JAGS 49:1535–1538, 2001© 2001 by the American Geriatrics Society 0002-8614/01/$15.00

Geriatricians Health Survey 2000

David Watts, MD,* Edeson Damasco-Ty, MD,*

†

Frank Ryan, DO,*

†

and Brian Goodman, PhD

†

OBJECTIVES:

To characterize geriatricians’ preventivehealth behaviors including vitamin/supplement use, exer-cise, smoking, alcohol use, and weight control.

DESIGN:

Mailed questionnaire.

SETTING:

United States.

PARTICIPANTS:

Two thousand six hundred eleven U.S.physicians certified as having added qualifications in geri-atric medicine and who were members in the AmericanGeriatrics Society; 1,524 returned completed question-naires (58%).

MEASUREMENTS:

Rates of supplement use and recom-mendations, preventive health visits, advance directivecompletion, exercise, religious service attendance, smok-ing, alcohol use, and amount of adult weight gain.

RESULTS:

Most responding geriatricians took at leastone vitamin supplement: 50% vitamin E, 50% a multivita-min (MVI), and 31% vitamin C. Calcium ingestion wascommon among women. Other supplement use was un-common: ginkgo compounds were consumed by 47 (3%),and 77 (5%) took a variety of other nonvitamin supple-ments. Over 90% recommended vitamins, especially mul-tivitamins and vitamin E, at least sometimes. Recommen-dations for ginkgo (38%) and St. John’s wort (33%) werealso common. Almost half of respondents had completed aformal advance directive. Exercise was practiced at leastweekly by 88%. Cigarette smoking was rare (1%), but atleast occasional alcohol use was common (85%). Most ofrespondents were men (74%), and 35% had completedfellowship training.

CONCLUSION:

Vitamin/supplement use was commonamong responding geriatricians but not universal. Respon-dents often recommended MVI, vitamin E, and vitamin C,but were less likely to consume or recommend other sup-plements. The most common preventive health behavior

among our respondents was exercise.

J Am Geriatr Soc 49:1535–1538, 2001.

Key words: geriatrician; vitamin supplements; behavior

I

ngestion of vitamins and supplements is common amongthe U.S. population,

1

including physicians. There is sig-nificant interest in supplement use as a method of amelio-rating some of the effects of the aging process. The antiox-idant theory of aging would suggest that taking supplementsof vitamins C and E, for example, might slow down oxida-tive processes and thereby some aging processes.

However, there is a dearth of evidence for the benefitof supplements as a preventive measure. There is no evi-dence that those who ingest supplements are healthier, orlive longer, than those who do not. By deliberate policy,nutritional supplement use is unregulated in the UnitedStates. Claims made or implied concerning the therapeuticor preventive benefits of various nutritional supplementsreceive little oversight.

Conflicting or confusing claims have led to widely di-vergent attitudes and practices by physicians and the gen-eral public. Supplement use has tended to increase in re-cent years, along with claims of health benefits. Yet manypeople remain skeptical and do not consume supplements.

We were interested in assessing supplement use amonggeriatricians, to see if there would be a consensus amongthese physicians that might help inform the public. Geria-tricians represent a group of physicians that has knowl-edge about aging, and, with many being members of the“baby boom” cohort themselves, is becoming more con-cerned about their own aging. We therefore assessed sup-plement use and other preventive health behaviors by geri-atricians to see whether general recommendations couldbe derived. We also asked about personal practices or at-tributes that might be associated with health status, in-cluding preventive care visits, religious service attendance,advance directive completion, and adult weight gain.

METHODS

We obtained a mailing list from the American GeriatricsSociety (AGS) including all U.S. members of the AGS whowere certified as having added qualifications in geriatric

From the *Department of Medicine, University of Wisconsin School of Medicine and

†

Middleton Memorial Veterans Hospital, Madison, Wis-consin.

Poster presented at the American Geriatrics Society annual meeting, Nash-ville, TN, May 2000.

Address correspondence to David Watts, MD, Section of Geriatrics and Gerontology, Department of Medicine, 2870 University Avenue, Suite 100, Madison, WI 53705.

