Spring 2025

Spring 2025 Issue

Nutrition: Probiotics’ Impact
By Angela Ballard, RN, EMT, and Florajen Probiotics
Today’s Geriatric Medicine
Vol. 18 No. 2 P. 26

A Simple Ingredient to Improving Elder Care

Quality nutrition is a key determinant of health throughout the lifespan.1 But for older patients, good nutrition is even more crucial to help prevent chronic disease and disability. The challenge for older adults lies in their changing nutritional needs and digestive systems. While the required intake of many nutrients increases, there’s often a decrease in energy requirements (leading to lower food intake) and decreased digestive efficiency.

Ensuring patients are getting the proper nutrient intake is critical in care. Fortunately, there’s an often underutilized tool in health care providers’ toolboxes to help the aging population improve digestion and, in turn, overall health: probiotics.

Diet Deficiencies
Many older adults aren’t consuming the recommended levels of nutrients necessary to stay healthy. A recent study in the journal Nutrients found that most older Americans could benefit from dietary improvements to reduce the risk of disability, chronic disease, and depression.2 Factors leading to poor diets in the elderly often include age-related changes in metabolism, reduced appetite, and impaired mobility (affecting obtaining and preparing healthful food).

Focusing not just on what goes in the body but also on the body’s ability to digest food and the microbiome that helps it do so hasn’t always been top-of-mind for clinicians, but that’s starting to change.

Probiotics and Geriatric Nutrition
The microbiome plays an important role in digestion and nutrient synthesis, but with aging, changes to the gut microbiota can occur. In fact, it’s estimated that older adults have approximately 1,000 times fewer “friendly” bacteria in their guts compared with younger adults, as well as higher levels of potentially illness-causing bacteria.3 This imbalance often leads to inflammation along the digestive tract and other issues.4

Not only do healthful bacterial counts decrease with aging, but studies have also shown that the composition of the microbiota gradually changes with age, resulting in less microbial diversity. This shift impacts digestion, as bacteria in the colon play an essential role in breaking down food and absorbing nutrients.5

To help maintain healthier bacterial populations, a growing body of research points to using probiotics to promote balance in the intestinal microflora and support the gut with a steady supply of beneficial bacteria. Doing so is thought to improve digestive motility (which slows with age), help digestion, prevent diarrhea, reduce lactose intolerance, and aid in the synthesis of vitamins and protein digestion.6,7 Probiotics work through bacteria strains that multiply and inhabit the gut. A common metric for the impact of a probiotic is the number of colony forming-units (CFUs) it contains, this is the number of alive and active microorganisms in one serving of a probiotic dietary supplement.

Common digestive issues in older adults are constipation, antibiotic-associated diarrhea, and Clostridium difficile infections.8 These are likely due to age-related changes in the bowel and gut flora frailty that increase susceptibility to infection and gastrointestinal disorders. Probiotics have been shown to help with these conditions by improving bowel function (particularly in conditions like constipation and irritable bowel syndrome) while also improving vitamin absorption and even addressing metabolic disorders.6,9-11 Specifically, research has indicated that probiotics can increase levels of essential vitamins like vitamin B12 and folate.12

Overall, studies show that probiotics can positively impact undernutrition, constipation, and immune system decline in the elderly by improving age-related shifts in gut microbiota and ultimately promoting healthy aging.13,14

How Probiotics Optimize Digestion
1. Enzyme Production: Probiotics produce digestive enzymes such as proteases, amylases, and lipases, which help break down proteins, carbohydrates, and fats. This enzymatic activity enhances digestion and makes nutrients more available for absorption.15

2. Short-Chain Fatty Acid (SCFA) Production: Probiotics ferment prebiotics in the colon, producing SCFAs like butyrate. These SCFAs increase mineral solubility, enlarge the gut absorption surface area, and promote pancreatic lipase production for fat breakdown.16

