Severe vitamin D deficiency in the institutionalized elderly

Abstract

Severe vitamin D deficiency has been found to be prevalent in institutionalized elderly persons in several countries. The aim of the present work was to assess the vitamin D status of institutionalized elderly and compare it to that of community-living independent elderly in southern Greece during summer. Serum 25-hydroxyvitamin D [25(OH)D] and plasma PTH were measured in 58 (aged 68-103 yr, median 83.5) elderly inmates of a nursing home (IE) in the town of Kalamata (latitude N 37 degrees ) and in 48 (aged 60-89 yr, median 72) community-dwelling elderly (CDE) in Athens (latitude N 38 degrees ). The CDE had mean serum 25(OH)D 67.6 nmol/l [95% confidence interval (CI) 57.4 to 79.5], not far from the value of 80 nmol/l which is generally considered to be the lower limit of vitamin D sufficiency. The IE had significantly lower mean 25(OH)D 19.0 nmol/l (17.1 to 21.1); values of 25(OH)D below 20 nmol/l characterize severe vitamin D deficiency and may cause osteomalacia. The group of CDE had significantly lower mean plasma PTH 1.5 pmol/l (1.0 to 1.8) compared to 4.5 (3.9 to 5.3) of IE. Ninety percent of CDE had normal plasma PTH whereas 60% of IE had secondary hyperparathyroidism (PTH values >4.0 pmol/l). In conclusion, the majority of institutionalized elderly in southern Greece had severe vitamin D deficiency and secondary hyperparathyroidism in contrast to the fairly good vitamin D status and lack of hyperparathyroidism in the community-living elderly during summer. These findings indicate the need for vitamin D and calcium supplementation of the institutionalized elderly throughout the year.

Vitamin D supplementation in a nursing home population

“…With a mean 25(OH)D 3 level of 39.9 nmol/L in the winter and 44.9 nmol/L in the summer, another study of elderly patients in long-term care facilities found that 18% of patients had severe vitamin D deficiency (defined as o25 nmol/L of 25(OH)D 3 ) in some seasons (usually late winter and spring) but at least 9% remained severely deficient even in summer [14]. Another recent study demonstrated severe vitamin D deficiency in many nursing home residents with a mean 25(OH)D 3 value of 19.0 nmol/L even in the summer compared to non-institutionalized seniors dwelling in the community who were found to have a mean 25(OH)D 3 level of 67.6nmol/L [3]. Furthermore, the risk of community dwelling seniors needing admission to a longterm nursing home facility is significantly increased with low vitamin D status [15].…”

“…In response to ultraviolet-B radiation from sunlight, vitamin D is obtained primarily from conversion of cutaneous 7-dehydrocholesterol to cholecalciferol (vitamin D 3 ), but can also be acquired from a limited number of primary foods, fortified foodstuffs, and through supplementation [1]. Vitamin D 3 is hydroxylated in the liver to 25(OH)D 3 -the main circulating metabolite which is used as the predominant biomarker of clinical vitamin D status.…”

“…Juxtaposed with this demographic is emerging evidence that many individuals, including seniors, are deficient in vitamin D [1][2][3]-a hormone involved in genetic regulation and a molecule involved in assorted physiological processes. As recent evidence confirms that sufficiency of vitamin D is associated with greatly diminished morbidity and mortality, [2,[4][5][6][7][8] it is necessary to secure adequate levels in the subpopulation of institutionalized seniors, a subgroup particularly predisposed to vitamin D insufficiency.…”

Body composition and micronutrient deficiencies in patients with an acute exacerbation of chronic obstructive pulmonary disease

“…It has also been shown that living situation (i.e. living alone vs living with family vs living in an aged care facility) can influence an individual's nutritional status . The importance of optimising nutrition in the management of COPD has been recognised globally and recommendations to this effect are seen in the practice guidelines of every major respiratory society…”

“…living alone vs living with family vs living in an aged care facility) can influence an individual's nutritional status. 19,20 The importance of optimising nutrition in the management of COPD has been recognised globally and recommendations to this effect are seen in the practice guidelines of every major respiratory society. 1,21 Numerous studies have shown that MD are common in subjects with COPD, in contrast, however, interventions aimed at addressing these deficiencies have yielded mixed results.…”