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NOVEMBER 2001–VOL. 49, NO. 11 JAGS

medicine (geriatricians). A survey was mailed in Novem-ber 1999 to the 2,611 physicians in this group; 1,524 re-sponded (58%). The survey instrument requested informa-tion on daily intake of specific supplements (vitamins C, E,multivitamin, calcium) and aspirin; certain nonvitaminsupplements were listed, including ginkgo, dehydroepi-androsterone (DHEA), St. John’s wort, and “other.”

We asked the geriatricians how often they recom-mended the above supplements to their patients. We alsoasked about other health behaviors, including preventivehealth visits, advance directive completion, exercise, reli-gious service attendance, adult weight gain, cigarette smok-ing, and alcohol use. Demographic information included age,sex, marital status, and fellowship completion. We used thepostmark on return mailings to identify the geographic lo-cation of our respondents.

Descriptive analyses were performed for all respon-dents on all survey items. Bivariate cross-tabulations by re-spondent age, gender, geographic location by region, andfellowship training were examined for statistical signifi-cance using chi-squared analysis.

RESULTS

Figure 1 indicates the number and percentages of survey re-spondents who ingested supplements on a daily basis. Oth-ers less commonly consumed included folate (consumed by18), glucosamine (9), and saw palmetto (8). Listed by fewerthan five respondents (0.3%) were co-enzyme Q10, sele-nium, ibuprofen, alpha-lipoic acid, chromium, garlic, flu-oxetine, nefazodone, ethanol, and chocolate chips.

Table 1 summarizes responses regarding other healthbehaviors.

Responses did not differ between those who had com-pleted a geriatrics fellowship (35%) and those who hadnot. Supplement ingestion did not differ by region.

Older responding geriatricians were more likely tohave had a recent preventive health visit (

P

�

.000), to

have completed an advance directive (

P

�

.001), and totake vitamin E (

P

�

.000).Female respondents were more likely to have had a re-

cent preventive health visit (

P

�

.000) and to take calcium(64% vs 19%,

P

�

.000). Male respondents were morelikely to take aspirin (55% vs 18%,

P

�

.000), to exercisemore frequently (

P

�

.001), and to have greater adultweight gain (

P

�

.001).Responding geriatricians who took supplements them-

selves were more likely to recommend them to their pa-tients (

P

�

.021). Overall, a higher frequency of exercisewas associated with a lower amount of adult weight gain(

P

�

.001). Eighty percent of respondents attended religiousservices at least occasionally (41% weekly or more). Reli-gious services attendance varied by region, with geriatriciansin the Southeast 2.3 times more likely to attend at leastweekly versus not at all, and those in the Northeast 1.5 times,the Midwest 1.0 times, and the West 0.4 times as likely.

Seventy-four percent of respondents were men. Fifty-three percent were between age 40 and 49, and 29% werebetween age 50 and 59. Of respondents who took vitaminE, 66% took 400 IU, and 27% took 800 IU. Among aspi-

Figure 1. Percentage of geriatrician respondents ingesting spe-cific supplements (N � 1,524). Overall percentages in gray;black and white bars refer to percentages of female and male re-spondents ingesting calcium and aspirin, respectively (P forgender differences � .000).

DHEA � dehydroepiandrosterone.

Table 1. Other Health Behavior Responses

Health Behaviors n %

Last preventive health visit:0–2 years 976 662–4 years 195 13Over 4 years 313 21

Advance directive completionYes 737 49No 776 51

Exercise sessions per weekNone 185 12One 136 9Two 210 14Three 375 25Four 226 15Five 179 12Six or more 191 13

Attend religious servicesNever 299 20Occasionally 597 40Weekly/more 614 41

Weight gain (pounds) since age 200–5 lb. 339 225–10 212 1410–15 249 1615–20 237 1620–25 149 10Over 25 327 22

Cigarette smokingYes 17 1No 1,507 99

Alcohol useNever 229 15Occasional 999 661 per day 243 16More than 1 53 3

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GERIATRICIANS HEALTH SURVEY 2000

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rin users, dosing was about equally divided between 81mg (43%) and 325 mg (42%).

