Vitamin D supplementation in elderly care home residents is largely viewed as a “medicine” rather than a protective nutrient, risking vitamin D deficiency in this particularly vulnerable population, say British public health scientists.
Writing in BMJ Nutrition Prevention & Health, they stress an urgent review is needed of the nutritional guidelines and regulations in England on the use of the vitamin in elderly residential care homes.
Vitamin D supplementation “needs a professional separation from medicine and reframing as a matter of public health nutrition as well as a medical responsibility,” emphasizes Joe Williams, MSc Public Health graduate, Brighton University, UK, and colleagues.
The findings reveal “both a failure to implement evidence-based recommendations and a social injustice in urgent need of public health advocacy and resolution,” they emphasize.
For 30 years, vitamin D 10 µg as a daily supplement has been endorsed for care home residents. In 2016, the recommendations were extended to the entire population in the winter months and throughout the year for those living in care homes.
But this new study shows care home staff understood that they were only allowed to give residents vitamin supplements that have been prescribed and that physicians had been advised by the UK National Health Service not to prescribe preventative vitamins because they can be bought cheaply over the counter.
“This means that elderly care home residents often do not get the vitamin D they require, leaving them at increased risk of falls,” Williams explained.
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In the United States, the Institute of Medicine recommends 800 IU/day of vitamin D, and the American Association of Family Physicians/American Geriatric Society recommends 1000 IU/day.
“It is not a medicine to be taken only as needed,” Catharine Ross, PhD, professor of nutrition and physiology at Penn State University, told Medscape Medical News.
“The diet of individuals who do not get much sunlight needs to include enough of the vitamin in foods or from a nutritional supplement,” she stressed.
“The elderly living in long-term care facilities are a particular concern,” she added. “They may not have much sun exposure, and it is known that the skin of older persons is not so efficient at making vitamin D. So for this group especially, attention does need to be paid to getting sufficient vitamin D from diet or a vitamin D-containing supplement,” she said.
Martin Kohlmeier, MD, PhD, from the UNC Nutrition Research Institute at the University of North Carolina at Chapel Hill, wholeheartedly agreed.
Vitamin D deficiency increases not only the risk of bone fractures, but could also make people more susceptible to SARS-CoV-2 infection and worsen outcomes, he said.
“Everybody should use a moderately dosed vitamin D supplement, and guiding patients and the public towards this is already established policy in many countries including the UK,” he said.
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“Unfortunately,” said Kohlmeier, “this message has not reached all health professionals and care providers.”
And he went so far as