3. Gut Barrier Function: Probiotics help maintain the integrity of the intestinal barrier, reducing inflammation and creating an optimal environment for nutrient absorption.15,16

4. Micronutrient Synthesis: Some probiotic strains can synthesize essential nutrients like vitamin K and vitamin B12, contributing to the host’s nutritional status.17,18

5. Bile Acid Metabolism: Probiotics can influence bile acid metabolism, improving cholesterol absorption and overall lipid metabolism.19

6. Competitive Exclusion: Probiotics outcompete harmful bacteria for binding sites on the gut lining, promoting a healthier environment conducive to better nutrient absorption.20

Final Thoughts
When probiotics seem like a good fit for older patients, clinicians may consider popular store-bought formulas that contain widely researched strains like Lactobacillus acidophilus, Bifidobacterium lactis and longum, and/or Lactobacillus rhamnosus. When selecting a probiotic, it’s important to understand that a probiotic is only as effective as the amount of bacteria (CFUs) that are still alive when it’s digested. So, for maximum effectiveness, look for probiotics that are kept refrigerated to keep cultures alive and fresh, as they’ll be more effective than the bacteria in a probiotic sitting out on a shelf.

Patients who prefer to consume probiotics through foods can include more fermented products, like yogurt, kefir, buttermilk, kombucha, sauerkraut, miso, tempeh, and kimchi, in their diets on a regular basis. However, with nutrition, consistency is key.

Helping older patients choose the most appropriate probiotic (or probiotic-containing food) involves consideration of their health needs and any symptoms or issues the care plan is aiming to address. Is there a specific bacterial strain that might best target a patient’s needs? Or would a combination product be a better choice? The evaluation may involve research into bacterial strains and their potential benefits. Caution is advised regarding probiotic use in patients who are significantly immune-compromised or who have swallowing issues. But for many older patients, after about 55 to 60 years old, research suggests that certain probiotics can help with digestive issues and improve the immune system.7

Probiotics may be the adjunct therapy geriatric care providers have been looking for to boost patients’ nutrition and vitality through improved digestion, nutrient uptake, and gut health. Consider probiotics for geriatric patients with nutrient deficiencies, who are tube feeding, or are taking a large number of vitamins or supplements, in addition to the classic probiotic applications such as offsetting antibiotic and drug-caused gut-disruption, immune function support, constipation, and bowel disorders.

— Angela Ballard, RN, EMT, is an educator, lecturer, and professional writer focusing on health and wellness topics. Her writing can be found in numerous publications and medical nonprofits’ communications. Academic papers include pieces in Dermatologic Surgery and Dermatologic Clinics.

— Florajen Probiotics assisted in the writing of this article. Florajen is a 30-year-old probiotic brand with extensive clinical experience and expertise. Florajen is owned and operated by Bridges Consumer Healthcare located in Chattanooga, Tennessee.

References
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2. Zhao H, Andreyeva T. Diet quality and health in older Americans. Nutrients. 2022;14(6):1198.

3. Elderly should take probiotics. BBC News website. https://news.bbc.co.uk/2/hi/health/5253182.stm. Updated August 7, 2006.

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15. Ding S, Yan W, Ma Y, Fang J. The impact of probiotics on gut health via alternation of immune status of monogastric animals. Anim Nutr. 2021;7(1):24-30.

16. Pro-biotics, gut microbiome and nutrient absorption. International Probiotics Association website. https://internationalprobiotics.org/home/pro-biotics-gut-microbiome-and-nutrient-absorption. Published July 26, 2023.

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19. Plaza-Diaz J, Ruiz-Ojeda FJ, Gil-Campos M, Gil A. Mechanisms of action of probiotics. Adv Nutr. 2019;10(suppl_1):S49-S66.

20. Latif A, Shehzad A, Niazi S, et al. Probiotics: mechanism of action, health benefits and their application in food industries. Front Microbiol. 2023;14:1216674.