Creatine as an Answer to the Challenges of Aging? Mechanisms, Benefits, and Safety in Older Adults

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Background. Age-related decline in muscle mass, strength, metabolic health and cognitive function is a major contributor to reduced functional independence in older adults. Creatine supplementation has emerged as a potential nutritional intervention due to its role in cellular energy metabolism; however, its efficacy and safety in aging populations remain topics of ongoing investigation. Aim. To critically evaluate, in a narrative review format, the current evidence regarding the efficacy and safety of creatine supplementation in older adults, with particular emphasis on outcomes related to skeletal muscle function, bone health, cardiometabolic outcomes, cognitive performance, neuroprotection and reported adverse effects. Material and methods. A narrative synthesis of literature indexed in PubMed was conducted, focusing on studies examining creatine supplementation in adults aged ≥55 years. Particular attention was given to randomized controlled trials, systematic reviews, and meta-analyses published in recent years. Results. Evidence consistently indicates that creatine supplementation, particularly when combined with resistance training, improves lean body mass, muscle strength, and selected functional performance measures in older adults. The effects on bone health appear limited and are likely indirect, mediated through enhanced muscle function. Emerging findings suggest potential benefits for cognitive performance, especially in memory-related domains. However, current evidence is insufficient to confirm clinically relevant neuroprotective effects. Conclusions. Creatine supplementation may be considered a safe and effective adjunct strategy for supporting musculoskeletal health and functional capacity in aging populations. Its broader effects require further long-term studies in diverse older populations.