Vitamin D is essential for bone health, immune function and overall wellbeing. And it becomes even more crucial as we age.

New guidelines from the international Endocrine Society recommend people aged 75 and over should consider taking vitamin D supplements.

But why is vitamin D so important for older adults? And how much should they take?

Young people get most vitamin D from the sun

In Australia, it is possible for most people under 75 to get enough vitamin D from the sun throughout the year. For those who live in the top half of Australia – and for all of us during summer – we only need to have skin exposed to the sun for a few minutes on most days.

The body can only produce a certain amount of vitamin D at a time. So staying in the sun any longer than needed is not going to help increase your vitamin D levels, while it will increase your risk of skin cancer.

But it’s difficult for people aged over 75 to get enough vitamin D from a few minutes of sunshine, so the Endocrine Society recommends people get 800 IU (international units) of vitamin D a day from food or supplements.

Why you need more as you age

This is higher than the recommendation for younger adults, reflecting the increased needs and reduced ability of older bodies to produce and absorb vitamin D.

Overall, older adults also tend to have less exposure to sunlight, which is the primary source of natural vitamin D production. Older adults may spend more time indoors and wear more clothing when outdoors.

As we age, our skin also becomes less efficient at synthesising vitamin D from sunlight.

The kidneys and the liver, which help convert vitamin D into its active form, also lose some of their efficiency with age. This makes it harder for the body to maintain adequate levels of the vitamin.

All of this combined means older adults need more vitamin D.

Deficiency is common in older adults

Despite their higher needs for vitamin D, people over 75 may not get enough of it.

Studies have shown one in five older adults in Australia have vitamin D deficiency.

In higher-latitude parts of the world, such as the United Kingdom, almost half don’t reach sufficient levels.

This increased risk of deficiency is partly due to lifestyle factors, such as spending less time outdoors and insufficient dietary intakes of vitamin D.

It’s difficult to get enough vitamin D from food alone. Oily fish, eggs and some mushrooms are good sources of vitamin D, but few other foods contain much of the vitamin. While foods can be fortified with the vitamin D (margarine, some milk and cereals), these may not be readily available or be consumed in sufficient amounts to make a difference.

In some countries such as the United States, most of the dietary vitamin D comes from fortified products. However, in Australia, dietary intakes of vitamin D are typically very low because only a few foods are fortified with it.

Why vitamin D is so important as we age

Vitamin D helps the body absorb calcium, which is essential for maintaining bone density and strength. As we age, our bones become more fragile, increasing the risk of fractures and conditions like osteoporosis.

Keeping bones healthy is crucial. Studies have shown older people hospitalised with hip fractures are 3.5 times more likely to die in the next 12 months compared to people who aren’t injured.

Vitamin D may also help lower the risk of respiratory infections, which can be more serious in this age group.

There is also emerging evidence for other potential benefits, including better brain health. However, this requires more research.

According to the society’s systematic review, which summarises evidence from randomised controlled trials of vitamin D supplementation in humans, there is moderate evidence to suggest vitamin D supplementation can lower the risk of premature death.

The society estimates supplements can prevent six deaths per 1,000 people. When considering the uncertainty in the available evidence, the actual number could range from as many as 11 fewer deaths to no benefit at all.

Should we get our vitamin D levels tested?

The Endocrine Society’s guidelines suggest routine blood tests to measure vitamin D levels are not necessary for most healthy people over 75.

There is no clear evidence that regular testing provides significant benefits, unless the person has a specific medical condition that affects vitamin D metabolism, such as kidney disease or certain bone disorders.

Routine testing can also be expensive and inconvenient.

In most cases, the recommended approach to over-75s is to consider a daily supplement, without the need for testing.

You can also try to boost your vitamin D by adding fortified foods to your diet, which might lower the dose you need from supplementation.

Even if you’re getting a few minutes of sunlight a day, a daily vitamin D is still recommended.

Elina Hypponen, Professor of Nutritional and Genetic Epidemiology, University of South Australia and Joshua Sutherland, PhD Candidate – Nutrition and Genetic Epidemiology, University of South Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

We talk about mental health more than ever, but the language we should use remains a vexed issue.

Should we call people who seek help patients, clients or consumers? Should we use “person-first” expressions such as person with autism or “identity-first” expressions like autistic person? Should we apply or avoid diagnostic labels?

These questions often stir up strong feelings. Some people feel that patient implies being passive and subordinate. Others think consumer is too transactional, as if seeking help is like buying a new refrigerator.

