal/natural medicines two weeks prior to interview by 2153 individuals aged 65 years and over. (4) The Australian National Nutrition Survey conducted personal interviews to establish the use of 10 specified vitamins and minerals on the day prior to interview by individuals aged 65 years and over (portion of sample aged 65 years and over not specified) (5) and finally, the Blue Mountains Eye Study conducted personal interviews to determine the use of supplements two months prior to interview among a sample of 2370 independently living residents aged 60 years and over. (6) According to this literature, 20-40% of Australians aged 60-65 years and over report the use of some form of dietary and health supplement. International studies confirm that 16-60% of this age group regularly use vitamin and mineral preparations. (7-14) The types of supplements used most often by older Australians are preparations containing vitamin C, vitamin E, multivitamins/minerals and B vitamins. (3-6,15) Magarey et al. (3) found that supplements were often consumed in dosages twice the recommended dietary intakes. The frequency and duration of supplement use has been poorly documented. Horwath and Worsley, (2) Magarey et al. (3) and Yu et al. (6) reported on the regular use of dietary supplements by older Australians; however, no agreement exists between studies with regard to what constitutes 'regular' supplement use. The reasons for specific supplement use by older Australians have not been investigated. Obtaining data about the patterns of supplement use would assist to quantify the potential risk for drug-nutrient interactions and to evaluate the safety and efficacy of the supplements consumed by this age group. Furthermore, attempts to understand the reasons why older Australians use supplements would inform the development of appropriate educational material for these individuals. The aim of the present paper is to explore the prevalence and patterns of supplement use in a representative sample of older Australians.

Methods

Almost 2500 Australians aged 65 years and over were randomly selected from the 2000 Australian Electoral Commission. All states and territories were proportionally represented in the sample. In January 2001, a letter outlining the nature of the investigation and inviting participation was posted to 2457 older Australians nationwide. Two weeks later the 12-page questionnaire was posted. A reminder to complete the survey was posted to all participants four weeks after the original letter had been mailed. Each respondent received the initial letter, questionnaire, follow up postcard and a prepaid envelope for returning the completed survey. In total, 1263 completed surveys were returned. This represents a response rate of 62% after allowing for confirmed nondeliveries.

The survey instrument was designed to obtain information about health and lifestyle practices of older Australians, including their use of dietary and health supplements. The development of the survey involved two in-depth focus groups and survey pretesting by residents in an aged care facility and independently living individuals aged 65 years and over. In total, 70 participants contributed to the construction and modification of the instrument. Information about dietary and health supplement use was obtained by asking participants 'Do you take any of the following types of supplements: vitamins, minerals, herbal preparations or other health products?' (collectively referred to in the present study as health and dietary supplements). Examples of each type of supplement were included in the questionnaire. For each type of supplement consumed participants provided information about: (i) the frequency of supplement use; (ii) the duration of supplement use; and (iii) sources of supplement information. Table 1 shows the questionnaire options for frequency of use, duration of use and sources of information. Participants were asked to write one specific reason for using each type of supplement consumed. Their responses were grouped into the following eight categories based on bodily systems: (i) Circulatory, for example 'to lower cholesterol, to improve memory, to improve the heart and circulation'; (ii) Genitourinary, for example 'for prostate problems, for urinary infections, for kidney problems'; (iii) Musculoskeletal, for example 'for joint pain, to stop muscle cramps, to ease stiffness, to build bones, for sore joints and osteoporosis'; (iv) Respiratory, for example 'stops colds and flus, for sinusitis, for sore throat and stops hay fever'; (v) Immunological, for example 'to ward off infections, to build immunity, to prevent cancer and to stop cold sores'; (vi) Haematological, for example 'to treat anaemia, to promote iron absorption and to thin the blood'; (vii) Dermatological, for example 'to improve wound healing, to relieve dry skin, helps hair, nails and skin'; and (viii) Gastrointestinal, for example 'to improve digestion, for nausea, to relieve flatulence, for an upset stomach and dyspepsia'. One other category, (ix) General, was created for the following non-specific responses 'for overall wellbeing, to improve stamina, to feel good, to make me feel better and to give me energy'.

