Successful aging through integrative nutrition: a four-pillar framework for deprescribing and resilience

Abstract

Polypharmacy, micronutrient deficiencies, and gut dysbiosis frequently intersect in older adults to drive frailty, falls, cognitive decline, and loss of independence in late life. Using a representative case of an 81-year-old woman with recurrent falls and chronic polypharmacy, this narrative review synthesizes some current evidence on integrative geriatric nutrition. We propose a four-pillar, nutrition-centered framework for guiding deprescribing and restoring resilience: food-based therapeutics for mild, self-limiting conditions that can safely substitute or reduce medications; nutrient density and targeted micronutrients including choline, creatine, C15:0, and vitamin D; the food matrix and anti-inflammatory dietary patterns to optimize nutrient bioavailability, metabolic signaling, and mitigation of cellular senescence; and gut microbiome–centered strategies that leverage fiber diversity, fermented foods, and synbiotics to support muscle, mood, cognition, and immune function. This framework incorporates evidence ranging from well-established interventions to emerging areas such as C15:0; therefore, findings should be applied with consideration of differing evidence maturity. Applied to the index case, this framework informs structured deprescribing, micronutrient repletion, diet-pattern shifts, and microbiome rehabilitation as low-risk pathways to reverse functional decline. Integrative geriatric nutrition, operationalized through these four pillars, offers clinicians a practical, scalable model to reduce medication burden while enhancing function, resilience, and quality of life in aging populations.

Keywords: Integrative geriatric nutrition, polypharmacy, deprescribing, gut microbiome, successful aging, frailty