Advocates of person-first language argue people shouldn’t be defined by their conditions. Proponents of identity-first language counter that these conditions can be sources of meaning and belonging.

Avid users of diagnostic terms see them as useful descriptors. Critics worry that diagnostic labels can box people in and misrepresent their problems as pathologies.

Underlying many of these disagreements are concerns about stigma and the medicalisation of suffering. Ideally the language we use should not cast people who experience distress as defective or shameful, or frame everyday problems of living in psychiatric terms.

Our new research, published in the journal PLOS Mental Health, examines how the language of distress has evolved over nearly 80 years. Here’s what we found.

Generic terms for the class of conditions

Generic terms – such as mental illness, psychiatric disorder or psychological problem – have largely escaped attention in debates about the language of mental ill health. These terms refer to mental health conditions as a class.

Many terms are currently in circulation, each an adjective followed by a noun. Popular adjectives include mental, mental health, psychiatric and psychological, and common nouns include condition, disease, disorder, disturbance, illness, and problem. Readers can encounter every combination.

These terms and their components differ in their connotations. Disease and illness sound the most medical, whereas condition, disturbance and problem need not relate to health. Mental implies a direct contrast with physical, whereas psychiatric implicates a medical specialty.

Mental health problem, a recently emerging term, is arguably the least pathologising. It implies that something is to be solved rather than treated, makes no direct reference to medicine, and carries the positive connotations of health rather than the negative connotation of illness or disease.

Arguably, this development points to what cognitive scientist Steven Pinker calls the “euphemism treadmill”, the tendency for language to evolve new terms to escape (at least temporarily) the offensive connotations of those they replace.

English linguist Hazel Price argues that mental health has increasingly come to replace mental illness to avoid the stigma associated with that term.

How has usage changed over time?

In the PLOS Mental Health paper, we examine historical changes in the popularity of 24 generic terms: every combination of the nouns and adjectives listed above.

We explore the frequency with which each term appears from 1940 to 2019 in two massive text data sets representing books in English and diverse American English sources, respectively. The findings are very similar in both data sets.

The figure presents the relative popularity of the top ten terms in the larger data set (Google Books). The 14 least popular terms are combined into the remainder.

Several trends appear. Mental has consistently been the most popular adjective component of the generic terms. Mental health has become more popular in recent years but is still rarely used.

Among nouns, disease has become less widely used while illness has become dominant. Although disorder is the official term in psychiatric classifications, it has not been broadly adopted in public discourse.

Since 1940, mental illness has clearly become the preferred generic term. Although an assortment of alternatives have emerged, it has steadily risen in popularity.

Does it matter?

Our study documents striking shifts in the popularity of generic terms, but do these changes matter? The answer may be: not much.

One study found people think mental disorder, mental illness and mental health problem refer to essentially identical phenomena.

Other studies indicate that labelling a person as having a mental disease, mental disorder, mental health problem, mental illness or psychological disorder makes no difference to people’s attitudes toward them.

We don’t yet know if there are other implications of using different generic terms, but the evidence to date suggests they are minimal.

Is ‘distress’ any better?

Recently, some writers have promoted distress as an alternative to traditional generic terms. It lacks medical connotations and emphasises the person’s subjective experience rather than whether they fit an official diagnosis.

Distress appears 65 times in the 2022 Victorian Mental Health and Wellbeing Act, usually in the expression “mental illness or psychological distress”. By implication, distress is a broad concept akin to but not synonymous with mental ill health.

But is distress destigmatising, as it was intended to be? Apparently not. According to one study, it was more stigmatising than its alternatives. The term may turn us away from other people’s suffering by amplifying it.

So what should we call it?

Mental illness is easily the most popular generic term and its popularity has been rising. Research indicates different terms have little or no effect on stigma and some terms intended to destigmatise may backfire.

We suggest that mental illness should be embraced and the proliferation of alternative terms such as mental health problem, which breed confusion, should end.

Critics might argue mental illness imposes a medical frame. Philosopher Zsuzsanna Chappell disagrees. Illness, she argues, refers to subjective first-person experience, not to an objective, third-person pathology, like disease.

Properly understood, the concept of illness centres the individual and their connections. “When I identify my suffering as illness-like,” Chappell writes, “I wish to lay claim to a caring interpersonal relationship.”

As generic terms go, mental illness is a healthy option.

Nick Haslam, Professor of Psychology, The University of Melbourne and Naomi Baes, Researcher – Social Psychology/ Natural Language Processing, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.