Supplement definition

In the present study, the term 'dietary and health supplement' referred to any capsule, tablet or liquid preparation that contained predominantly vitamins, minerals, herbal products, or other health preparations. Excluded from this definition were preparations such as lecithin, wheat germ, unprocessed bran, slippery elm, kelp, protein powders, charcoal, homoeopathic medicines, electrolyte formulas, aromatherapy oils, flower essences, tissue salts and other complementary medicines. Although the primary focus of the present study was to assess supplemental intakes of nutrient preparations, we also measured utilisation of herbal medicines. We felt this was important because of the growing awareness of the potential for drug-herbal interactions to occur and because of the paucity of data about the prevalence of this supplement use by older individuals. It was not the intention of the present study to assess the broader use of complementary medicines by older Australians.

Method of categorising supplements

Supplements were allocated to one of 45 supplement types based on the predominant constituent(s) contained in the preparations. The majority (35) of different supplement types were consumed by fewer than 5% of supplement users and have been excluded from the analysis and discussion.

Ethics approval

This project was reviewed and approved by the human ethics committee of Southern Cross University, Lismore, NSW.

Statistical analysis

The Statistical Package for the Social Sciences (SPSS, Chicago, IL, USA) version 10.0 for Windows was used to conduct the data analysis. Descriptive statistics were used to report the data about prevalence and patterns of supplement utilisation.

Results

The general demographic and health features of the sample have been reported elsewhere. (15,16) In brief, just over half (51%) were males and almost three quarters (73%) were born in Australia. The distribution of age groups was as follows: 29%, 65-69 years; 49%, 70-79 years; and 18%, 80 years and over. The majority of the sample were living with their partner only (58%), reported an annual income after retirement of less than $19 000 (55%), and rated their health as good, very good, or excellent (77%). The most commonly reported health conditions were hypertension (44%), arthritis (42%) and high cholesterol (28%).

Patterns of supplement utilisation

Forty-three per cent of the sample (n = 548, 224 males and 324 females) reported using at least one dietary or health supplement at the time of the survey. More than half (52%, n = 324) of all females reported using at least one health or dietary supplement, compared with just over one-third (35%, n = 224) of men. For all types of supplements, females were heavier users than males. The majority of supplement users reported regular (every day or every few days) supplement use. Table 2 lists the 10 most commonly consumed supplements, including the percentage of regular and occasional users. With the exception of zinc, prolonged use of supplements (more than three years) was the most common response for all supplement types. Table 3 shows the duration of use for the most commonly used supplements. For all types of supplements, individuals relied on a few consistent sources of information. Table 4 shows the four most commonly cited sources of supplement information. For each supplement type, a proportion cited general reasons for use (e.g. to improve stamina, to feel good or to promote energy). Table 5 shows the three most commonly cited reasons for taking each type of supplement.

Discussion

Although the present study is the seventh to investigate the prevalence of supplement use in the older population, it is the only national study to provide data on the frequency, duration and motives for supplement use in a sample representative of older Australians for age, ethnicity, living arrangements, income, self-perceived health status and commonly reported health conditions. (17) The proportion of males in this sample (51%) was slightly higher than that of the general population of Australians aged 65 years and over (44%). (18)

The extent of supplement usage by the older population reflects a high level of interest in self-care and health maintenance--more than half (52%) the women and over one-third (35%) of men reported using at least one product at the time of survey. The most popular supplements were preparations containing vitamin C, multivitamins/minerals and vitamin E. This is in agreement with other Australian studies. (2,3,5,6) International studies have shown that the use of vitamin C and vitamin E preparations is consistently in the range of 10-25% of all older supplement users. (8,10,12,19-24) Regular and prolonged use of high-dose vitamin C preparations can cause adverse reactions, interfere with several laboratory tests and mask the diagnosis of certain conditions, such as gout and colon cancer. At large doses (1 g/day) vitamin C may cause diarrhoea and interfere with diagnostic tests, such as serum cholesterol, serum triglycerides, serum and urine glucose tests, and increases urinary excretion of uric acid, which could obscure the diagnosis of gout. (25,26) Vitamin C in doses as low as 250 mg/day may impair screening for colon cancer and give false negative results on the guaiac assay for occult blood. (25,26) Although vitamin E is relatively non-toxic, adverse effects such as diarrhoea, nausea and heart palpitations have been reported with excessive doses (>1200 IU/day). (26,27) At much lower intakes (e.g. 400 IU/day), vitamin E can decrease platelet adhesion, inhibit the production of prothrombin, increase clotting times and (theoretically) increase the risk of haemorrhagic strokes. (26-28) Individuals consuming vitamin E while on anticoagulants are well advised to have periodic monitoring of their clotting times. (29) For more information about contraindications and precautions associated with vitamin, mineral and herbal preparations and interactions with pharmaceutical drugs, health professionals should consult the following books: Handbook of Herbs and Supplements and Their Therapeutic Uses, (27) Clinical Guide to Nutrition and Dietary Supplements in Disease Management, (25) An Evidence-Based Approach to Vitamin and Minerals (28) and Herbs and Natural Supplements. (26)