DISCUSSION

Because participation was anonymous, we cannot investi-gate whether nonrespondents differed from respondents inany outcome variables. Thus, any inferences derived fromthis study refer only to the 58% who responded. This re-turn rate was comparable with other recent surveys ofother physicians’ health practices.

2

Vitamin/supplement use was common among respond-ing geriatricians. The majority of our respondents (66%)took at least one nutritional supplement on a daily basis.Supplement use is common among the general public aswell, with a 1993 poll finding that seven in 10 Americansuse supplements at least occasionally.

3

Recent estimatesare that U.S. supplement sales are $14 billion annually.

4

Geriatricians’ supplement use reflects this high level ofpopular interest in optimal nutrition as a preventive.

However, one purpose of our study was to look forconsensus among our geriatrician respondents, to seewhether we could derive general recommendations on sup-plement use that would be of clinical relevance. There wasno consensus on supplement ingestion, with our geriatri-cian respondents choosing diverse combinations and dos-ages of nutritional supplements. Many respondents whotook no supplements at all stated that the best policy wasto eat a diet rich in fruits and vegetables, a position similarto that of the American Dietetic Association

5

and ex-pressed in The Medical Letter.

6

The most common daily supplement was a multivita-min. Multivitamin preparations typically contain modestamounts of vitamins C (60 mg) and E (30 IU) and a mix-ture of B vitamins, vitamin D, folate, and minerals. Recentinterest has focused on multivitamins, including folate in-gestion, and an association with lowered risk of coloncancer

7

and reduction of homocysteine levels—a risk fac-tor for vascular disease.

8

Vitamin D supplementation hasbeen suggested as beneficial in retarding bone loss in indi-viduals lacking adequate sun exposure,

6

which could be arelevant consideration among our respondents. A recentreport indicates that taking a daily multiple vitamin incombination with vitamin A, C, or E reduces risk of dyingfrom heart disease or stroke.

9

We did not ask our respondents who took multivita-mins why they did so, but given the fact that this was themost common single daily supplement, it would appearthat the ease of ingesting a number of potentially benefi-cial substances in this manner facilitated compliance intaking a multivitamin.

Antioxidant vitamins C and E were the most commonindividual nutrients. Many respondents took individualsupplements of vitamins E (typically 400 IU) and C (usu-ally 500 mg), often in addition to a daily multivitamin.Some evidence associates higher levels of alpha-tocopherol(E) with improved cognitive functioning in older adults.

10

Other epidemiological data associate vitamin supplementuse and lowered rates of ischemic heart disease.

11

The freeradical theory of aging implies that supplemental antioxi-dant vitamins may retard cellular aging associated withoxidative damage. This is a subject of intense interest andcontroversy on the part of the scientific community and

the public.

12–14

Recent recommendations include upperdosing limits for antioxidant supplementation, reflectingconcern about pro-oxidant effects and potential harmfrom excessive dosing.

15

Precisely half of our respondents took vitamin E, andslightly under a third took daily vitamin C. As a group,our respondents reflect the current confusion and conflict-ing information about the relative benefits and risks oflong-term antioxidant supplementation. Further study wouldneed to clarify why individual geriatricians decided to in-gest vitamins E or C. That older responding geriatricianswere more likely to ingest vitamin E may reflect theirgreater level of concern for neuroprotection.

That aspirin was the most common daily preventiveingested by our male respondents reflects the benefits indi-cated by the Physicians Health Study on risk reductionwith respect to vascular disease. Aspirin use has beenfound to be common among cardiologists as well.

16

Fe-male respondents had a much lower rate of aspirin inges-tion, consistent with the failure of epidemiological studiesto indicate a benefit in women.

17

Calcium was the most common daily nutrient ingestedby women. Female respondents’ high rates of calcium in-gestion reflect concern about maintenance of bone health,in a group of physicians who commonly manage clinicaleffects of osteoporosis. The wide divergence between fe-male and male respondents’ calcium reflects their relativerisk of developing osteoporosis. Additional studies wouldbe needed to learn whether other physician groups exhibitsuch a gender difference with respect to calcium intake.