Currently, there are few data from which to determine the prevalence of herbal medicine use by older Australians. The Australian National Health Survey (4) found that 12% of participants aged 65-74 years reported the use of 'herbal/natural' products (not defined) in the two weeks before interview. In the present study, the use of herbal medicine preparations was uncommon. With the exception of gingko, most herbal medicine preparations were taken by fewer than 5% of supplement users. Although gingko has a history of traditional use in China and Japan as an anti-inflammatory and antiasthmatic, its actions on the central nervous system have only been recently established. Research has shown that gingko improves cerebral circulation, aiding memory and concentration, and it is one of the most useful herbs for the treatment of senile dementia. (26,30,31) A recent study of elderly Americans (mean age 82 years) living in a retirement community found that 20% used herbal medicines. (32) Gingko was the most commonly reported herbal medicine, believed by the majority of users to be effective for memory loss. Advanced age, degree of frailty, and concerns about cognitive decline appear to be important determinants of herbal medicine use in the older population.

Elderly supplement users often rely on their doctors for advice about vitamin and mineral supplements. (21,33,34) In the present study, doctors were cited as important sources of information about supplements, particularly calcium preparations presumably for the prevention or treatment of osteoporosis. However, because most doctors receive only basic training in clinical nutrition, their ability to advise individuals about other types of supplements is likely to be limited. For a broader perspective on the merit of other preparations supplement users may need to consult a dietitian, nutritionist, or suitably qualified practitioner of complementary medicine.

Few investigations have specifically examined the reasons why older individuals use dietary supplements. All of the existing literature on this aspect of supplement behaviour comes from studies conducted in the USA. These show that older supplement users cited 'the desire for more energy' and the desire to correct a perceived 'dietary inadequacy' as common reasons for the use of supplements containing vitamins B12, C, D and E. (21) Supplement users consistently state that they use vitamin C for their general health and to prevent coughs and colds. (10,13,21,22) Sheehan et al. (22) identified many older supplement users who believed that some forms of illness, including cancer, were caused by a vitamin deficiency.

Our results suggest that older Australian supplement users share similar beliefs about dietary supplements and have similar intentions to their American counterparts, with one notable exception--supplement users in the present study did not cite dietary inadequacy as a motive for using any of the 10 most commonly used preparations. We found that individuals who used vitamin C and garlic products believed that these preparations were important in the defence against colds and other respiratory complaints. Fish oil/omega 3 preparations were popular supplements with those who reported musculoskeletal problems, possibly for their anti-inflammatory action. A desire to improve general wellbeing and to enhance energy and stamina were common reasons cited for using supplements. Older individuals may be of the opinion that supplemental intakes of vitamins and minerals can combat fatigue. However, in the older person several factors can contribute to feelings of tiredness and fatigue, including dietary inadequacy (e.g. insufficient energy or micronutrient intake), dehydration, medication side effects, sleep disturbances and numerous medical disorders. By relying on supplements to boost energy levels, older individuals could delay the appropriate nutritional and medical assessment necessary to identify the causes of their fatigue.

Our results about the prevalence of supplement utilisation must be interpreted cautiously. Since we did not have information about all the constituents in each product, significant under-reporting of supplement items (e.g. vitamins, minerals, or botanicals) may have occurred. For example, mixed nutrient preparations such as multivitamin/mineral supplements were grouped into one category. Their relative contribution of individual nutrients, such as vitamin C, vitamin E, calcium and zinc was not accounted for. It is now common to find vitamins and minerals added to a range of product types, and this even occurs in some botanical formulas. For this reason, our estimates of the use of these nutrients from the supplements we coded probably inadequately reflect the true contribution that supplements make to total nutrient consumption. None of the other supplement utilisation investigations conducted in Australia provided any explanation of how products were coded into discrete supplement classifications. The problem of under-reporting the intake of supplement items is therefore likely to be a major methodological flaw common to many previous investigations.

In conclusion, a high proportion of elderly participants in the present study reported regularly using dietary supplements and for extended periods. The most popular products were multivitamins and single vitamin preparations such as vitamin C and vitamin E. Since some preparations can interfere with laboratory tests, it is important that health professionals provide supplement users with information explaining the contraindications and precautions associated with supplement use. Because supplement use is so commonly practised, accurate data about the intake of these preparations must be collected in order to evaluate the potential benefits and risks associated with using them and to examine associations between supplement utilisation, morbidity and disease. Future studies of supplement utilisation need to explain the method used to classify dietary and health supplements.

Acknowledgements

This study received funding from Blackmore's Ltd. Pty and Southern Cross University, Lismore, NSW. We are grateful for their financial contribution to this project. We would also like to thank Dr Stephen Myers and Dr John Stevens who contributed to the conception of the study, the reviewers who provided feedback on an earlier version of the manuscript and, lastly, our appreciation is extended to all those willing participants who provided such valuable information.

References

1. Baghurst KI. Who's buying the vitamins--vitamin consumption patterns in Australia. Proc Nutr Soc (Aust) 1989; 14: 62-8.

2. Horwath CC, Worsley A. Dietary supplement use in a randomly selected group of elderly Australians. Results from a large nutrition and health survey. J Am Geriatr Soc 1989; 37: 689-96.

3. Magarey AM, Tiddy JA, Wilson PC. The diets of elderly men and the use of dietary supplements: Australian non-veterans compared with war veterans. Aust J Nutr Diet 1993; 50: 25-8.

4. Australian Bureau of Statistics. National Health Survey. Report No. 4377.0. Canberra: Commonwealth of Australia, 1995.

5. Australian Bureau of Statistics. National Nutrition Survey. Report No. 4802.0. Canberra: Commonwealth of Australia, 1995.

6. Yu XQ, Smith W, Webb K, Mitchell P, Leeder SR. Prevalence and predictors of dietary supplement use in an older Australian population. Aust J Nutr Diet 1999; 56: 69-75.

7. Brzozowska A, Enzi G, Amorin Cruz J. Medicine use and supplementation practice among participants of SENECA Study. J Nutr Health Aging 2002; 6: 34-8.

8. Block G, Cox C, Madans J, Schreiber GB, Licitra L, Melia N. Vitamin supplement use, by demographic characteristics. Am J Epidemiol 1988; 127: 297-309.

9. Looker A, Sempos CT, Johnson C, Yetley EA. Vitamin-mineral supplement use: association with dietary intake and iron status of adults. J Am Diet Assoc 1988; 88: 808-14.

10. Hale WE, Stewart RB, Cerda JJ, Marks RG, May FE. Use of nutritional supplements in an ambulatory elderly population. J Am Geriatr Soc 1982; 30: 401-3.

11. Houston DK, Daniel TD, Johnson MA, Poon LW. Demographic characteristics of supplement users in an elderly population. J Appl Gerontol 1998; 17: 79-96.

12. Stewart ML, McDonald JT, Levy AS, Schucker RE, Henderson DP. Vitamin/mineral supplement use: a telephone survey of adults in the United States. J Am Diet Assoc 1985; 85: 1585-90.

13. Freeman MS, Sargent RG, Sharpe RG, Waller JL, Powell FM, Drane W. Cognitive, behavioral and environmental correlates of nutrient supplement use among independently living older adults. J Nutr Elder 1998; 17 (3): 19-40.

14. Dorant E, Van den Brandt P, Hamstra A et al. The use of vitamins, minerals and other dietary supplements in the Netherlands. Int J Vitam Nutr Res 1993; 63 (Suppl): 4-10.

15. Brownie S, Myers SP. Dietary and health supplement use among older Australians: results from a national survey. Australas J Ageing 2003; 22: 171-8.

16. Brownie S, Rolfe M. Health characteristics of older Australian dietary supplement users compared to non supplement users. Asia Pacific J Clin Nutr 2004; 13: 365-71.