Respondents who took supplements were more likelyto recommend them. Our results are consistent with find-ings of earlier studies showing a positive association be-tween physician’s personal health habits and recommen-dations to patients.

18

With dietary supplements, amid theplethora of conflicting information, the assessment of risksand benefits of supplement use would appear more suscep-tible to individual physician biases than with other medi-cal recommendations.

Nonvitamin, nonmineral supplement use was uncom-mon. Relatively few responding geriatricians took othernutritional supplements besides vitamins E, C, multivita-min, calcium, and aspirin, but the list of other substancesingested was diverse. Almost 3% took ginkgo, a plant-derivedsubstance with antioxidant and putative cognitive-enhancingproperties. DHEA was taken by just under 1%. Recently,a 1-year double-blind, placebo-controlled trial of DHEAreported benefits for women (but not men) on such pa-rameters as bone turnover, skin status, and libido.

19

Our data would suggest that this group of youngermiddle-aged respondents did not generally perceive a ben-efit from ingestion of nonvitamin, nonmineral supple-ments, because less than 10% consumed any other sub-stance than vitamin E, vitamin C, multivitamin, calcium,or aspirin.

Eighty-five percent of respondents consumed alcohol,whereas only 1% smoked. Alcohol use among physicianshas been shown to be common in other studies. TheWomen Physician’s Health Study revealed that 72.5% hadconsumed alcohol within the preceding month.

20

A NewZealand study found that less than 10% of physicianswere abstainers.

21

Although only one of our respondents

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listed alcohol as a supplement, the majority incorporatedat least occasional alcohol into their lifestyles.

Smoking rates were even lower among our respondentsthan those reported in other physician surveys. In theWomen Physicians’ Health Study, 3.7% smoked.

20

A na-tional survey found that 3% of family physicians smoked.

2

Geriatricians are mainly a “baby boom” cohort, a demo-graphic group with lower rates of smoking than either ear-lier or later birth cohorts.

Most respondents (80%) attended religious services atleast occasionally. Religious service attendance

22

and pri-vate religious activity

23

have been associated with im-proved health status and outcomes. Geriatricians’ likeli-hood of religious service attendance reflects the pattern ofthe region in which they practice, with weekly service at-tendance most likely in the Southeast, and least likely inthe Far West.

Advance directive completion was common. The ad-vance directive completion rate (49%) among our respon-dents was greater than the 32.5% completion rate indi-cated in an AMA physician survey.

24

Consistent with theAMA study, older responding geriatricians were morelikely to have completed an advance directive.

We suggest that geriatricians’ frequent exposure toend-of-life issues makes them more aware of the potentialbenefits of advance directive completion. Recommenda-tions to patients to complete an advance directive may befacilitated if the physician has one him or herself.

Exercise was the single most common preventivehealth behavior. Eighty-eight percent of our respondentsexercised at least weekly; 65% exercised three or moretimes per week. These rates are higher than the 54% offamily physicians who reported exercising regularly.

2

Greaterlevels of exercise appeared to be associated with improvedweight control, which has independent benefits in reduc-ing risk of developing coronary disease, hypertension, anddiabetes mellitus type II.

25

Evidence suggests that exercisemay be beneficial in preventing cognitive decline, and thePhysicians Health Study suggested that regular exercisewas associated with reduced risk of stroke.

26

CONCLUSION

Our results indicate that, although supplement use is com-mon among U.S. geriatricians, it is not universal. Thiswould appear to reflect confusing, conflicting informationand health claims in an unregulated mercantile environ-ment. Interest in supplements and other preventive healthbehaviors is strong, and information from interventionstudies is likely to become more available in coming years.For now, though, there is wide variation in geriatricians’behavior with regard to supplement use. We anticipatethat this area will evolve as more information becomes

available. Current evidence supports a proactive, interven-tionist approach and a healthy skepticism about mosthealth claims for supplement use.

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