17. Australian Bureau of Statistics. Older People, Australia: A Social Report. Report No. 4109.0. Canberra: Commonwealth of Australia, 1999.

18. Australian Institute of Health and Welfare. Older Australia at a Glance. Report No. 12. Canberra: Commonwealth Department of Health and Aged Care, 1999.

19. Ervin RB, Wright JD, Kennedy-Stephenson J. Use of dietary supplements in the United States, 1988-94. Vital and Health Statistics--Series 11: Data from the National Health Survey 1999; 244: i-iii, 1-14.

20. Slesinski MJ, Subar AF, Kahle LL. Trends in use of vitamin and mineral supplements in the United States: the 1987 and 1992 National Health Interview Surveys. J Am Diet Assoc 1995; 95: 921-3.

21. Read MH, Graney AS. Food supplement usage by the elderly. J Am Diet Assoc 1982; 80: 250-53.

22. Sheehan ET, Delett A, Read MH et al. Vitamin and mineral supplement practices and nutrition beliefs of the elderly in seven western states. Nutr Res 1989; 9: 251-8.

23. Vitolins MZ, Quandt SA, Case LD, Bell RA, Arcury TA, McDonald J. Vitamin and mineral supplement use by older rural adults. J Gerontol A Biol Sci Med Sci 2000; 55: M613-17.

24. Hartz SC, Otradovec CL, McGandy RB et al. Nutrient supplement use by healthy elderly. J Am Coll Nutr 1988; 7: 119-28.

25. Jamison J. Clinical Guide to Nutrition and Dietary Supplements in Disease Management. Melbourne: Churchill Livingstone, 2003.

26. Braun L, Cohen M. Herbs and Natural Supplements: An Evidence-Based Guide. Sydney: Elsevier, Mosby, 2005.

27. Bratman S, Girman A. Handbook of Herbs and Supplements and Their Therapeutic Uses. St Louis: Mosby, 2003.

28. Higdon J. An Evidence-Based Approach to Vitamins and Minerals. New York: Thieme, 2003.

29. Pryor WA. Vitamin E and heart disease: basic science to clinical intervention trials. Free Radic Biol Med 2000; 28: 141-64.

30. Ernst E. The risk-benefit profile of commonly used herbal therapies: gingko, St John's wort, ginseng, Echinacea, saw palmetto, and kava. Ann Intern Med 2002; 136: 42-53.

31. Birks J, Grimley E, Van Dongen M. Gingko Biloba for Cognitive Impairment and Dementia. Cochrane Database Systematic Review. 2002.

32. Weng YL, Raab C, Georgiou C, Dunton N. Herbal and vitamin/mineral supplement use by retirement community residents: preliminary findings. J Nutr Elder 2004; 23 (3): 1-13.

33. Daly MP, Sobal J. Vitamin/mineral supplement use by geriatric outpatients in the United Kingdom. J Nutr Elder 1990; 10: 55-64.

34. Schneider CL, Nordlund DJ. Prevalence of vitamin and mineral supplement use in the elderly. J Family Prac 1983; 17: 243-7.

Southern Cross University, Lismore

S. Brownie, ND, PGDipSci, Clinical Supervisor, PhD candidate, School of Natural and Complementary Medicine

M. Rolfe, BSc, MStat, Statistician, Graduate Research College

Australian Centre for Complementary Medicine Education and Research, a joint venture of the University of Queensland and Southern Cross University, Lismore

S. Brownie, ND, PGDipSci, Clinical Supervisor, PhD candidate, School of Natural and Complementary Medicine

Correspondence: S. Brownie, Southern Cross University, PO Box 157, Lismore NSW 2480, Australia. Email: [e-mail]

Table 1. Questionnaire options for frequency of use, duration of use and
sources of information in a national survey of supplement use by
Australians aged 65 years and over (n = 1263)

Frequency of use     Duration of use    Sources of information/advice

Every day            Less than 1 month  Doctor or nurse
Every few days       1-3 months         Newspaper or magazine
Once a week          3-6 months         TV/radio
A few times a month  6-12 months        Health food store
Every now and then   1-3 years          Natural therapist
                     More than 3 years  Friends or family
                     Don't know         Chemist/pharmacy
                                        Other

Table 2. The most commonly consumed preparations and frequency of use in
a national survey of supplement use by Australians aged 65 years and
over (n = 1263)

                              Profile of supplement users (n = 548)
                                              Frequency of use
                              No. supplement  Regularly  Occasionally
Supplement                    users (%)       (%)        (%)

Vitamin C (+/- bioflavonoid)  141 (26)        74         26
Multivitamin/mineral           97 (17)        84         16
Fish oil/omega 3               95 (17)        93          7
Vitamin E                      89 (16)        92          8
Calcium (+/- vitamin D)        73 (13)        94          6
Garlic (capsules or oil)       60 (11)        83         17
Vitamin B (single or mixed)    53 (9)         91          9
Single vitamin or single       43 (7)         81         19
  mineral (a)
Zinc                           34 (6)         67         33
Gingko                         28 (5)         92          8

(a) Other than those listed in the questionnaire.
Regularly = 'every day' or 'every few days'.
Occasionally = 'once a week' or 'a few times a month' or 'every now and
then'.

Table 3. Duration of the most commonly consumed preparations in a
national survey of supplement use by Australians aged 65 years and over
(n = 1263)

                                      Duration of use
                              0-3     3-12
                              months  months  1-3+
Supplement                    (%)     (%)     years (%)  >3 years (%)

Vitamin C (+/- bioflavonoid)   6      13      17         64
Multivitamin/mineral          11      17      15         57
Fish oil/omega 3              11      16      27         46
Vitamin E                      5      12      21         62
Calcium (+/- vitamin D)        8      18      17         57
Garlic (capsules or oil)       5       5      27         63
Vitamin B (single or mixed)   25      11      17         47
Single vitamin or single       5      28      30         37
  mineral (a)
Zinc                          16      27      30         27
Gingko                         7      32      25         36

(a) Other than those listed in the questionnaire.

Table 4. The four most commonly cited sources of product information in
a national survey of supplement use by Australians aged 65 years and
over (n = 1263) (a)

                                                       Family/
                              Doctor/nurse  Newspaper  friends  Chemist
Supplement                    (%)           (%)        (%)      (%)

Vitamin C (+/- bioflavonoid)  19            18         16       12
Multivitamin/mineral          19            11         21       10
Fish oil/omega 3              11            15         33        2
Vitamin E                     20            26         19        9
Calcium (+/- vitamin D)       53             8         10        6
Garlic (capsules or oil)       7            25         31        1
Vitamin B (single or mixed)   19            19         19       10
Single vitamin or single      49            19          9        5
  mineral (b)
Zinc                          23            23         12        6
Gingko                        19            27         27        4

(a) Rows do not add to 100%. Excluded from this table are those
individuals who obtained supplement information from other sources.
(b) Other than those listed.

Table 5. The three most commonly cited reasons for taking each
preparation in a national survey of supplement use by Australians aged
65 years and over (n = 1263) (a)

Type of supplement            Reason           %   Reason

Vitamin C (+/- bioflavonoid)  Respiratory      58  General health
Multivitamin/mineral          General health   80  Respiratory
Fish oil/omega 3              Musculoskeletal  33  General health
Vitamin E                     General health   57  Circulatory
Calcium (+/- vitamin D)       Musculoskeletal  88  General health
Garlic (capsules or oil)      Respiratory      42  General health
Vitamin B (single or mixed)   General health   57  Dermatological
Single vitamin or single      General health   45  Musculoskeletal
  mineral (b)
Zinc                          General health   29  Genitourinary
Gingko                        Circulatory      88  General health

Type of supplement            %   Reason           %

Vitamin C (+/- bioflavonoid)  27  Immunity          8
Multivitamin/mineral           5  Musculoskeletal   5
Fish oil/omega 3              29  Circulatory      13
Vitamin E                     23  Dermatological    9
Calcium (+/- vitamin D)        9  Circulatory       2
Garlic (capsules or oil)      34  Circulatory       7
Vitamin B (single or mixed)    9  Circulatory       6
Single vitamin or single      19  Circulatory      19
  mineral (b)
Zinc                          15  Respiratory      12
Gingko                        12  --               --

(a) Rows do not add to 100%. Excluded from this table are those
individuals who cited other reasons for supplement use.
(b) Other than those listed.